Approach to a crying infant
A) History: Description of the pattern and type of cry will detect a fussy infant.

• High pitched incessant cry may indicate cerebral irritation ( meningitis)

• Shrieking cry with pulling at the ears may indicate Acute Otitis Media.

• Persistent crying with irritability and grunting may indicate respiratory distress (ALRI)

• Intermittent bouts of crying associated with pallor, with the knees drawn up over the abdomen and extension of the great toe may indicate early intussusception.

• History of recent immunization especially DPT

• History of an elder sibling ( injuries inflicted due to sibling rivalry)

B) Physical examination: It requires special skill to examine a crying child. Keen observation of the child for a few minutes will enable us to locate any acute illnesses. Examination

should include looking for any insect bite marks, feeling the anterior fontanelle, otoscopic examination, rapid review of the respiratory, cardiac systems, neurologic examination (for meningeal signs), per abdominal examination (for Masses, distention

due to over feeding ) and per rectal examination.
C) Management: Whenever there is an identifiable cause the management is directed towards it, if necessary a referral may be required if acute illness as mentioned above is detected or suspected.