Makindo Medical Notes

👶 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 😢