25 Sept 2023 • 'Because they can't talk....and we need to listen.'

This is the answer a pediatrician gave an exhausted mother, when she asked him why her baby had been crying inconsolably.🤱

Being one of the most perplexing presentations and a common symptom in the first 3 months of life, excessive crying leads to approximately 20% of pediatric consultations.🤔

Evaluation of the crying child is a challenging situation, and to help us learn better, Dr. Baldev Prajapati shares his insights and expertise in the session 'The Crying Child: Differential Diagnosis & Management Strategies'.

Most of the time, crying may be due to hunger, discomfort like a wet diaper, or separation, however when these needs are addressed, it usually ceases.👶

Nonetheless, it is important to consider the pathological causes of excessive crying, some of which are intestinal Colic, earache, bronchiolitis, acute appendicitis or even night terrors and nightmares.

An effective history taking can lead us in the right direction to the diagnosis👩🏻‍⚕

• Age: Infantile colic is usually seen at 3-4 months of age, while intussusception is seen in relation to weaning.
• Vaccination and drugs: Pain may be seen 24 hours after the DPT vaccine and medications like anticholinergics can cause urinary retention.
• Pattern and Duration of cry: For instance, sudden outbursts are seen in intestinal colic, while persistent crying is seen in a ear infection.
• System-based review: To assess associated symptoms like fever, constipation, vomiting, breathing difficulties and so on.
• History of trauma: Minor falls or injuries may not be reported.

The next step should be a careful physical examination🩺:

• General: Overall appearance (sick - looking?), fever (infections?), gums (bleeding in scurvy), limb bones and clavicles (fractures?), perianal region (anal fissures) should be evaluated.🤒

• Systematic: Checking for abdominal rigidity and guarding when suspecting surgical abdomen, and evaluating for a bulging anterior fontanelle, signs of meningeal irritation to rule out meningitis.🧠

Investigations like CBC and urine analysis, and even imaging modalities like chest X-ray and Barium enema may be used to confirm a certain diagnosis.💉

Once the diagnosis is made, the child can be treated appropriately. Dr. Prajapati has shared some invaluable knowledge on management of the crying child, for example never to prescribe sedatives in such children.🚨

Are you eager to learn more?🤗

Go ahead and Click here to watch the replay of The Crying Child: Differential Diagnosis & Management Strategies by Dr. Baldev Prajapati right here on Medflix💛