Children are not simply micro-adults, but have their own specific problems.
BELA SCHICK (1877–1967)
The family doctor usually treats children for common minor complaints such as non-serious viral respiratory infections and minor skin problems, offering parental advice and reassurance. Many of these everyday problems are discussed in this chapter, while immunisations (CHAPTER 9) and more complicated problems such as anaemia, diarrhoea and chronic cough are covered elsewhere (see PART 3, Problem solving in general practice).
Crying and fussing in infants
Crying and fussing is a very common concern in the infant in the first few months. The term ‘colic’ (which is still widely used) needs to be used with caution, as it infers something is wrong with the gut of the infant, when most of the time this is not the case.1
The normal pattern is for crying to start increasing around two weeks of age, to peak around two months, and then settle down around three to four months of age, perhaps five. On average, a baby cries or fusses for 3 hours a day. The amount of crying varies from baby to baby, but all babies cry—and not just human babies; in the early months babies of other mammal species cry as well. This is a survival instinct, to get the full attention of the carer and to establish attachment. It can also cause a great deal of distress for a mother or other carer, so active listening, careful assessment to exclude other causes and advice and reassurance are important.
History—crying pattern and duration, assessment of the child’s temperament and parents’ coping abilities.
Perform careful physical examination, including growth parameters, feeding and settling pattern, and development.
Reassure parents that extra attention will not affect the baby but overstimulation should be avoided.
Give parental reassurance and education (including advice on soothing techniques and coping strategies).
Practice tip—the period of purple crying1
A useful term developed by specialists in this area is ‘the period of PURPLE crying’ <www.purplecrying.org>. The letters of the word ‘purple’ stand for characteristics of this period of crying, namely:
P = Peak—your baby may cry more each week, the most at 2 months, then less at 3–5 months
U = Unexpected—crying can come and go and you won’t know why
R = Resists soothing—your baby may not stop crying no matter what you try
P = Pain-like face—babies may look like they are in pain, even when they’re not
L = Long-lasting—crying can last as much as 5 hours a day, or more
E = Evening cluster—your baby may cry more in the late afternoon or evening