Management of a crying child

1. THE CRYING CHILD
PRESENTERS: SERIAL NUMBER 44, 58 AND 72
MODERATOR: DR. BABA JIBRIN
DEPARTMENT OF PAEDIATRICS
USMANU DANFODIYO UNIVERSITY, SOKOTO

2. 2
Outline
 Introduction/definition of crying child
 Epidemiology
 Types of cry
 Effect of excessive crying in infants
 Why is child crying
 Evaluation of a crying child
 Conclusion
 References
13/12/2021
The Crying Child

3. 3
Introduction
 Crying is the shedding of tears in response to an emotional state, pain, or physical
irritation of the eye
 It is the normal physiological response to many stimuli in nonverbal children
 In babies, cry has crucial role in soliciting attention and care from adults
 A child is a human being between birth and puberty (< 18 years)
 Healthy children cry for about 3 hours per day on an average at 6 weeks of age
with the peak occurrence between 3 PM and 11 PM
 Incessant crying is one of the common reasons for many emergency visits during
infancy which often lead to considerable parental stress and anxiety
13/12/2021
The Crying Child

4. 4
Epidemiology
 The incidence varies from 1.5% to 11.9% depending on
the case definitions and age group
 It is high in infants below 3 months of age and
decreases considerably beyond 6 months of age.
 Reported incidence of serious underlying organic
causes is around 5 to 10% in babies with incessant
crying
13/12/2021
The Crying Child

5. 5
Types of cry in children
1. Normal cry
2. Abnormal cry
a. Rhythmic cry
b. Fussy cry
c. Whiny cry
d. Infantile colic/ behavioral cry
e. High pitch cry
13/12/2021
The Crying Child

6. 6
Abnormal cry
 These are types of babies’ cry that are unusual and
denote abnormality and pathology in the baby, such
as pain or insect bite
 It can be:
 A high pitch cry or
 An incessant or inconsolable cry
13/12/2021
The Crying Child

7. 7
Abnormal cry
A. Rhythmic cry
 This is a repetitive pattern of cry where the baby make sounds like “neh”
due to the baby trying to suck and putting the tongue on the roof of the
mouth
 It is usually short, low pitched cries that rise and fall
 This type of cry denotes hunger
B. Fussy cry
 This happens when the baby is not hungry and has been in a single
position for long
 They tend to make a fuss with short low pitch cries which can be consoled
by changing their position or giving a new toy. This denote boredom
13/12/2021
The Crying Child

8. 8
Abnormal cry
C. Whiny cry
 This cry is a nasal cry ,that sounds like they are saying “owh” and look
like a yawn
 This type of cry builds in intensity with time
 This denotes tiredness and means the baby needs to take a nap
D. Infantile colic/Behavioural cries
 This is defined as a paroxysmal crying of more than 3hours a day
occurring for more than 3days a week lasting for more than 3weeks in
an otherwise healthy child who is older than 3 weeks and younger
than 4 months of age
13/12/2021
The Crying Child

9. 9
Abnormal cry
 Some consider colic as a spectrum ranging between normal cry
and a distinct behavioral syndrome
 Colic is a diagnosis of exclusion made after careful history taking
and clinical examination and ruling out any organic cause
 Colic is the leading of incessant cry
E. High pitch cry
 This type of cry pierces the ears , characterized by loud shrieks
accompanied by a baby arching its back and grunting
 it means a baby is in pain
13/12/2021
The Crying Child

10. 10
Abnormal cry
 This type of cry can also be experienced
after a vaccine shot
 it is usually fierce but shortlived
F. Incessant/inconsolable cry
 This is the type of cry that is difficult to
console
 it goes on for a long time with grunts
and stuttering breath after
 This type of cry denotes pain and
significant discomfort
 Infantile colic is the commonest cause
 This type of cry can also be experienced
after a vaccine shot 13/12/2021
The Crying Child

11. 11
Effects Of Excessive crying in infancy
1. Parental anxiety and depression
2. Parental sleep deprivation
3. Attachment difficulties between infant and children
4. Excessive cry in babies can trigger an episode of
cyanotic spells in patients with TOF, VSD and TGA.
13/12/2021
The Crying Child

