Crying Child Over 3 Months of Age - Irritability - Fussiness

Pediatric HouseCalls Online

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.

See More Appropriate Topic (instead of this one) If

• FEVER or any symptom of illness(e.g., diarrhea or constipation), see that topic.
• Crying from an injury, see specific INJURY topic.

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WHEN TO CALL YOUR DOCTOR

Call 911 Now (your child may need an ambulance) If

• 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 9am and 4pm) 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.

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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 "Call Your Doctor" symptoms.

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Disclaimer: This information is not intended 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: 1/19/2009

Last Revised: 6/12/2008

Content Set: Pediatric HouseCalls Online

Copyright 1994-2009 Barton D. Schmitt, M.D.