Flashcards in Irritable infant Deck (28):
DDX for irritable infant
Normal crying for age - hunger, physical discomfit, tiredness
Cow's milk protein intolerance
Infection eg meningitis
Injury e.g. non accidental
Other source of pain
Acute onset *: UTI, otitis media, raiseICP, Hair tourniquet of fingers or toes, Corneal FB/Abrsion, Incarcerated inguinal hernia.
Red flags in an irritable infant that suggest a severe cause instead of colic
Less responsive socially
Poor wt gain
maternal and family psychosocial state (Shaken baby syndrome)
Things to ask about in an irritable infant
change in behaviour or
Other symptoms that suggest serious disease - vomiting, lethargy, poor Wt gain.
Don't forget to examine testicular torsion or incarcerated inguinal hernia
What is a abnormal amount of time for a baby to cry
>3hr/day for >3day/week.
Clinical characteristics of a colic baby
crying develops in the early weeks of life and peaks around 6-8 weeks of age
usually worse in late afternoon or evening but may occur at any time
may last several hours
infant may draw up legs as if in pain, but there is no evidence that colic is attributable to an intestinal problem or wind
usually improves by 3 - 4 months of age
what would support excessive tiredness as a cause of crying baby
If baby was getting 1.5hrs at a time and 3m old >2hrs awake.
What suggests hunger as a cause
this is more likely if a mother reports her baby has frequent feeds (i.e. less than 3 hrly), poor wt gain and inadequate milk supply
What suggest Cow milk or soy protein allergy as cause
Delayed non-IgE mediated reactions.
suspect if there is vomiting, blood or mucus in diarrhoea, poor weight gain,
family history in first degree relative or signs of atopy (eczema / wheezing), significant feeding problems (especially worsening with time)
Dx is made by tx for 2 wks
Mx of cow milk or soy protein allergy
eliminating cow milk by modifying the mother's diet or changing to an extensively hydrolysed formula for a period of 2 weeks
What suggest gastro-oesophageal reflux as a cause
>4 times per day vomiting
or if baby has feeding difficulties.
Not necessary associated with crying baby
May be secondary to cowlick/soy intolerance.
Tx not shown to affect crying.
Tx of Gastro-oesophageal reflux
Mx of irritable infant
failure to thrive
Yes - consider cow milk allergy/Reflux and trail cow milk free formula or maternal diet.
No - medical cause unlikely. Think tired, hungry, unable to self soothe. Discuss normal sleep and crying, discuss settling techniques, maximise parental support and arrange follow up.
DDX for acute onset of irritability infant
Raised intracranial pressure
Hair tourniquet of fingers/toes
Corneal foreign body/abrasion
Incarcerated inguinal hernia
Ix for acute onset irritability
Urine MCS (if acute and vomiting)
Fluorescein staining of eyes if hx suggestive
Mx of crying baby when excluded medical causes
- Engage partnership with parents
- Explain normal crying and sleep patterns, signs of tiredness
- Assist parents to help their baby deal with discomfort and distress.eat settling, sleep. avoid stimulation, baby massage, dental music,
- Assess maternal and emotional state and mother baby relationship (PND)
- Provide information sheets.
Followup and refer.
MX of infantile colic
Education for mother
Resolves after 3 months
No long term complications
Avoid overfeeding, wind carefully, rhythmical rocking or carrying can help.
Recommend social support for mum in the mean time.
Symptoms and signs of intussusception
+/- legs drawn up
Vomiting - bile stained is late
Red currant jelly stool
Usually 3-24 months old
may have a viral infection prior
Sausage shape mass in abdominal in RUQ
Ix and findings for intussusception
AXR - rounded edge of the intussusception against the gas filled lumen of distal bowel with signs of proximal bowel obstruction
USS - doughnut sign - presence of bowel in bowel
Blood group and hold
Mx of intussusception
Resus if needed 20ml/kg NS
Nil by mouth
+/- NGT and ABX
Air or barium enema
If fail then laparotomy
Symptoms and signs of strangulated inguinal hernia
Common in preterm infants
HX of intermittent inguinoscrotal bulge with associated irritability.
Often increase in size when the child is crying
Swelling extends up into the groin, does not transilluminate
Tesis is palpable, distinct from the swelling
Mx of strangulated inguinal hernia
Symptoms and signs of testicular torsion
Tender swollen scrotum
Occurs in pubertal boys
Discolouration of scrotum
Cremasteric reflex absent
Mx of testicular torsion
Surgical emergencies (8-12hr)
Keep child fasted
Group and hold
Signs of non accidental Injury
Hidden head injuries
explanation of injury is unconvincing
Delay in obtaining medical advice
Multiple injuries sustained at different times
Bruise except on toddlers leg. look at shape and colour
Burns and scalds - e.g. symmetrical without splash marks or cigarette burn e.g. deep circular ulcers
Retinal haemorrhages eg shaken body
Signs of neglect
Signs of non accidental injury
child is wary or over affectionate towards examiner
Fail to thrive
Signs of sexual abuse
Genital examination - bruises tears or nothing at all.
Signs of physical neglect
Unkempt dirty appearance
uncared for nappy rash
Failure to thrive