Crying baby

Common Benign Causes

Hunger: Crying often stops after feeding; look for signs like rooting or sucking on fingers
Tiredness: Crying due to fatigue, often with rubbing eyes or yawning, typically resolves with sleep
Discomfort (e.g., wet diaper, temperature): Irritation from a dirty diaper or being too hot/cold; baby often settles when the issue is addressed
Overstimulation: Crying due to excessive noise, lights, or activity; calming the environment may help
Need for attention: Crying stops when held or soothed; common in younger infants who seek comfort

Medical Causes

Gastroesophageal reflux disease (GERD): Crying associated with feeding, back arching, irritability, and regurgitation.
Cow’s milk protein allergy: Persistent crying with vomiting, diarrhea, and possible skin rashes after feeding.
Colic: Excessive crying in an otherwise healthy baby, often in the late afternoon or evening, resolving by 3-4 months of age.
Infections (e.g., otitis media, urinary tract infection): Crying with fever, irritability, and other signs of infection, such as ear pulling.
Teething: Crying with drooling, gum swelling, and a desire to chew on objects.
Constipation: Crying during bowel movements, hard stools, and infrequent bowel movements.
Intussusception: Intermittent, severe crying episodes with drawing up of legs, possible vomiting, and “red currant jelly” stools.
Testicular torsion: Sudden severe pain with inconsolable crying, usually in a male infant, with scrotal swelling and tenderness.
Meningitis: Persistent crying with fever, irritability, poor feeding, and possibly a bulging fontanelle or neck stiffness.
Hypoglycemia: Crying associated with jitteriness, lethargy, and feeding difficulties, especially in infants with poor feeding.

Less Common Causes

Hair tourniquet: A hair or thread wrapped around a finger, toe, or genitalia, causing pain and possibly ischemia
Corneal abrasion: Crying due to eye irritation, with eye rubbing, redness, and sensitivity to light
Fractures: Crying and irritability after trauma, with pain on movement of the affected limb
Drug withdrawal: Crying in infants born to mothers who used certain drugs during pregnancy, associated with tremors, irritability, and poor feeding
Congenital heart disease: Crying with cyanosis, poor feeding, and failure to thrive, particularly when associated with feeding or exertion
Inborn errors of metabolism: Persistent crying with poor feeding, vomiting, lethargy, and metabolic crisis signs, though rare
Sepsis: Crying with fever, lethargy, poor feeding, and signs of systemic infection, particularly in neonates
Neurological conditions (e.g., hydrocephalus, intracranial hemorrhage): High-pitched crying, irritability, poor feeding, and abnormal head growth

Onset and Duration

Age of onset: Early crying may suggest feeding issues, GERD, or colic, while later onset may be due to teething or developmental milestones
Duration of crying: Persistent crying over hours or days may indicate colic, GERD, or a serious underlying condition
Pattern of crying: Episodic crying may suggest intussusception or colic, while continuous crying may indicate infection or discomfort
Time of day: Evening crying may suggest colic, while crying associated with feeding may suggest GERD
Triggers: Crying triggered by feeding, position changes, or environmental factors may help pinpoint the cause
Recent illness or changes: Recent fever, infections, vaccinations, or changes in routine may provide clues to the cause

Background

Birth history: Complications during birth, prematurity, or neonatal jaundice may predispose to conditions like GERD or neurological issues causing crying
Feeding history: Type of feeding (breast or bottle), frequency, difficulties, and any associated symptoms like vomiting or arching of the back may suggest GERD or milk protein allergy
Growth and development: Monitor growth charts and milestones to identify failure to thrive or developmental delays linked to crying
Family history: History of atopy, congenital conditions, or neurological disorders may offer clues
Social history: Family stressors, parental anxiety, and environmental factors (e.g., smoking, pets) may influence crying patterns and require addressing during consultation
Previous medical history: Any past illnesses, hospitalizations, or surgeries may predispose the infant to specific conditions like GERD or infections that cause crying
Vaccination history: Recent vaccinations may lead to transient irritability and crying, typically resolving within a few days
Medications: Current or recent use of medications (e.g., antibiotics, analgesics) may have side effects contributing to crying
Parental concerns and coping: Understanding parents’ perceptions and concerns about the crying, as well as their coping mechanisms, can be vital in managing the situation

Bedside Tests

Physical examination: Comprehensive assessment, including inspection of skin, eyes, ears, mouth, and genitalia, as well as palpation of the abdomen and musculoskeletal system to identify signs of infection, trauma, or other causes
Weight and growth monitoring: Regular measurements to assess for failure to thrive or abnormal growth patterns
Temperature measurement: To rule out fever as a cause of crying, which may suggest infection or inflammation
Observation during feeding: To identify any feeding difficulties, signs of discomfort, or gastroesophageal reflux during feeds
Urinalysis: To rule out urinary tract infection, particularly in infants with unexplained crying and fever
Blood glucose testing: Particularly in newborns or infants with poor feeding, to rule out hypoglycemia
Pulse oximetry: To assess oxygen saturation, particularly if respiratory distress or congenital heart disease is suspected

Laboratory and Imaging Investigations

Full blood count: To assess for infection (raised white cells) or anemia
C-reactive protein (CRP): To assess for inflammation or infection, particularly if sepsis or serious bacterial infection is suspected
Blood cultures: If sepsis is suspected, particularly in neonates with fever and irritability
Electrolytes and metabolic panel: To assess for electrolyte imbalances, particularly in cases of dehydration or suspected inborn errors of metabolism
Abdominal ultrasound: To assess for intussusception, pyloric stenosis, or other abdominal pathology
Head ultrasound or MRI: To assess for hydrocephalus, intracranial hemorrhage, or other neurological conditions in infants with abnormal neurological examination
X-ray (chest/abdomen): To assess for fractures, pneumonia, or bowel obstruction
Urine microscopy and culture: To confirm urinary tract infection if indicated by urinalysis
Stool analysis: If gastrointestinal pathology is suspected, such as blood in stool for intussusception or infection
Echocardiogram: If congenital heart disease is suspected, particularly in infants with cyanosis, poor feeding, and failure to thrive
Lumbar puncture: If meningitis is suspected, particularly in febrile infants with persistent irritability and abnormal neurological signs

Child health