12. 12
Why is child crying
 The causes are divided into
a) Organic
1. Viral illness
2. UTI
3. Meningitis
4. AOM
5. Septic arthritis
6. Cellulitis
7. sepsis
b) Non-organic/trivial cause
1. Hunger
2. Wet diaper
3. Tiredness/sleepiness
4. Attention seeking
5. Infantile colic
6. Overclothing
7. Insect bite/post vaccination
13/12/2021
The Crying Child

13. 13
Causes Of Cry
b) Surgical/others
1. Fractures/traumas
2. Burns
3. Foreign bodies
4. Child abuse
5. Gastro-oesophageal reflux
6. Corneal abrasion
7. Obstructed hernia
8. Testicular/ovarian torsion
13/12/2021
The Crying Child

14. 14
13/12/2021
The Crying Child

15. 15
Evaluation of a crying child
 History
 Physical examination
 Investigations
 Treatment
13/12/2021
The Crying Child

16. 16
Evaluation of a crying child
 History
 Comprehensive history taking and physical examination should
be the cornerstone in approaching a crying infant
 Duration
 Frequency
 Periodicity and
 Intensity of crying episodes
 Aggravating and alleviating factors should be recorded
13/12/2021
The Crying Child

17. 17
Evaluation of a crying child
 A good History should also focus on
 Age
 comorbid medical conditions
 sibling and family history
 recent vaccination
 photophobia, feeding and sleeping behaviour
 It is also important to assess the mother – infant relationship,
maternal fatigue and stress
 Parents are excellent observers and are often able to find subtle
signs and symptoms
13/12/2021
The Crying Child

18. 18
Evaluation of a crying child
 Physical examination.
 Physical examination ascertains whether the child is
healthy or ill- looking
 Vital signs should be recorded and the entire body,
including genitals, should be thoroughly inspected
 Eyelids have to be everted for ocular foreign bodies
 Infants who continue to cry throughout the initial
assessment should be observed further and re-
examined during normal periods
13/12/2021
The Crying Child

19. 19
Evaluation of a crying child
For example
 high pitched incessant cry may indicate central nervous
system infection.
 A continuous cry associated with grunting may indicate
respiratory infection / foreign body.
 Screaming with pulling at the ears may indicate AOM
 Intermittent bouts of crying associated with pallor, with the
knees drawn up over the abdomen may indicate
intussusception
 Paroxysmal crying episodes in an otherwise healthy infant less
than 4 months of age typically occurring in the late
afternoon and evening suggest infantile colic
13/12/2021
The Crying Child

20. 20
Evaluation of a crying child
 Detailed observation of cry often gives diagnostic clues
 Physical examination should be systematic including
head to foot examination
 Some parts of examination may be repeated if required
as examining a fussy infant is not easy
13/12/2021
The Crying Child

21. 21
Evaluation of a crying child
 Investigations
 The clinical assessment should guide decision making about sequential
investigations.
 The yield of the laboratory investigations vary with the context of
screening test or confirmation test.
1. Corneal fluorescence test; for screening for corneal abrasion
2. Abdominal ultrasound; intussusception
3. blood cultures; sepsis
4. Urine MCS
5. Stool MCS
6. Gastric washout
7. Ear swab MCS 13/12/2021
The Crying Child

22. 22
Treatment
 Crying is a 'common denominator’ for a variety of illnesses and
physiological disturbances
 Management of these incessant crying episodes will depend on the
diagnosis obtained
 Ruling out apparent causes of crying such as hunger, sleepiness and
tiredness is the first step in treating an infant with persistent crying
 In febrile crying infants with or without a focus of infection, the
management should be based on any standard guidelines for sepsis
work up.
 Other surgical and miscellaneous conditions should be managed
accordingly.
13/12/2021
The Crying Child

23. 23
Treatment
 Treatment strategies for infant colic include drugs, dietary
modifications and behavioral interventions.
 Behavioral interventions should be tried first as it has documented
efficacy.
 If they fail to produce relief, drug and dietary management may
be tried.
 Dicyclomine has been shown to effectively reduce infant crying in
two randomized controlled trial
13/12/2021
The Crying Child

24. 24
Treatment
 Supportive care is very essential when no underlying medical
cause is found
 Mother’s emotional state and the mother–baby relationship should
be addressed
 Ensure that the baby is adequately fed and rested. Some general
measures such as firmly holding the baby, swaddling, massaging,
singing and playing white noise may be tried
 White noise has a soothing effect on crying and irritable infants
13/12/2021
The Crying Child

