An infant who presents with excessive crying may or may not have a serious underlying condition. Poole developed an algorithm for initial evaluation of the crying infant to help determine if a more extensive evaluation is warranted. The author is from Children's Hospital in Denver.


Acute and excessive crying indicates an acute episode that is persisting longer than the usual crying period for that infant without apparent cause.


Reasons for concern:

(1) excessive crying during the first week of life

(2) excessive crying beyond 4 months of age

(3) recurrent episodes of crying in an infant who does not appear to be healthy, well-nourished or developing normally

(4) crying that does not fit the pattern of infantile colic

(5) fever present

(6) crying continues after several hours of observation



(1) history and physical examination

(2) urinalysis with culture

(3) observe the patient over the next 1-2 hours



positive finding on history or physical examination

identify cause and treat; ensure appropriate follow-up of the patient

urinalysis positive

treat for urinary tract infection; consider diagnostic tests to identify predisposing conditions; ensure appropriate follow-up of the patient

crying ceases spontaneously during initial observation period

follow-up within 24 hours

history of recurrent episodes and/or findings consistent with colic

treat for infant colic; follow-up if persists

crying persists during the initial observation period

continue observation until crying stops or diagnosis made; consider more extensive testing


Workup for infant with persistent crying:

(1) radiologic studies

(2) chemistry tests

(3) toxicology studies

(4) pulse oximetry

(5) lumbar puncture



• For the infant with no obvious cause for the crying, the diagnosis of infantile colic becomes very important. This may be somewhat subjective during the first few episodes, until a pattern becomes established.


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