Some Medical Disorders That Cause Excessive Crying in Infants and Young Children
Cause* | Common Features† | Tests |
|---|---|---|
Heart disorders | ||
Heart failure‡ or an abnormal heart rhythm‡ | Difficulty breathing, difficulty feeding, and excessive sweating Often an abnormal heart sound detected during a doctor's examination | Chest x-ray ECG Echocardiography |
Digestive disorders | ||
Vomiting Diarrhea or constipation Poor feeding Weight loss, poor growth, or both Blood in stools | Stool tests Symptoms that lessen when the formula is changed Possibly endoscopy, colonoscopy, or both | |
Hard, less frequent bowel movements that are difficult to pass Sometimes apparent pain during a bowel movement Sometimes tears (fissures) in the anus | A doctor’s examination | |
Symptoms that occur after feeding, including fussiness or crying, spitting up, or arching of the back Sometimes a cough when lying down or poor weight gain | A doctor’s examination Sometimes treatment with drugs to suppress acid production (if symptoms are relieved, the cause is probably gastroesophageal reflux disease) Sometimes x-rays of the upper digestive tract after barium is given by mouth or a test to measure acidity or reflux episodes in the esophagus (called a pH probe or an impedance probe) or endoscopy | |
Incarcerated hernia‡ | Red, swollen, tender bulge in the groin | A doctor's examination |
Intussusception‡ (sliding of one segment of intestine into another) | Crying that occurs in bouts every 15 to 20 minutes with children often drawing their legs up to their chest Later, tenderness of the abdomen when it is touched and bowel movements that look like currant jelly (because they contain blood) Typically in children 3 to 36 months old | Ultrasonography of the abdomen Insertion of air into the rectum (air enema) |
Volvulus‡ (twisting of the intestine) | Vomiting, a swollen abdomen, and/or tenderness of the abdomen when it is touched Possibly blood in stools or no stools | An x-ray of the abdomen Barium or air enema |
Infections | ||
Ear infection (otitis media) | Often cold symptoms (such as a runny nose and cough) Sometimes fever Ear pain | A doctor’s examination |
Fever and lethargy or listlessness Bulging of the soft spots (fontanelles) between the skull bones Fussiness and irritability (especially when held), inconsolability, and poor feeding | A spinal tap (lumbar puncture) | |
Urinary tract infections (UTIs) | Often fever Crying or complaints of pain with urination | Examination (urinalysis) and culture of urine |
Injury | ||
Broken bone | Swelling or bruising Unwillingness to use a limb Pain during bathing, changing, or a doctor's examination | X-rays |
Corneal abrasion (a scratch on the surface of the eye) | No other symptoms | |
Hair tourniquet | Swollen tip of a toe, a finger, or the penis with a hair wrapped below the swelling | A doctor’s examination |
A head injury‡ | An inconsolable, high-pitched cry Sometimes a swollen area on the head | CT of the head |
Other causes | ||
Drugs used to treat colds | Recent drug treatment for a cold | A doctor’s examination |
A tooth erupting or about ready to erupt, drooling Sometimes sleeplessness or restless sleep at night Sometimes mild fever | Symptoms that resolve after tooth erupts | |
Testicular torsion‡ (twisting of a testis) | A swollen, painful, red scrotum | Doppler ultrasonography of the scrotum |
A vaccine reaction | Recent vaccination (within 24–48 hours) | A doctor’s examination |
* Medical disorders cause fewer than 5% of cases of excessive crying. | ||
† Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present. | ||
‡ These disorders, although rare, are life-threatening and require immediate medical intervention. | ||
CT = computed tomography; ECG = electrocardiography. | ||