Published online March 2, 2009
PEDIATRICS Vol. 123 No. 3 March 2009, pp. 841-848 (doi:10.1542/peds.2008-0113)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Freedman, S. B.
Right arrow Articles by Thull-Freedman, J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Freedman, S. B.
Right arrow Articles by Thull-Freedman, J.
Related Collections
Right arrow Office Practice
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

ARTICLE

The Crying Infant: Diagnostic Testing and Frequency of Serious Underlying Disease

Stephen B. Freedman, MDCM, MSc, FRCPC, Nesrin Al-Harthy, MD and Jennifer Thull-Freedman, MD, MSc

Division of Pediatric Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

OBJECTIVE. To determine the proportion of children evaluated in an emergency department because of crying who have a serious underlying etiology. Secondary outcomes included the individual contributions of history, physical examination, and laboratory investigations in determining a diagnosis.

PATIENTS AND METHODS. We performed a retrospective review of all afebrile patients <1 year of age who presented with a chief complaint of crying, irritability, screaming, colic, or fussiness. All children with a serious underlying illness were identified by using a priori defined criteria. Chart review was conducted to determine if history, physical examination, or investigation data contributed to establishing the child's diagnosis.

RESULTS. Enrollment criteria were met by 237 patients, representing 0.6% of all visits. A total of 12 (5.1%) children had serious underlying etiologies with urinary tract infections being most prevalent (n = 3). Two (16.7%) of the serious diagnoses were only made on revisit. Of the 574 tests performed, 81 (14.1%) were positive. However, only 8 (1.4%) diagnoses were assigned on the basis of a positive investigation. History and/or examination suggested an etiology in 66.3% of cases. Unwell appearance was associated with serious etiologies. In only 2 (0.8%) children did investigations in the absence of a suggestive clinical picture contribute to the diagnosis. Both of these children were <4 months of age and had urinary tract infections. Among children <1 month of age, the positive rate of urine cultures performed was 10%. Ocular fluorescein staining and rectal examination with occult blood testing were performed infrequently, and results were negative in all cases. Successful follow-up was completed with 60% of caregivers, and no missed diagnoses were found.

CONCLUSIONS. History and physical examination remains the cornerstone of the evaluation of the crying infant and should drive investigation selection. Afebrile infants in the first few months of life should undergo urine evaluation. Other investigations should be performed on the basis of clinical findings.

Key Words: crying • emergencies • diagnosis

Abbreviations: ED—emergency department

Accepted Jul 2, 2008.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 JWatch PediatricsHome page
The Crying Baby: What to Do?
Journal Watch Pediatrics and Adolescent Medicine, April 15, 2009; 2009(415): 4 - 4.
[Full Text]

eLetters:

Read all eLetters

Child Abuse is also an Important and Serious Cause of Crying in Infants
Rachel P. Berger, et al.
Pediatrics Online, 16 Mar 2009 [Full text]
Urine Evaluation in Crying, Afebrile Infants: Does the Study's Data Support This Recommendation?
Carmina Erdei Grozavescu, et al.
Pediatrics Online, 20 Aug 2009 [Full text]