Crying and fussing

normal crying times:

• 2wk = 2hrs/day

• 6wk = 3hrs/day

• 12wk = 1hr/day

• common problem first 3mo

• normal physiological aspect of a maturing CNS

• excessive if lasts for long periods when baby should be sleeping or playing

• usually at 6-9pm

• common cuases

  • hynger

    • underfeeding = manin feeding problem

  • wet or soiled nappy

  • loneliness

  • infant colic (2-16wks)

  • individual temperament

  • teething (usually a problem after 12mo

  • reflux oesophagitis

Management

• careful examination

• reassurnace

• avoid overstimulation

• the 5s

  • swaddling

  • side/stomach

  • shush (as loudly as hcild)

  • swing

  • suckling

Infantile colic

• regular unexplained periods of inconsolable crying

• baby 2-16wk old

  • especially at 10wks

• prolonged crying - at least 3hrs

• crying during late afternoons early evening

• fleses legs and clenches fists

  • “stomach ache”

Exclude;

• cow’s milk intolerance

• lactose intolerance

• GORD

• pain from:

  • otitis media

  • UTI

  • bowel obstruction

  • other causes

management

• reassurance and explanation to parents

• pacifying methods

  • use genlesness

  • avoid quick movements

  • make sure not hungry

  • make sure burped and give posture feeidng

  • don’t worry about leaving crying child for 10mins or so after 15mins of trying consolaiton

• consider simethicone preparations

  • try and avoid medications

Teething

• cute first teeth from age 6mo until 2-3yrs

• fum slighlty swollen and red

• often little discomfort but can be very painful

• clinging/fretful/dribbling more than usual

• chews

• irritable

• doesn’t cause fever

• pitted darkj teeth

  • breastfed for long periods (3yrs)

  • pitting of front surgfce of teeth

  • won’t go away

  • adult teeth will be normal

Snuffling infant

• 1/3 mornal babies

• few weeks after birth

• not a problem unless affects feeding

• paracetamol

• nasal toilet

  • 1 teaspoon salt dissolved in boiled water

    • cotton bud

  • saline nose drops

  • stronger deconfestant not advised

Blocked nasolacrimal duct

• 20% develop watery eyes

  • resovle by 12mo (most)

• excessive eye watering

  • narrowing nasolacrimal ducts

• obvious 3-12wks

• mucous and muopus may appear in tears

• discharge worse on waking

• most improve spont

• @ 6mo consider treatment

  • massage drainage ducts several times daily

    • firmly placing tip of little finger over inside corner of eye and stroking downward to tip of nose

• minor infection treated with warm cottonwool soks

• more severe blockage 12mo

  • ducts probed/dilated under light anaesthesai

• artificial duct may beed to be created rarely