Management of Infant Crying

This week, I'm highlighting some blog posts that I did for Erin MacPherson's Christian Mama's Guide last year. Some of you may not know but I am a real live pediatric ER RN. As always, these posts are meant to be educational and do not replace a doctor's visit if your child is ill.

Erin has a WICKED sense of humor and is releasing a series of books this spring so I hope you'll keep an eye out for them.

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.

Were you aware of other sources for pain in the infant like a hair tourniquet or corneal abrasion?