Irritable baby Flashcards Preview

MD 3: Paeds > Irritable baby > Flashcards

Flashcards in Irritable baby Deck (13):

Important features on history for presentation of irritable/unsettled baby

Antenatal and birth history

Time course of issue - gradual vs. acute - exclude serious infection, organic cause

Crying - duration, frequency, pattern, day vs. night, what they do to manage

Sleep hx - number of hours, pattern

Feeding - what, how long BF, how much and frequency, solids (timing of introduction, what), behavioural issues with feeding/eating, irritable after feeds or settles with feeds, any problems with feeding/BF

Bowels - frequency of stools, mucus, blood, frothiness, greasiness, smell, pale, consistency, relationship to feeds/eating, ulceration around anus

Vomiting - nature of vomit - bile, blood, milk. Relationship to meals, seems well or irritable between, still hungry

Urine - any issues? decreased wet nappies

Weight, growth & development

Hx eczema, rash, allergies/atopy


FHx - atopy, coeliac, IBD

- mood
- supports
- shaking the baby


DDx for irritable baby

If acute/change from previously settled baby - exclude serious cause - infection, surgical abdo etc

Normal behaviour
- Parent's with unrealistic expectations, limited knowledge, MH issues

Chronic organic
- Reflux
- Cow's milk protein allergy
- Lactose overload/malabsorption
- Coeliac disease


Management strategies for irritable baby who is clinically well

1. Reassurance
2. Parental education
- Normal crying
- Normal bowels, vomiting
- Normal sleeping
3. Behavioural strategies
- Controlled crying
- Camp out method
4. Screen and monitor maternal/parental MH


Definition of colic

Crying for >3 hours, >3 days a week, >3 months with no medical cause

90% inconsolable crying has no medical cause


What Ix can be considered if clinically indicated?

Urine MCS - exclude UTI as cause

Stool sample - reducing sugars or pH<5 suggestive of lactose overload/malabsorption

Coeliac disease screen - Anti-tTG (Tissue transglutimase antibody), follow up with gastroscopy + biopsy


What are the clinical features of reflux in an infant?

Regular vomiting after feeds (>4/day)
Issues with feeding - back swallowing, coughing/choking, food refusal
Generally doesn't affect weight/growth but if severe can be a cause of FTT
Can be associated with respiratory symptoms (aspiration) - cough, wheeze, apnoeas

Typically starts 1-2 weeks after milk comes in if breast feeding


What are Rx options for likely GORD in an infant?

-Exclude other causes of vomiting - infection (esp. UTI), vomiting
-Generally no investigations
-Reassure it is a benign and self-limiting condition
-Milk thickeners (add to formula or expressed breast milk)
-Advise smaller, regular feeds
-Prone positioning after feeds if being closely monitored and baby is awake
-consider trial of hydrolysed formula
-PPIs and H2-antagonists can be used


What are the clinical features of cow's/soy milk protein allergy?

Two chronic types - proctolitis, enteropathy
Non-IgE (delayed) food mediated allergy

Enteropathy - chronic diarrhoea, vomiting ++, irritability and FTT. Typically only formula (not BF infants)

Proctolitis - blood in stools, generally well with no weight gain, can occur in BF and formula fed infants

Typically resolves after 18-24 months


What are the Rx options for cow's/soy milk protein allergy?

Trial hydrolysed formula - improvement in symptoms confirms likely diagnosis

If BF - elimination diet for mother


What are the clinical features of lactose overload/malabsorption?

Frothy, watery diarrhoea
Excoriation/ulceration of perianal area
Food refusal

Rare - may be functional (overload due to foremilk ++) or secondary due to infection/mucosal injury from milk protein allergy


What are management options for lactose overload/malabsorption?

-Diagnosis confirmed with stool sample (reducing sugars, pH<5) and response to feed changes
-If breast feeding - block feed to decrease foremilk consumption (has the most lactose)
-If formula trial lactose-free formula


How can you describe normal infant crying to a parent?


- Peak of crying - usually settled in hospital and first 1-2 weeks, then from 2 weeks - 3/4m will become increasingly unsettled with peak at 6-8w
-Unexpected - may be no reason for crying, start/stop suddenly
-Resist soothing - may be unconsolable
-Pain like expression - may look like they're in pain but generally they're not
-Long lasting - average, low and high criers - on average cry ~3hrs/day and can cry up to 5-6hr/day
-Evening - tends to be worse in the afternoon/evening


What are normal feeding and bowel habits to explain to parents?

- Normal to wake for feeds ~2-3 hours
- Normal to have small vomits (posits) after feeds - usually not painful or resulting in weight loss

- Normally 16-17 hours/day - 7 during day, 9 overnight
-Have light and deep cycles - may open eyes, jerk etc - need to settle back to sleep
-Self-soothing/settling is a learned skill
-Structure, routine, predictability of cues and settling techniques are important in child learning to self-sooth