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Crying should be distinguished from colic (see Approach to the Care of Normal Infants and Children: Colic). Crying is the only means an infant has to signify distress. Causes may be mundane (eg, a neonate accustomed to the tight environment of the womb becoming frightened by unrestricted arm and leg movements) or serious (eg, ear infection, abdominal pain). Often there is no obvious cause. Persistent or prolonged crying, especially with signs of illness, requires a search for a cause. Crying almost always improves by 4 to 6 mo; when it does not, providers should suspect physical pain or tension within the family.
Evaluation
History:
History focuses on the amount, timing, and quality of the crying as well as any signs of illness. Reports of fever or URI suggest possible otitis media. Reports of diarrhea or vomiting suggest pain from a GI process, ranging from gastroenteritis to more serious conditions. Reports of extreme parental frustration suggest tensions within the family that may be reflected in the infant's behavior.
Physical examination:
Examination focuses on growth parameters and any signs of illness. Distorted or erythematous tympanic membranes suggest otitis media. Abdominal distention or masses suggest an intra-abdominal process causing pain. Fever and fussiness without an apparent cause may result from UTI.
Testing:
In most cases, testing is unnecessary unless otherwise indicated by history and examination.
Treatment
The clinician's role in managing crying is to present explanations and options to parents, who can then try different strategies to diminish the child's crying. Approaches vary with cause and age. Infants are often comforted by swaddling, ambient noise, and movement, as in rocking or swinging in a swing. Both infants and older children often respond to a ride in the car. If parents and physician are convinced that there is no serious cause for the crying, the infant may be allowed to cry for a short period (“5-minute rule”), then parents comfort the infant and re-start the clock. Often parents are relieved to know that they can let the infant cry, and often the infant will stop spontaneously before the prescribed period is over.
Last full review/revision November 2005
Content last modified November 2005
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