Causes, treatment and clinical outcome in infants admitted because of excessive crying to the paediatric department of the Isala clinics, Zwolle, the Netherlands, 1997/'03

OBJECTIVE: Evaluation of the strategy of admitting excessively crying infants after no improvement is seen following measures taken by the family physician. DESIGN: Retrospective. METHOD: By studying medical records, data were collected for all infants who were admitted to the paediatric department of the Isala clinics in Zwolle because of excessive crying in the period 1997/'03. Excessive crying here was defined as 'crying that was regarded by the parents as excessive', whereby strict time criteria did not have to be met. RESULTS: In the study period of 6.5 years, 88 children were admitted because of excessive crying: 51 boys and 37 girls, with an average age of 10 weeks (range: 0.5-40). Measures taken without success prior to referral included: hypoallergenic feeding in 51 cases (58%), alternative medical treatment in 18 (20%) and antacids in 9 (10%). In 3 patients (3%) a possible cause of the excessive crying was identified and improvement occurred after treatment: cow's milk allergy (n = 2) and recurrent respiratory tract infections caused by a humoral immunodeficiency (n = 1). Clinical indications for an underlying cause were present in another 8 patients but this could be neither confirmed nor excluded. In 77 patients (88%) the crying rapidly improved within a few days without a specific intervention. In most children, hypoallergenic feeding could be replaced by regular cow's milk formulas without any problems. After discharge, there were so re-admissions for excessive crying (11%). CONCLUSION: In the majority of infants admitted to hospital for excessive crying, no underlying cause was found and the crying rapidly improved within a few days without a specific intervention. We therefore recommend that excessively crying infants merely be observed clinically for several days. There is no indication for immediate diagnostic or therapeutic interventions. It is important, however, to counsel parents about their own anxiety and distress and the influence these may have on the infant's crying behaviour.