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Flashcards in Irritable infant Deck (28):
1

DDX for irritable infant

Normal crying for age - hunger, physical discomfit, tiredness
Cow's milk protein intolerance
Gastro-Oesophageal reflux
Infection eg meningitis
Intussusception
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.

2

Red flags in an irritable infant that suggest a severe cause instead of colic

Fever
lethargy
Poor feeding
Less responsive socially
Poor wt gain
Sudden onset
maternal and family psychosocial state (Shaken baby syndrome)

3

Things to ask about in an irritable infant

feeding
temperature
change in behaviour or
social responsiveness
Other symptoms that suggest serious disease - vomiting, lethargy, poor Wt gain.
Don't forget to examine testicular torsion or incarcerated inguinal hernia

4

What is a abnormal amount of time for a baby to cry

>3hr/day for >3day/week.

5

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

6

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.

7

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

8

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

9

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

10

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.

11

Tx of Gastro-oesophageal reflux

Ranitidine
Omeprazole

12

Mx of irritable infant

Is there
Vomiting
diarrhoea
eczema
failure to thrive
feeding difficulties
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.

13

DDX for acute onset of irritability infant

UTI
Otitis media
Raised intracranial pressure
Hair tourniquet of fingers/toes
Corneal foreign body/abrasion
Incarcerated inguinal hernia

14

Ix for acute onset irritability

Urine MCS (if acute and vomiting)
Fluorescein staining of eyes if hx suggestive

15

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.

16

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.

17

Symptoms and signs of intussusception

Intermittent screaming/colic
+/- legs drawn up
Shock/pallor
Vomiting - bile stained is late
Red currant jelly stool
Diarrhoea
Usually 3-24 months old
may have a viral infection prior
Sausage shape mass in abdominal in RUQ

18

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

19

Mx of intussusception

IV access
Resus if needed 20ml/kg NS
Analgesia
Nil by mouth
+/- NGT and ABX
Air or barium enema
If fail then laparotomy

20

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
Painful
Swelling extends up into the groin, does not transilluminate
Tesis is palpable, distinct from the swelling
Firm
Irreducible

21

Mx of strangulated inguinal hernia

Surgical emergency
IV access

22

Symptoms and signs of testicular torsion

Sudden onset
Tender swollen scrotum
Intense pain
~Nausea
Occurs in pubertal boys
Discolouration of scrotum
very tender
Swollen
Riding high
Cremasteric reflex absent

23

Mx of testicular torsion

Surgical emergencies (8-12hr)
Keep child fasted
Group and hold

24

Signs of non accidental Injury

Bites
Hidden head injuries
Suspicious fracture
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

25

Signs of neglect

Signs of non accidental injury
child is wary or over affectionate towards examiner
Fail to thrive

26

Signs of sexual abuse

Genital examination - bruises tears or nothing at all.
Pregnancy
STI

27

Signs of physical neglect

Unkempt dirty appearance
sores
uncared for nappy rash
Failure to thrive

28

Signs of emotional abuse

Frozen, watchful appearance
Expressionless face, wary eyes
Abnormally affectionate to strangers