Inconsolable Crying in Infants: Differential Diagnosis in the Pediatric Emergency Department

The document from 2018 examines the causes of inconsolable crying in infants, particularly in the emergency department setting. It notes that while crying is common in infants, with a peak at 6 to 8 weeks, excessive crying accounts for 20% of pediatric consultations for infants up to 3 months old, with only 5% having an organic cause. Urinary tract infections are the most common organic cause. The document lists various conditions that can cause inconsolable crying, including Hair Tourniquet Syndrome, Diaper Dermatitis, and more serious conditions like Intussusception and meningitis. It also discusses the lack of correlation between gastroesophageal reflux and crying, and the ineffectiveness of proton pump inhibitors in reducing crying. The importance of a thorough medical history and physical examination is emphasized, with urinalysis recommended for febrile infants. If no organic cause is found and crying persists, infantile colic may be considered. The document concludes that a detailed history and examination are usually enough to diagnose the cause of crying, and further tests are not recommended unless the infant is febrile, in which case urinalysis should be performed.