Some Causes of Crying in Children
Cause | Suggestive Findings | Diagnostic Approach |
|---|---|---|
Cardiac | ||
Delayed or absent femoral pulses Tachypnea Cough Diaphoresis Poor feeding Systolic ejection murmur, systolic click | Chest radiograph ECG Ultrasound | |
Tachypnea Cough Diaphoresis Poor feeding Third heart sound (S3) gallop | Chest radiograph 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 radiograph ECG |
Gastrointestinal | ||
Anal tears or fissures History of decreased stool frequency and hard pellet stools Distended abdomen | History and physical examination | |
Hyperactive bowel sounds Vomiting and loose, frequent stools | History and physical examination | |
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 | Ultrasound Abdominal radiograph Air enema | |
Cow's milk protein intolerance (milk protein allergy) | Vomiting Diarrhea or constipation Blood in stools Poor feeding Growth and weight faltering (formerly known as failure to thrive) Rash | Stool heme test Trial of eliminating cow's milk protein from diet (eg, using hydrolyzed formula or removing milk protein from the mother's diet if breastfeeding/chestfeeding) |
Volvulus | Bilious vomiting Tender, distended abdomen Bloody stools Absent bowel sounds | Abdominal radiograph Barium enema |
Tender, erythematous mass in groin | History and physical examination | |
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 symptoms of ear pain Erythematous, opaque, bulging tympanic membrane | History and physical examination | |
Respiratory infection (bronchiolitis, pneumonia) | Fever Sometimes cough Tachypnea Sometimes hypoxia Sometimes wheezing, crackles, or decreased breath sounds on auscultation | Chest radiograph |
Urinary tract infection (UTI) | Fever Possible vomiting | Urinalysis and culture |
Trauma | ||
Corneal abrasion | Crying with no other symptoms | Fluorescein testFluorescein test |
Fracture (eg, due to child abuse) | Area of swelling and/or ecchymoses Favoring of a limb | Skeletal survey radiographs 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 | History and physical examination |
Head trauma with intracranial bleeding | Inconsolable, high-pitched cry Localized swelling on skull with underlying deformity | Head CT |
Inconsolable, high-pitched cry Lethargy Seizure activity | Head CT Retinal examination Skeletal survey Age-appropriate evaluation for child abuse | |
Other | ||
Swollen, erythematous, asymmetric scrotum Absent cremasteric reflex | Doppler ultrasound or nuclear scanning of the scrotum | |
Vaccine reaction | History of recent immunization | History and physical examination |