Colic/Crying baby

Question 1

Is crying normal for an infant? If so, how often do they usually cry? When does their crying improve by?

Answer 1

Yes - a 6-8 week old (peak of crying) will cry 2-3 times/day, usually in late afternoon/evening. Each episode may last a few hours. Gets better by 3-4 months/age

Question 2

What is determined as excessive crying for an infant? What is this condition called?

Answer 2

> 3 hrs/day for >3 days/week - this is the definition of colic

Question 3

Name 2 non-pathological causes of crying

Answer 3

Sleep deprivation

Hunger

Question 4

How long do infants up to 6 months usually sleep for? How long do they have to be awake for before getting tired?

Answer 4

Usually 15-16 hours/day

Often get tired after being awake for 1.5-2hrs

Question 5

Name 3 pathological Ddx for chronic/protracted crying. Name a distinguishing feature of each diagnosis

Answer 5

Cow milk/soy protein allergy - look for vomiting, bloody/mucusy diarrhoea, FHx atopy
GORD - look for frequent vomiting and other symptoms of GORD (apnoea, poor weight gain, haematemasis, chronic cough)
Lactose malabsorption - look for perianal excoriations, frothy/watery diarrhoea

Question 6

Name 3 Ddx of acute onset crying

Answer 6

UTI
Otitis media
Raised ICP
Hair tourniquet of fingers/toes
Corneal foreign body/abrasion
Incarcerated inguinal hernia

Question 7

Name 3 red flags for a crying infant

Answer 7

Sudden onset of irritability/crying
Maternal depression/poor mental state (watch for Shaken Baby Syndrome)
Symptoms of pathological diagnoses

Question 8

Go through the 5 aspects of management of a child with colic (from RCH guidelines)

Answer 8

1. Engage a partnership with parents (get on their side)
2. Explain normal sleeping and crying - use sleep/crying diary, encourage parents to look for signs of tiredness
3. Suggest environmental changes to improve child’s sleeping (establish pattern to sleep, reduce stimulation, gentle music/rocking) and to give the mother some respite
4. Assess maternal state and mum-baby relationship
5. Provide printed information sheets

Question 9

Name 3 ways to recognise a tired child

Answer 9

Frowning
Clenched hands
Jerking arms and legs
Crying
Grizzling

Question 10

What scale is used for postnatal depression?

Answer 10

Edinburgh Postnatal Depression scale

Question 11

If you think a crying child might have a pathological cause to their crying, what can you trial?

Answer 11

Trial of cow milk free formula or cow milk free maternal diet (may have cow milk allergy) - see if symptoms improve