SAQ 322 – Paediatrics – inconsolable crying in a thriving infant

Paediatrics – inconsolable crying in a thriving infant.

a. Potential causes

• Trauma, including accidental and non-accidental injury, bites, or tumours.
• Infections such as otitis media, herpes stomatitis, UTI, meningitis, or osteomyelitis.
• Maternal or parental stress, anxiety, or depression.
• Strangulation such as hair or fibre tourniquet.
• Cardiorespiratory disease.
• Reflux, medication or formula reactions, anal fissure, lactose intolerance, or cow's milk allergy.
• Intracranial hypertension, immunisations, eye problems, or retinal haemorrhage.
• Surgical causes such as volvulus, intussusception, inguinal hernia, or testicular torsion.

b. History

• Temporal association with feeds.
• Variation with context or environment.
• Parental emotional response and actions.
• Support systems; screen for depression and consider non-accidental injury risk.
• Growth and development, noting physical causes are rare when thriving.
• Associated symptoms such as vomiting, diarrhoea, or eczema.

c. Discharge approach

• Explain the infant is not unwell or in pain and that crying/unsettled behaviour improves with time.
• Acknowledge parental anxiety and stress empathetically.
• Provide constructive support options within and outside the family.
• Give written management advice and support contacts.
• Arrange follow-up with maternal/child health nurse, GP, or general paediatrics.
• Offer admission for severe cases or concern about parental exhaustion or risk of non-accidental injury.