Some Causes of Crying
Cause | Suggestive Findings | Diagnostic Approach |
|---|---|---|
Cardiac | ||
Delayed or absent femoral pulses Tachypnea Cough Diaphoresis Poor feeding Systolic ejection murmur, systolic click | Chest x-ray ECG Ultrasonography | |
Tachypnea Cough Diaphoresis Poor feeding Third heart sound (S3) gallop | Chest x-ray ECG Echocardiography | |
Supraventricular tachycardia | Tachypnea Cough Diaphoresis Poor feeding Heart rate > 180 beats/minute (usually 220–280 beats/minute in infants; 180–220 beats/minute in older children) | Chest x-ray ECG |
Gastrointestinal | ||
Anal tears or fissures History of decreased stool frequency and hard pellet stools Distended abdomen | Clinical evaluation | |
Hyperactive bowel sounds Loose, frequent stools | Clinical evaluation | |
History of spitting up, arching, or crying after feedings | Swallowing study Esophageal pH or impedance probe study | |
Severe colicky abdominal pain alternating with calm, pain-free periods Lethargy Vomiting Currant-jelly stools | Ultrasonography Abdominal x-ray Air enema | |
Cow's milk protein intolerance (milk protein allergy) | Vomiting Diarrhea or constipation Poor feeding Failure to thrive | Stool heme test |
Volvulus | Bilious vomiting Tender, distended abdomen Bloody stools Absent bowel sounds | Abdominal x-ray Barium enema |
Tender, erythematous mass in groin | Clinical evaluation | |
Infection | ||
Fever Inconsolability, irritability Lethargy Bulging anterior fontanelle in infants (see Neonatal Bacterial Meningitis) Nuchal rigidity (meningismus) in older children (see Bacterial Meningitis in Infants Over 3 Months of Age) | Lumbar puncture for cerebrospinal fluid testing | |
Fever Pulling at ears or complaints of ear pain Erythematous, opaque, bulging tympanic membrane | Clinical evaluation | |
Respiratory infection (bronchiolitis, pneumonia) | Fever Sometimes cough Tachypnea Sometimes hypoxia Sometimes wheezing, crackles, or decreased breath sounds on auscultation | Chest x-ray |
Urinary tract infection (UTI) | Fever Possible vomiting | Urinalysis and culture |
Trauma | ||
Corneal abrasion | Crying with no other symptoms | |
Fracture (eg, due to child abuse) | Area of swelling and/or ecchymoses Favoring of a limb | Skeletal survey x-rays to check for current and old fractures |
Hair tourniquet | Swollen tip of a toe, finger, or penis with hair wrapped around the appendage proximal to the swelling | Clinical evaluation |
Head trauma with intracranial bleeding | Inconsolable, high-pitched cry Localized swelling on skull with underlying deformity | Head CT |
Abusive head trauma (shaken baby syndrome) | Inconsolable, high-pitched cry Lethargy Seizure activity | Head CT Retinal examination Skeletal survey |
Other | ||
Cold drugs | History of recent cold drug therapy | Clinical evaluation |
Swollen erythematous asymmetric scrotum, absent cremasteric reflex | Doppler ultrasonography or nuclear scanning of the scrotum | |
Vaccine reaction | History of recent immunization | Clinical evaluation |