As promised, my friend Jordyn Redwood, ER nurse and writer extraordinaire is going to be posting common medical Q & A’s on my blog twice every month. I’m superexcited about this and think it will not only be a ton of fun but it will also be really informative. So, a huge thank you to Jordyn! And, if you want to know more about her, Jordyn is not only a novelist with a book coming out from Kregel in a few months, but she’s also a blogger who writes a superfun blog called “Redwood’s Medical Edge” where she discusses now novelists approach medical issues in their books. Check it out here.
Management of Infant Crying
There is nothing that will bring a weary family into the ER faster than an infant who won’t stop crying. This is a leading cause of ER visits for the infant population.
Our approach starts with a good physical exam looking for a source of something that would cause the infant pain. Is there an ear infection? Is there a hair tourniquet? Did they accidentally scratch their eye? Are they dry and fed?
A hair tourniquet happens when a piece of hair becomes wrapped around a baby’s fingers, toes or penis in the case of boys. They are usually easy to identify because the area distal to the constriction becomes purple from lack of blood flow. Imagine when you wrap a string too tightly around the tip of your finger.
If a hair tourniquet is found and we can see the piece of hair, first we’ll try to unwrap it. If it isn’t embedded into the skin, we may try a hair removal product to disintegrate it. If the hair is deeply embedded, the child may require surgical removal.
A corneal abrasion is a scratch to the eyeball and is quite painful. To look for these in a child, we’ll stain their eyeball with a dye and look at it with a Wood’s lamp in a darkened room. If one is present, generally the child is sent home with an antibiotic ointment for the eye for several days.
If a source of the infant’s pain cannot be found, we’ll generally try soothing measures like oral pain medication to see if that will calm the infant.
If the child continues to cry, a source of infection cannot be found and the baby is also resistant to soothing measures, then the physician may choose to proceed with a spinal tap and additional septic work-up. One reason for an inconsolable infant is meningitis.
If a septic work-up is negative, the infant may be said to have colic. I’m going to do a special post about this crying pattern.
Were you aware of other sources for pain in the infant like a hair tourniquet or corneal abrasion?
What is Colic?
I remember being a nurse in the pediatric ICU and floating to the neonatal ICU. This is an alien environment to the pediatric ICU nurse. The babies are small. Some are in little glass houses called isolettes.
Then, there were these sugar packets on most warmers just like those you would find in a coffee shop. Whenever a baby would cry, a NICU nurse would place a pacifier into the sugar granules and then plop the pacifier into the baby’s mouth. I remember thinking… no wonder these infants are crying all the time— they’re crashing off sugar!
But in reality, these NICU nurses were ahead of their time—as nurses usually are.
A leading reason infants are seen in the ER is for a complaint of crying. See my earlier post on Management of Infant Crying for initial treatment strategies.
If no source for the infant’s crying can be found then they may be said to have colic. Colic is a pattern of infant crying that fits Wessel’s criteria of crying more than three hours a day for more than three days a week for more than three weeks.
If you’re interested at all in infant crying you need to look into the work of Dr. Ronald Barr. He’s a Canadian pediatrician that has done a lot of research in infant crying. One of his studies looked to see if there was a cross-cultural difference in infant crying. To do this, he looked at two cultural extremes: an African tribe and the way we raise babies here in the west.
In the Kungsan African tribe, infants usually co-sleep with parents (not recommended in the US), are constantly carried, are continuously fed (infant has immediate access to the breast), and they pick up a crying baby in less than 10 seconds. Their lives are relatively calm.
In the West, we sleep our infants in cribs, give them solitary time, pulse feed (feeding on a schedule), and give our babies lots of stimulation. Any hands up for Baby Einstein videos? And, generally, we allow are babies to cry longer before we check on them.
These are merely differences between the two. What Dr. Barr found is that despite these cultural differences, babies generally had the same crying pattern. This pattern showed that the crying starts at two weeks, peaks sometime at the second month and begins to decrease after four-five months.
What he found is the infants who are “colicky” are likely 95th percentile criers. Just like when your child gets their height and weight measured at the doctor’s office. Infant crying can viewed in terms like this as well. This crying pattern is normal infant behavior and not a disease.
What about a cause of crying like cow’s milk intolerance or reflux? These can be causes for crying in infants. However, this represents only about 5% of cases. Was that a lot lower than you thought?
What Dr. Barr also found was that giving sucrose (sugar) seemed to soothe this crying pattern in some infants. So, those crafty NICU nurses had caught onto this. Now, there are special formulations of sugar that we give to help ease infant’s crying or give for pain during painful procedures.
What did you think the cause of colic was?
Jordyn Redwood has served the pediatric population and their families for many years. She has five years of experience in the pediatric ICU and ten years of pediatric ER nursing which is the area she currently works. Jordyn also teaches CPR and advanced resuscitation courses.
Jordyn is also a suspense author. Her novel, Lilly’s Ashes, will be published by Kregel in the Spring of 2012. She also hosts a medical blog for authors which you can find at www.jordynredwood.com.
Disclaimer: Remember, these posts are for education and discussion. If your child is sick and you think they require medical attention, take them to their pediatrician or local emergency department.