Crying baby
👶 Crying is one of the commonest reasons for paediatric consultations.
Most cases are benign, but serious conditions must be excluded.
👉 The role of the clinician is to:
1) Rule out red flags 🚨
2) Reassure and support parents 🫂
3) Manage underlying causes when present.
🩺 Clinical Approach to the Crying Baby
- History 📖
- Duration & Timing: Evening colic vs persistent crying throughout day.
- Associated symptoms: Fever, vomiting, diarrhoea, poor feeding, sleep change.
- Family history: Food allergy, colic, atopy.
- Perinatal history: Pregnancy/delivery complications, neonatal jaundice, prematurity.
- Examination 👀
- General appearance: Irritable vs lethargic vs well-appearing.
- Vitals: Fever, tachypnoea, cardiovascular status.
- Growth parameters: Weight, length, head circumference.
- Head-to-toe exam:
- 🧠 Fontanelle (bulging → raised ICP)
- 👂 Otitis media, ENT infection
- 👶 Abdomen: distension, tenderness, hernia
- ⚽ Genitalia: torsion, hernia, rash
- 🖐️ Limbs: trauma, fractures
- 🌡️ Skin: rash, meningococcal spots, eczema
⚖️ Differential Diagnosis
- Benign / Common causes 🙂
- Hunger or feeding difficulty 🍽️
- Fatigue / overtiredness 😴
- Colic (<3 months, paroxysmal evening crying) 🌀
- Diaper rash, tight clothing, or irritation 👕
- Overstimulation (noise, environment) 🎶
- Serious / Red flag causes 🚨
- Infection: Sepsis, meningitis, UTI
- GI: GERD, milk protein allergy, intussusception (colicky pain, red-currant stool)
- Trauma: Fractures, especially non-accidental injury 🛑
- Neuro: Raised ICP, haemorrhage, hydrocephalus
🔎 Investigations (if red flags)
- 🧪 Bloods: FBC, CRP, cultures if febrile.
- 💧 Urine dip & culture: exclude UTI.
- 📸 Ultrasound abdomen: intussusception, pyloric stenosis.
- 🖥️ Neuroimaging (CT/MRI): suspected trauma, ICP.
💊 Management
- General support:
- 🫂 Reassure parents on normal crying patterns (esp. evening fussiness).
- 🤱 Ensure correct feeding technique, adequate intake.
- 🛌 Soothing strategies: swaddling, rocking, white noise.
- Treat underlying causes:
- 🦠 Infection → antibiotics/antivirals.
- 🌀 Colic → reassurance, feeding adjustments, probiotics.
- 🥛 Milk protein allergy → hypoallergenic formula / maternal diet modification.
- ⬆️ GERD → thickened feeds, upright positioning, ± H2 blocker/PPI.
📅 Follow-Up
- Reassess infant & parental coping within days to weeks.
- If crying persists or worsens → revisit diagnosis.
🚩 Red Flags – Immediate Review
- Fever <3 months 🌡️
- Lethargy or poor feeding 💤
- Bulging fontanelle, seizures 🧠
- Persistent vomiting/diarrhoea 🤢
- Signs of trauma or NAI 🛑
- Inconsolable despite soothing attempts 😢
