Without question, one of the most challenging tasks in life is to raise a child. The degree of difficulty of this challenge is heightened when that child becomes “inconsolable.” Since a young infant or child has a limited repertoire to convey illness, constant crying needs to be taken seriously by us in the Emergency Department. So, before you jump to the conclusion that this is merely “Colic” in the 2 month old, let us quickly highlight some entities that should be at the top of your DDx when evaluating the inconsolable child.
Inconsolable Child: A Mnemonic May Help
- Personally, I have a difficult time remembering Mnemonics, but this one can be helpful.
- IT CRIES
- I = Infections (ex, UTI, Meningitis, Sepsis)
- T = Trauma (ex, Subdural Hematoma, Fractures, Non-accidental trauma)
- C = Cardiac Disease (ex, SVT)
- R = Reaction to meds, Reflux, Rectal/Anal Fissure
- I = Intussusception
- E = Eyes (ex, corneal abrasion, foreign body, glaucoma)
- S = Strangulation, Surgical Processes (ex, Hernia, Testicular/Ovarian Torsion)
Inconsolable Child: Head to Toe Exam is Key!
- Neuro exam – change in MS? Hypoglycemia??
- Full fontanelle – space-occupying lesion? Infection?
- Hematoma or Ecchymosis – Trauma?
- Corneal abrasion? Little kids often have talons for fingernails. [Harkness, 1989]
- Eversion of eyelid for retained FB
- Red eye and excessive tearing? Congenital conjunctivitis? Glaucoma?
- Acute Otitis Media
- Retained FB
- Strawberry tongue? (Kawasakai Disease?)
- Diaper Region
- Petechiae, purpura, etc.
Inconsolable Child: But, What About Colic?
- Colic is certainly a possibility… but, it is a diagnosis of exclusion!
- Colic also has some criteria… so not all crying is colic!
- 10-26% of infants experience colic
- Excessive crying for:
- >3 hrs per day,
- >3 days per week,
- >3 weeks in duration
- Can begin as early as 2nd week of life
- Peaks around 6th week of life
- Should resolve by 16th week of life.
Moral of the Morsel
- A thorough history and physical exam will be the best tool to help you determine the cause of the crying. [Freedman, 2009]
- Be diligent: pry open the mouth, look in the diaper area, exam each appendage (large and small).
- Don’t be in a hurry to diagnose colic!