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Crying babies

Crying babies. Katie Lazenby. 10,687 results for crying babies on Amazon. Introduction. Normal attachment behaviour Peaks 6-8 wks – 2.6 hrs crying/day Problematic in 20% babies “colic” - >3hrs/day, 3 days/wk, >3 wks. 5% organic cause Many caused by inability to self-soothe. History.

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Crying babies

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  1. Crying babies Katie Lazenby

  2. 10,687 results for crying babies on Amazon

  3. Introduction • Normal attachment behaviour • Peaks 6-8 wks – 2.6 hrs crying/day • Problematic in 20% babies “colic” - >3hrs/day, 3 days/wk, >3 wks. • 5% organic cause • Many caused by inability to self-soothe

  4. History • Parents’ views, experience, support • Crying patterns • Other Sx – blocked nose, vomiting, constipation, diarrhoea, eczema • Sleeping & feeding patterns • Family stress, maternal depression

  5. Examination • Head to toe, explaining to parents • Exclude potential cause discomfort eg. Nappy rash/eczema • Orifices – phimosis, anal fissure, oral thrush, otitis media • Plot weight growth chart

  6. Causes • Medical • GORD • Lactose intolerance • Cow/soya milk protein allergy • Non-medical • Tired • Hungry • Will not settle • Family psychosocial difficulties

  7. GORD • Increased prevalance preterm, GI obstruction, neurological problems eg. CP • Features – frequent vomiting shortly after feed, difficulty feeding, crying, failure to thrive, apnoeic episodes, wheeze/cough. • Mx • Upright posture post feed, tilt cot, avoid overfeeding • Food thickener • Infant Gaviscon • Hospital Rx – domperidone, ranitidine, omeprazole

  8. Lactose intolerance • Controversial theory • Low lactase levels – lactose build up - lactic acid • 1 wk trial lactase drops (Colief – can buy or Rx ACBS) • Use behaviour diary to monitor effect, if response continue to 3-6 months. • Low lactose feed not recommended

  9. Cow/soya milk allergy • 50% crossover with soya • Vomiting, diarrhoea (blood/mucus), poor weight gain, atopy, FHx. • Trial diet modification • Breastfed – mother avoid all dairy, caesin & whey. Use soya milk, take calcium supplement • Bottlefed – hydrolysed cow’s milk/soya milk (Nutramigen 1, Pregestimil, Pepti-junior) • 1 wk trial, behaviour diary

  10. Tired baby • Average sleep • Newborn - 16 hrs • 2-3 months – 14 hrs • Time before tiring • 6 wks – 1.5 hrs • 3 months – 2 hrs • Signs tiredness – frowning, clenching fists, jerking limbs • Sleep hygiene – consistent place, soothe without picking up, background white noise.

  11. Hungry baby • Frequet feeding, not settling post feed, poor weight gain • Mother may c/o poor milk supply – HV/breastfeeding counsellor advice • Top ups with formula in evening

  12. Will not settle • ?delayed neuromaturation – reduced ability to self soothe • Distractions • Carry in sling • Minimise separation • Walk in pram/push over uneven surface • Warm bath • White noise

  13. Psychosocial problems • Factors affecting baby’s behaviour/parent’s response to crying: • Infant-parent relationship • social and cultural beliefs of family • problems in pregnancy • Post natal depression (can aso be triggered by irritable baby)

  14. Management • Exclude medical cause • Reassurance • Explain normal crying and sleeping patterns • Behaviour diary • Follow up and ongoing support • Websites/helplines • HV • Assess for post natal depression

  15. Websites • CRY-SIS • Charity running telephone helpline and offering useful checklist • www.cry-sis.org.uk • Parentline • www.parentlineplus.org.uk • Home-Start UK • Volunteers providing home visiting scheme • www.home-start.org.uk

  16. Medication • Anticholinergics effective but not suitable due to S/Es. • Simethicone (Infacol) licensed for colic but no benefit over placebo in trials. 1 wk trial may be helpful. • Trials of diet modification - cow’s milk exclusion/lactase drops.

  17. When to refer • Paediatrics: • Parents not coping despite intervention • Suspected medical cause / uncertain diagnosis • Unable to wean off treatment after 6 months • Perinatal mental health service if concerns re severe postnatal depression

  18. AKT question A 3-month-old baby girl is brought to see you by her mother.She reports a 1 month constant crying, which is worse at night.She is bottle-fed and is feeding well. There is no vomiting.Her weight has remained steady on the 25th centile since birth.On examination, she has a well-circumscribed discoid red lesion approximately 8 mm diameter on the top of her thigh. There isan identical lesion on her lower back.

  19. Which is the SINGLE MOST appropriate initial management optionfor this patient? Select ONE option only. • A. Advice and reassuranceB. Refer to community paediatricianC. Refer to dermatologistD. Refer to health visitorE. Refer to social services

  20. Answer E. This describes a case of non-accidental injury (NAI)—thediscoid red lesions representing old cigarette burns. This wouldrequire an immediate referral to social services. This highlightsthe importance of considering the family and social situationwhen faced with a crying baby.

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