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Should Your Child See a Doctor?

Crying Child 3 Months and Older – Irritability – Fussiness

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Definition

  • Excessive crying, irritability or fussiness
  • Child is too young to tell us or show us the cause for his crying
  • Crying from an illness or physical symptom should be triaged using that topic

Causes 

  • Not caused by hunger, since by this age parents can recognize hunger.
  • Main cause: coming down with an illness
  • Other common causes: overtired, stressed, whining, tantrums, separation anxiety. This guideline detects many infants with sleep problems.
  • Painful causes include earache, blocked nose from cold, sore throat, mouth ulcers, raw diaper rash, meatal ulcer on tip of penis, constipation. Teething generally doesn't cause crying.
  • Always consider pain as a possible cause of fussiness or crying that is persistent. Inconsolable crying may be the only symptom initially in a young child with ear infection or even appendicitis.

When to Call Your Doctor for Crying Child Over 3 Months of Age - Irritability - Fussiness

Call 911 If…

 
  • Your child is not moving or very weak
 

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • Stiff neck or bulging soft spot
  • Possible injury (especially head or bone injury)
  • Very irritable, screaming child for over 1 hour
  • You are afraid you or someone might hurt or shake your baby
  • Your child cannot be comforted after trying this advice for 2 hours
  • Crying interferes with sleeping for over 2 hours
 

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen
  • Pain (eg. earache) suspected as cause of crying
 

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
  • Mild, off-and-on fussiness (acts normal when not crying) continues over 2 days
  • Excessive crying is a chronic problem
 

Parent Care at Home If

  • Mild fussiness present less than 2 days and you don't think your child needs to be seen
 

Home Care Advice for Mild Consolable Crying

  1. Reassurance: Most infants/toddlers become somewhat irritable and fussy when sick or overtired. Crying tells us your child is not feeling well. If the crying responds to comforting, it's probably not serious.
  2. Comforting: Try to comfort your child by holding, rocking, massage, etc.
  3. Sleep: If your child is tired, put him to bed. If he needs to be held, hold him quietly in a horizontal position or lie next to him. Some overtired infants need to cry themselves to sleep.
  4. Undress Your Child: Sometimes part of the clothing is too tight or uncomfortable. Also check the skin for redness or swelling (e.g., insect bite).
  5. Discontinue Medicines: If your child is taking a cough or cold medicine, stop it. The crying should stop within 4 hours. Antihistamines (e.g., Benadryl) can cause screaming and irritability in some children. Pseudoephedrine (decongestant) can cause jitteriness and crying.
  6. Expected Course: Most fussiness with illnesses resolves when the illness does. Most fussiness due to stress or change (e.g., new day care) lasts less than 1 week.
  7. Call Your Doctor If:
    • Constant crying lasts over 2 hours
    • Intermittent crying lasts over 2 days
    • Your child becomes worse
     

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.


References

  1. Bolte R. The crying child. Contemp Pediatr. 2007; 24(5):74-81.
  2. Corwin MJ, Lester BM, Golub HL. The infant cry: What can it tell us? Curr Probl Pediatr. 1996;26:325-334.
  3. Poole SR. The infant with acute, unexplained, excessive crying. Pediatrics. 1991; 88:450-455.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 1/4/2010

Last Revised: 12/11/2009 3:01:11 PM

Copyright 1994-2010 Barton D. Schmitt, M.D.

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