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The crying infant
Essentials
- 1
Define if this presentation is part of a recurrent stereotypical pattern in an otherwise well infant or a single acute episode.
- 2
A careful history and examination will often lead to an appropriate diagnosis.
- 3
Screening tests, except for urine culture, have little utility.
- 4
Carefully review carer’s coping and supports.
- 5
Organise appropriate follow-up.
Introduction
Crying is normal physiological behaviour in young infants and an important method of communication. Carers are usually able to identify and manage the cause (e.g. hunger, tiredness, discomfort) and console the infant. Infants cry more during the first 4 months of life than at any other time; colic is more frequent in the first 6 weeks of life (prevalence 17% to 25%, with variability depending on location of study and definition used). Brazelton, in his study of 80 infants of American families with minimal psychological stresses, defined ‘normal crying’ as 1 hour and 45 minutes per day at age 2 weeks, a peak of 2 hours and 45 minutes per day by 6 weeks, decreasing to less than 1 hour per day at age 12 weeks. Medical advice may be sought if the crying is felt to be unusually intense or persistent, or the infant is unable to be consoled by the usual methods. The classification of crying as normal or excessive is highly subjective and will vary according to infant, carer and situational factors. All three areas need to be assessed in this type of presentation. Either a single episode of crying, or recurrence of a pattern of excessive crying, may precipitate emergency department (ED) presentation.
Recurrent crying
Colic
Most infants with excessive crying do not have an underlying medical cause. Recurrent excessive crying in an otherwise healthy infant is often termed colic. Colic was originally described in 1954. It is a diagnosis of exclusion which can only be made if the pattern is recurrent and stereotypical and careful history, examination and a period of follow-up have ruled out other important causes. The definition of colic varies but is frequently arbitrarily defined as a total of more than 3 hours per day of irritability, fussing and crying on at least 3 days a week for at least 3 weeks. The infant is otherwise healthy, active and thriving, with no other features suggestive of underlying disease. This pattern typically occurs in the afternoon or evening, ceasing by 3 to 4 months of age. Crying may be associated with the infant going red in the face, flexing their legs or passing wind. The aetiology of infantile colic is poorly understood and likely to be multifactorial.
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