Acute and excessive crying indicates an acute episode that is persisting longer than the usual crying period for that infant without apparent cause.
Reasons for concern:
(1) excessive crying during the first week of life
(2) excessive crying beyond 4 months of age
(3) recurrent episodes of crying in an infant who does not appear to be healthy, well-nourished or developing normally
(4) crying that does not fit the pattern of infantile colic
(5) fever present
(6) crying continues after several hours of observation
Evaluation:
(1) history and physical examination
(2) urinalysis with culture
(3) observe the patient over the next 1-2 hours
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Assessment
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Management
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positive finding on history or physical examination
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identify cause and treat; ensure appropriate follow-up of the patient
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urinalysis positive
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treat for urinary tract infection; consider diagnostic tests to identify predisposing conditions; ensure appropriate follow-up of the patient
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crying ceases spontaneously during initial observation period
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follow-up within 24 hours
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history of recurrent episodes and/or findings consistent with colic
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treat for infant colic; follow-up if persists
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crying persists during the initial observation period
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continue observation until crying stops or diagnosis made; consider more extensive testing
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Workup for infant with persistent crying:
(1) radiologic studies
(2) chemistry tests
(3) toxicology studies
(4) pulse oximetry
(5) lumbar puncture
Limitations:
• For the infant with no obvious cause for the crying, the diagnosis of infantile colic becomes very important. This may be somewhat subjective during the first few episodes, until a pattern becomes established.
