CRYING

One definition = unexplained paroxysmal bouts of fussing &/or crying > 3h/d x 3 or more days/wk x > 3 weeks

Causes of acute crying in one series of 59 afebrile infants (Pediatrics 88:450, 1991):

Diagnoses to keep in mind in the fussy infant/neonate:

• Thrush
• Constipation
• Corneal abrasions
• Toxins
• Occult foreign bodies
• Other GI disease (GERD; intussusception, appendicitis)--Note that Omeprazole was not ass'd with any difference in fussing behavior compared with placebo in a 4wk randomized trial in 30 irritable infants 3-12mo with GERD (J. Pesd 143:219, 2003--JW)
• Metabolic disease
• Glaucoma
• High-pitched cry is considered a potential sign of CNS disease
• Tremulousness or agitation suggests drug intoxication

Treatments found to be effective in randomized trials (Pediatrics 106:184, 2000--AFP)

• "Hypoallergenic" diet (no milk, eggs, wheat, or nut products) in breastfeeding women
• "Hypoallergenic" or soy-based formulae
• An herbal tea with chamomile, vervain, licorice, fennel, and balm-mint
• Oral sucrose
• Instructions to parents to reduce stimulation

Treatments not found to be effective in randomized trials:

• Simethicone
• Scopolamine
• Supplemental lactase
• Fiber-rich formula
• Car-ride simulator

Probiotics for colic/crying

• In a non-blinded trial in 83 breast-fed infants with colic (> 3h/d of crying > 3d/wk) randomized to Lactobacillus reuteri 5 gtt QD 30min after feeding vs. simethicone 30mg BID after feeding) x 28d, at 28d the Lactobacillus recipients were sig. more likely to have a reduction from baseline to < 3h/d (95% vs. 7%). Peds. 119:e124, 2007--JW)
• In a study in 46 healthY breast-fed infants 2-16wks old with crying > 180 min/day (median 300min) randomized to Lactobacillus reuteri 5 drops (freeze-dried suspension in oil) QD before morning feeding vs. placebo x 21d; At 21d, the active-tx recipients had sig. lower incidence of continuing to cry > 180min/day (16% VS. 57%) (Peds 126:e526, 2010-JW)