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MANAGING THE CRYING BABY

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Title: MANAGING THE CRYING BABY


1
MANAGING THE CRYING BABY
  • Doreen Cassar
  • MD, Dip Womens Health (ICGP)
  • MCFD Jan 06

2
Crying what is it?
  • A means of communication
  • All babies cry part of the normal behavioural
    development of child (Brazelton 1962)
  • n shaped curve for crying in first 3 months
  • Total crying in 24 hrs tends to increase in first
    few weeks
  • Peaks in 2nd month
  • Decreases to more stable level by 4th month

  • (Konner 1989)

3
Crying when is it a problem?
  • gt 3hrs/day, gt 3days/wk for gt 3 weeks
  • (Wessel et al 1954)
  • defined as COLIC
  • In otherwise well fed, healthy baby
  • Commoner in late afternoon or evening
  • Sudden onset for no apparent reason
  • Difficult or impossible to console
  • Incidence in GP 12-20 of infants

4
Manage - who?
  • Child
  • Parent/carer

5
Parent
  • Views contrasting info ? anxiety , distrust
  • Put at ease
  • Concerns health beliefs
  • Cope differentiate crying level of exhaustion
  • Depressed
  • Support
  • Family dynamics

6
LISTEN TO PARENTS
  • parents are more effective than professionals in
    the early diagnosis of a wide range of child
    health problems
  • (Hall
    1989,Polnay 1989)

7
Child
  • Crying - acute / more of the usual
  • Acute ? more serious illness
  • More of the usual - ? Colic

8
History
  • Pattern of crying
  • Sleep history
  • Temperament
  • Family dynamics

9
History cont.
  • Feeding history under / over feeding early
    weaning
  • difficulty during feeds associated symptoms
  • Past history illness, hospitalisation, surgery,
    allergies
  • Pregnancy /birth events maternal / neurological
  • causes
  • Drug history over the counter / prescribed

10
Physical examination
  • Aim to exclude organic causes of crying
  • Systemic examination of all systems is essential

11
  • lt 5 of crying is due to an organic cause
  • Most common organic causes
  • Otitis media
  • Colic
  • Reflux
  • Cows milk protein or lactose
    intolerance
  • UTI
  • Meningitis
  • Shaken Baby Syndrome

12
Potential causes of crying
  • Infections
  • Dental / oral
  • Genitourinary
  • Gastrointestinal
  • Trauma
  • Cardiovascular
  • Toxic / metabolic

13
Physical examination
  • Ability to be consoled
  • Expose baby fully
  • Overall appearance
  • Stability of vital signs
  • Temperature

14
In practice
  • ? Take over child early in consultation
  • Assess consolability how?

15
Physical exam. Cont.
  • Skin rashes. perfusion, bruising
  • HEENT - fontanelle, sclera, corneal abrasions,
    pupillary activity, haemorrhages, otitis,
    pharyngitis, foreign bodies, neck
  • Dental / oral new teeth, thrush
  • Chest breath sounds ,tachypnea
  • CVS murmurs, tachycardia, arrthymias

16
Physical exam. Cont.
  • Abd.- tenderness, bowel sounds, masses
  • GU hernias, torsion, strangulation by hair
    tourniquets, anal fissures, blood pr, nappy
    rash, phimosis,
  • Extremities focal tenderness, hair tourniquets
  • CNS overall activity level, responsiveness,
    Kernigs, Brudzinskis
  • Weight growth chart

17
  • Examination alone usually reassures parents

18
Non organic causes
  • Thirst
  • Hunger
  • Loneliness
  • Tired
  • Scared
  • Full diaper
  • Too hot/cold
  • Noise
  • Lights to bright
  • Smoky environment
  • Seeking cuddle

19
Investigation
  • Is it needed?
  • If history is typical and examination negative
  • no investigations required

20
Repeated Crying
  • Wise to check -
  • Home environment
  • Childs room
  • Family interactions / dynamics

21
Parents anxiety
  • Makes major demand on GP time
  • - Stems from sense of lack of control
  • - Bewilderment
  • - Failure to diagnose
  • - Unhelpful explanations
  • - Various treatment patterns
  • More information and education needed

22
Treatment
  • Explain normal crying / sleep pattern
  • Assist parents to deal with discomfort
  • Child medication rarely indicated
  • Colic mixtures are of no proven benefit
  • Formula changes are not usually
    helpful unless proven cows milk allergy or
    lactose intolerance
  • Weaning from breast milk not helpful
  • Mother treat depression / anxiety, arrange
    support

23
Referral when?
  • If baby
  • Avoids gaze
  • Withdraws emotionally and does not respond to
    parents when not crying
  • Does not enjoy play
  • Remains distressed after 4 months of age
  • Continues to have feeding and sleep problems
  • Mother -
  • Severe postnatal depression risk to self and
    child paranoia

24
Key messages
  • Listen to parents
  • Acknowledge parents difficulties
  • In many cases a specific cause of crying may not
    be found
  • Overall appearance of child should guide
  • Family needs detailed instructions reassure,
    most parents cannot deal with uncertainty
  • Follow up essential empower to come again

25
  • Thank you

26
(No Transcript)
27
Associated Features
  • Temperature
  • Difficulty in feeding/feeding history/
  • overfeeding/premature weaning
  • Vomiting/diarrhoea/constipation
  • Curling, arching back, straining
  • Difficulty in breathing/cough Urination
  • Eczema, itch nappy rash Sleep
    patterns
  • Activity level /Irritable
    Ability to be consoled

28
Past history
  • Illnesses
  • Allergies
  • Hospitalisations
  • Surgery
  • Pregnancy complications
  • Birth event

29
Medications
  • Prescribed
  • Over the counter
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