Acute, Unexplained, Excessive Crying


There are benign to life-threatening causes of prolonged crying in infants. True inconsolability represents a serious condition in most infants and require investigation for injury (accidental or inflicted), infection, SVT, corneal abrasion, hair tourniquet, hernia or testicular torsion, or abdominal emergency.
If after a through ED evaluation, a cause for excessive crying has not been identified & child continues to be inconsolable, admission to hospital is warranted.
 
Conditions Associated with Uncontrollable Crying, Irritability, and/or Lethargy in Neonates
System Emergent Nonemergent
Central nervous system Intracranial hemorrhage (neonatal alloimmune thrombocytopenia, birth trauma, vitamin K deficiency)
Meningitis*  
Elevated intracranial pressure  
Eye, ear, nose, throat Nasal obstruction (choanal atresia or stenosis) Corneal abrasion, ocular foreign body
  Otitis media
  Nasal congestion (upper respiratory infection)
  Oral thrush
  Stomatitis
Pulmonary Pneumonia
Cardiac Supraventricular tachycardia
Heart failure  
GI Malrotation/Volvulus Gastroesophageal reflux disease (reflux)
Intussusception
Incarcerated hernia Gastroenteritis
  Anal fissure
  Intestinal Colic
GU Testicular torsion Urinary tract infection
Penile hair tourniquets Diaper rash
Paraphimosis  
Musculoskeletal Hair tourniquet of finger/toe Injuries (diaper pin, sharp or irritating objects from clothing)
Nonaccidental trauma
Infectious Sepsis* Upper respiratory infection
Pneumonia  
Meningitis*  
Metabolic Inborn errors of metabolism
Hypoglycemia  
Congenital adrenal hyperplasia