Crying Child - 3 Months and Older  
Back to Index

 
Does this describe your child's 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 recommended cough and cold medicines for children under 4 years.)

If not, see these topics
  • 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

When to Call Your Doctor

Call 911 Now (your child may need an ambulance) If
  • Not moving or very weak
Call Your Doctor Now (night or day) If
  • Your child looks or acts very sick
  • Stiff neck or bulging soft spot
  • Won't move one arm or leg normally
  • Cries every time if touched or moved
  • Possible injury (especially head or bone injury)
  • Very irritable, screaming child for over 1 hour
  • You are afraid you or someone might hurt or shake your baby
  • Crying continuously (cannot be comforted) for more than 2 hours
  • Refuses to drink or drinking very little for more than 8 hours
  • You think your child needs to be seen urgently
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think your child needs to be seen, but not urgently
  • Pain (eg. earache) suspected as cause of crying
  • Crying intermittently (can be comforted) BUT child not acting normally when not crying
Call Your Doctor During Weekday Office Hours If
  • You have other questions or concerns
  • Mild, off-and-on fussiness (acts normal when not crying) continues over 2 days
  • Excessive crying is a chronic problem
Parent Care at Home If
  • Mild fussiness of unknown cause present less than 2 days and you don't think your child needs to be seen
  • Normal protest crying
  • Temper tantrum crying
  • Sleep problem crying
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, it's 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 family 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.
  2. Call Your Doctor If:
    • You have other questions or concerns
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.
  2. Tips for Responding to Temper Tantrums:
    • Ignore most tantrums (e.g., demanding something the child doesn't need).
    • For tantrums from frustration (e.g., when something doesn't work), help your child.
    • For aggressive (hitting) or destructive (throwing) tantrums, put in timeout until your child calms down.
    • Don't give in to tantrums. No means No.
    • Be a good role model. Avoid yelling or screaming at others (adult tantrums).
  3. Call Your Doctor If:
    • You have other questions or concerns
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.
  2. Tips for Treating the Sleep Problem:
    • Re-train your child to be a good sleeper at bedtime and naptime.
    • Place your child in the crib "drowsy but awake".
    • Once placed in the crib, don't take out again.
    • Visit your child as often as needed until asleep.
    • For night awakenings, however, it's fine to hold your child.
    • Do all of this in a loving way with a calm voice.
    • Never feed until asleep.
    • Never sleep in the same bed with your child.
  3. Call Your Doctor If:
    • You have other questions or concerns

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

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 9/15/2011

Last Revised: 12/1/2011

Content Set: Pediatric HouseCalls Symptom Checker

Copyright 1994-2012 Barton D. Schmitt, M.D.