Irritable infant Flashcards
DDX for irritable infant
Normal crying for age - hunger, physical discomfit, tiredness Cow's milk protein intolerance Gastro-Oesophageal reflux Infection eg meningitis Intussusception Injury e.g. non accidental Other source of pain Acute onset *: UTI, otitis media, raiseICP, Hair tourniquet of fingers or toes, Corneal FB/Abrsion, Incarcerated inguinal hernia.
Red flags in an irritable infant that suggest a severe cause instead of colic
Fever lethargy Poor feeding Less responsive socially Poor wt gain Sudden onset maternal and family psychosocial state (Shaken baby syndrome)
Things to ask about in an irritable infant
feeding
temperature
change in behaviour or
social responsiveness
Other symptoms that suggest serious disease - vomiting, lethargy, poor Wt gain.
Don’t forget to examine testicular torsion or incarcerated inguinal hernia
What is a abnormal amount of time for a baby to cry
> 3hr/day for >3day/week.
Clinical characteristics of a colic baby
crying develops in the early weeks of life and peaks around 6-8 weeks of age
usually worse in late afternoon or evening but may occur at any time
may last several hours
infant may draw up legs as if in pain, but there is no evidence that colic is attributable to an intestinal problem or wind
usually improves by 3 - 4 months of age
what would support excessive tiredness as a cause of crying baby
If baby was getting 1.5hrs at a time and 3m old >2hrs awake.
What suggests hunger as a cause
this is more likely if a mother reports her baby has frequent feeds (i.e. less than 3 hrly), poor wt gain and inadequate milk supply
What suggest Cow milk or soy protein allergy as cause
Delayed non-IgE mediated reactions.
suspect if there is vomiting, blood or mucus in diarrhoea, poor weight gain,
family history in first degree relative or signs of atopy (eczema / wheezing), significant feeding problems (especially worsening with time)
Dx is made by tx for 2 wks
Mx of cow milk or soy protein allergy
eliminating cow milk by modifying the mother’s diet or changing to an extensively hydrolysed formula for a period of 2 weeks
What suggest gastro-oesophageal reflux as a cause
> 4 times per day vomiting
or if baby has feeding difficulties.
Not necessary associated with crying baby
May be secondary to cowlick/soy intolerance.
Tx not shown to affect crying.
Tx of Gastro-oesophageal reflux
Ranitidine
Omeprazole
Mx of irritable infant
Is there Vomiting diarrhoea eczema failure to thrive feeding difficulties Yes - consider cow milk allergy/Reflux and trail cow milk free formula or maternal diet. No - medical cause unlikely. Think tired, hungry, unable to self soothe. Discuss normal sleep and crying, discuss settling techniques, maximise parental support and arrange follow up.
DDX for acute onset of irritability infant
UTI Otitis media Raised intracranial pressure Hair tourniquet of fingers/toes Corneal foreign body/abrasion Incarcerated inguinal hernia
Ix for acute onset irritability
Urine MCS (if acute and vomiting) Fluorescein staining of eyes if hx suggestive
Mx of crying baby when excluded medical causes
- Engage partnership with parents
- Explain normal crying and sleep patterns, signs of tiredness
- Assist parents to help their baby deal with discomfort and distress.eat settling, sleep. avoid stimulation, baby massage, dental music,
- Assess maternal and emotional state and mother baby relationship (PND)
- Provide information sheets.
Followup and refer.
