Chapter 10 Crying and Irritability in the Young Child
1 Why is an organized approach important to the evaluation of crying in an infant?
The etiology of crying in the nonverbal and frequently uncooperative infant is often obscure. A well-organized approach is critical because the differential diagnosis is vast, ranging from a normal physiologic or temperamental response to life-threatening medical or surgical pathology. Finding the right answer with a reasonable utilization of resources is a big part of the “art” of pediatrics (Table 10-1).
Table 10-1 Relatively Frequent Serious Conditions Associated with Intractable Crying that must be Excluded Prior to Emergency Department Discharge
| Condition | Clinical Correlates |
|---|---|
| Meningitis/encephalitis | Lethargy, vomiting, paradoxical irritability, fever |
| Sepsis | Lethargy, poor perfusion, fever, petechiae |
| Septic hip | Pain with range of motion/abnormal positioning of hip |
| Battered child syndrome | Bruising, bony tenderness, incompatible history |
| Shaken baby syndrome | Lethargy, full fontanelle, retinal hemorrhages |
| Intussusception | Paroxysmal abdominal pain, lethargy, bloody stool, abdominal mass; rectal examination may be abnormal |
| Volvulus | Bilious vomiting, abdominal tenderness |
| Appendicitis | Abnormal examination of abdomen |
| Incarcerated inguinal hernia | Abnormal examination of inguinal region |
| Hemolytic-uremic syndrome | Bloody diarrhea, hematuria/proteinuria, hemolytic anemia, thrombocytopenia, azotemia |
| Hypoxemia | Tachypnea, retractions, nasal flaring, wheezing, cyanosis |
| Hair encirclement | Abnormal examination of digits, genitalia, or uvula |
| Testicular torsion | Abnormal examination of scrotum |
| Supraventricular tachycardia | Heart rate >220 beats per minute |
3 Describe the clinical features of the infant colic syndrome.
Barr RG: Charging our understanding of infant colic. Arch Pediatr Adolesc Med 156:1172–1174, 2002.
