Crying Child Over 3 Months of Age - Irritability - Fussiness

Symptoms

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 (before 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

Should I Call?

WHEN TO CALL YOUR DOCTOR

Care at Home

HOME CARE ADVICE FOR MILD CONSOLABLE CRYING

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, its 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.
   • Pseudoephedrine (decongestant) can cause jitteriness and crying.
   • 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 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.

Tips for Responding to Temper 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.

Tips for Treating the Sleep Problem:

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