25. 25
Prevention
 General health promotion and health education.
 Specific protection- immunisation .
 Treatment of specific disease.
 Limitation of disability
 Rehabilitation
13/12/2021
The Crying Child

26. 26
Conclusion
 Crying is a normal part of your baby’s development
and is normal for all babies from all cultural
backgrounds
 An inconsolable cry without any obvious causes such as
hunger, thirst, loneliness, wet diaper, loud noise, requires
detailed search for a medical cause
13/12/2021
The Crying Child

27. 27
References
 The evaluation and management of an incessantly crying infant
Jayavardhana Arumugam1, S Sivandam2, A M Vijayalakshmi3 Sri
Lanka Journal of Child Health 2012; 41(4): 192-198
 Encyclopedia on early childhood education
 Kiwix the medical encyclopedia
13/12/2021
The Crying Child

28. 28
THANK YOU FOR LISTENING
13/12/2021
The Crying Child

29. The Crying Child
29
13/12/2021

30. The Crying Child
30
13/12/2021

31. CLINICAL PRESENTATION
• PARALYTIC POLIOMYELITIS
• Is the least common form (<1%)
• It's characterized by descending asymmetric acute flacid paralysis
(AFP)
• Proximal muscles are affected earlier than the distal muscles
• paralysis starts at hip and proceed towards extremities giving rise to
the characteristics tripod sign (child sits with flexed hip, both arms are
extended towards the back for support

32. The Crying Child
32
13/12/2021
• Sites involved can be spinal, bulbar or
bulbospinal and the nature of paralysis varies
accordingly
• The disease progression is typically biphasic,
aseptic meningitis occurs followed by recovery
and then fever with paralytic features 1-2 days
after

33. The Crying Child
33
13/12/2021
• Sites involved can be spinal, bulbar or
bulbospinal and the nature of paralysis
varies accordingly
• The disease progression is typically
biphasic, aseptic meningitis occurs
followed by recovery and then fever with
paralytic features 1-2 days after

34. The Crying Child
34
13/12/2021

35. TREATMENT
• There is no specific antiviral treatment for poliomyelitis
• The management is supportive and aim at limiting progression of the
disease
• All intramuscular injections and surgical procedures are
contraindicated during the acute phase of the disease especially in
the first week of the illness as they might result in the progression of
disease

36. The Crying Child
36
13/12/2021

37. TREATMENT
• ABORTIVE POLIOMYELITIS
• Supportive treatment with analgesics, sedatives and bed rest untill
child's temperature is normal
• Careful neurologic and musculoskeletal examination should be
performed 2 months later to detect any minor involvement

38. The Crying Child
38
13/12/2021

39. TREATMENT
• NONPARALYTIC POLIOMYELITIS
• Similar to that of avortive form
• Analgesics for relief for the discomfort of muscle tightness and spasm
of the neck, trunk and extremities
• Hot packs for 15-30 minutes every 2-4 hours
• Hot tube bath and firm bed
• Patient should be carefully examined every 2 months after apparent
recovery to detect minor residual effect that may cause postural
problems in later years

40. The Crying Child
40
13/12/2021

41. • PARALYTIC POLIOMYELITIS
• Mechanical ventilation is often needed in
• patients with bulbar paralysis. Tracheostomy care is
• often needed in patients requiring long-term ventilatory
• support. Phys ical therapy is indicated in cases of
• paralytic disease. In paralytic disease, provide frequent
• mobilization to avoid development of chronic decubitus
• ulcerations. Active and passive motion exercises are
• indicated during the convalescent stage.

42. The Crying Child
42
13/12/2021

43. e. Faecal
• impaction is frequent in cases of paralytic disease and
• can be treated with laxatives as soon as it develops. A
• multidisciplinary approach with the Phys iotherapist,
• Pulmonologist, Neurologist, Immunologist, and
• Infectious Diseases Specialist is essential.
• Diet: Patients with poliomyelitis are prone to develop
• constipation, therefore a diet rich in fibre is usually
• indicated.
• Other supportive care: Patients with poliomyelitis may
• develop bladder dysfunction for which catheterization is
• frequently required or manual compression of the
• bladder.
• Prevention; Two types of vaccines

44. The Crying Child
44
13/12/2021
• GENERAL HEALTH PROMOTION
• Health education
• Environmental sanitation
• Personal hygiene
• SPECIFIC PROTECTION
• ..