Approach to the inconsolable infant

 

Case: Parents bring a 2-month-old male infant to the emergency department for evaluation. Parents state the child “has been crying excessively over the past 24 hours and has been at times inconsolable.”

Is this crying normal? The definition of normal crying originates from a 1962 article by T. Berry Brazelton, who determined that the median hours an infant spends crying is 1.75 hours a day at two weeks of age, peaks at 2.75 hours a day at six weeks of age, and decreases to less than one hour of crying a day by 12 weeks.¹ 

Though many of these cases are attributed to normal behavior, it is important to seriously consider the concerns of any caregiver who has noticed an acute change in the crying patterns of a child. Remember, not all inconsolable crying is colic. In these patients, always consider colic a diagnosis of exclusion. 

The crying and inconsolable infant has a limited ability to convey information to us. Therefore, using a mnemonic, such as “IT CRIES”, in the approach to these sometimes difficult pediatric patients can help remind us of those diagnoses that should be on the top of our differential.

IT CRIES

•  I = Infectious (Otitis media, UTI, Meningitis, Sepsis, HFM, Kawasaki, Thrush)
• T = Trauma (Abuse, Fractures, Subdural Hematoma, frenulum tears), Hair Tourniquet
• C = Cardiac Disease (Congenital Heart Disease, Dysrhythmia), Colic, Constipation
• R = Reflux, Rectal/Anal Fissure, Reaction to Medications
• I  = Intussusception
• E = Eyes (Corneal abrasion, Foreign Body, Glaucoma)
• S = Surgical Processes (Hernia, Testicular/Ovarian Torsion), Sugar (hypoglycemia)

 

 

 

 

 

 

 

Want to read more?

Is a Crying Baby an Emergency or Just Normal Infant Behavior? ACEPNOW