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Crying Child Over 3 Months of Age - Irritability - Fussiness

Definition

  • Excessive crying, irritability or fussiness
  • Child is too young to tell us or show us the cause for his crying
  • Crying is the only symptom
  • Crying from an illness or physical symptom should be triaged using that topic

Causes

  • Main cause: coming down with an illness. Young children cry about being sick, even if they don't have any pain.
  • Physical pain: Painful causes include earache, sore throat, mouth ulcers, raw diaper rash, meatal ulcer on tip of penis, constipation.
  • Behavioral causes: overtired, stressed, whining, tantrums, separation anxiety. This topic detects many infants with sleep problems. Crying also occurs during sleep habit re-training programs. Some preverbal children (beofre 2 years) cry for everything.
  • Teething: Teething generally doesn't cause crying.
  • Gas: Gas in the intestines does not cause crying.
  • Hunger: Not caused by hunger, since by this age you can recognize hunger.
  • Decongestants (pseudoephedrine or phenylephrine) also can cause jitteriness and crying in some children. (Note: FDA does not recommend cough and cold medicines for children under 4 years.)

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
  • Immunization(s) within the last 4 days, see IMMUNIZATION REACTIONS

 

Disclaimer: This information is not intended to 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. For more information, click here.

Author and Senior Reviewer: Barton D. Schmitt, M.D. Clinical content review provided by Senior Reviewer and Healthpoint Medical Network.
Last Review Date: 6/1/2011
Last Revised: 8/1/2011 2:55:50 PM
Content Set: Pediatric HouseCalls Symptom Checker
Version Year: 2012
Copyright 1994-2012 Barton D. Schmitt, M.D.

When To Call

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
  • Won't move one arm of leg normally
  • Cries every times if touched or moved
  • 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
  • Crying continuously (cannot be comforted) for more than 2 hours
  • Refuses to drink or drinking very little for more than 8 hours
  • You think your child needs to be seen urgently

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen, but not urgently
  • Pain (eg. earache) suspected as cause of crying
  • Crying intermittenly (can be comforted) BUT child not acting normally when not 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 of unknown cause present less than 2 days and you don't think your child needs to be seen
  • Normal protest crying
  • Temper tantrum crying
  • Sleep problem crying

 

Disclaimer: This information is not intended to 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. For more information, click here.

Author and Senior Reviewer: Barton D. Schmitt, M.D. Clinical content review provided by Senior Reviewer and Healthpoint Medical Network.
Last Review Date: 6/1/2011
Last Revised: 8/1/2011 2:55:50 PM
Content Set: Pediatric HouseCalls Symptom Checker
Version Year: 2012
Copyright 1994-2012 Barton D. Schmitt, M.D.

Care Advice

Mild Fussiness of Unknown Cause

  1. Reassurance: 
    • Your child is crying and fussing more than usual, but acting normal when not crying.
    • He could be coming down with an illness and that will usually become clear in a day or so.
    • He could be reacting to some changes in your home or child care setting. See if you can come up with some ideas.
    • Children can also temporarily go through a "clingy phase" without an explanation.
    • If the crying responds to comforting, it's 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.
    • The FDA does not approve any of these medicines for children under 4 years old.
  6. Expected Course: Most fussiness with illnesses resolves when the illness does. Most fussiness due to family stress or change (e.g., new child 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

Normal Protest Crying

  1. Reassurance:
    • Normal children cry when they don't get their way.
    • Normal children cry when you make changes in their routines.
    • Crying is their only form of communication in the first years of life.
    • Crying can mean, "I don't want to".
    • This is called normal protest crying and is not harmful.
    • Do not assume that crying means pain.

Temper Tantrum Crying

  1. Reassurance:
    • Crying is the most common symptom of a temper tantrum.
    • This is likely the cause if most of the crying occurs when your child is angry, upset or trying to get his way.
    • All kids have some temper tantrums, starting at about 9 months of age.
  2. Tips for Responding to Temper Tantrums:
    • Ignore most tantrums (e.g., demanding something the child doesn't need).
    • For tantrums from frustration (e.g., when something doesn't work), help your child.
    • For aggressive (hitting) or destructive (throwing) tantrums, put in timeout until your child calms down.
    • Don't give in to tantrums. No means No.
    • Be a good role model. Avoid yelling or screaming at others (adult tantrums).

Sleep Problem Crying

  1. Reassurance:
    • Your child may have a sleep problem if most of your child's crying occurs when you put him in his crib (or bed) and at night. Suspect a sleep problem if your child acts normal during the day.
    • Sleep problems are common in childhood.
  2. Tips for Treating the Sleep Problem:
    • Re-train your child to be a good sleeper at bedtime and naptime.
    • Place your child in the crib "drowsy but awake".
    • Once placed in the crib, don't take out again.
    • Visit your child as often as needed until asleep.
    • For night awakenings, however, it's fine to hold your child.
    • Do all of this in a loving way with a calm voice.
    • Never feed until asleep.
    • Never sleep in the same bed with your child.

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.  

To find a pediatrician, click here.

 

Disclaimer: This information is not intended to 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. For more information, click here.

Author and Senior Reviewer: Barton D. Schmitt, M.D. Clinical content review provided by Senior Reviewer and Healthpoint Medical Network.
Last Review Date: 6/1/2011
Last Revised: 8/1/2011 2:55:50 PM
Content Set: Pediatric HouseCalls Symptom Checker
Version Year: 2012
Copyright 1994-2012 Barton D. Schmitt, M.D.

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