Skip to Main Content

Probability diagnosis


Infantile ‘colic’


Viral URTI/illness

Otitis media


Serious disorders not to be missed


  • Cardiac failure


  • Meningitis/encephalitis

  • Gastroenteritis

  • Other systemic infection


  • Gastro-oesophageal reflux/oesophagitis

  • Injury esp. non-accidental, birthing

Pitfalls (often missed)

Severe nappy rash


Cow’s milk intolerance

Lactose intolerance

Balanitis (males)


  • Bowel obstruction/pyloric stenosis

  • Intussusception

  • Other congenital e.g. oesophageal atresia

Masquerades checklist

Urinary tract infection

Is the patient trying to tell me something?

?hunger ?soiled napkin ?tiredness ?family dysfunction ?inattention

Key history

Obtain detailed account from parents of the crying pattern and duration, as well as the circumstances of discomfort incl. feeding, time relationship to feeds and associations, particularly vomiting or possetting, presumed abdominal discomfort, constipation, bowel actions and fever. Establish if breastfeeding or providing other milk and food. Ask about recent immunisation.

Key examination

  • General features: appearance of the child, growth parameters and vital signs

  • Abdominal examination esp. inspection, palpation and auscultation

  • Examine skin looking for evidence of eczema and napkin rash

  • Examine the ears, fontanelles

  • Also assess the child’s temperament and coping abilities

Key investigations

Nil for most cases


  • urinalysis

  • MCU

  • FBE


  • stool analysis

  • referral for upper GIT investigation

Diagnostic tips

The normal pattern is for crying to start increasing around 2 weeks of age, to peak around 2 months and then settle down 3–4 months of age.

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.