The crying baby
Mrs Small had been trying for a baby for 4 years. She embarked on infertility investigations, but fortunately fell pregnant naturally. She is overweight and developed gestational diabetes which she managed well. Her baby was born at term using ventouse and had good Apgar scores.
From about 4 weeks of age her baby ,Shanayahas been crying all the time. In addition to this she has been bringing up milk and is pulling her legs up. Mum is exhausted, struggling with breast feeding and asked the pharmacist about what milk she should use if her breast milk isn’t enough. The baby is screaming in the pharmacy, and the pharmacist recommends Infacol and also suggests trying Aptamil if she has already tried SMA, but to check with the GP first .
Mrs Small calls for an emergency appointment and is seen by the Nurse Practitioner on duty. She takes her mother with her to confirm that the baby is crying all the time. The nurse prescribes Gaviscon infant in addition to the Infacol and advises to persist with breast feeding.
The following day, Mrs Small brings Shanaya to an emergency appointment with her GP saying that the above medication helps slightly with the legs being pulled up , but Shanaya is still crying and bringing up milk. Sometimes the milk comes up straight away and sometimes 1-2 hours after a feed. It is like cottage cheese. She is worried that Shanaya has not gained any weight in the last week. Mum is exhausted and very worried .
There is no diarrhoea and she has a dry skin rash that is slightly better using her friend’s Aveeno emollient.
Mum is angry that her baby’s tongue tie was not picked up earlier , but luckily the health visitor has now made a referral. Mum asks the GP for a prescription for Aptamil and a referral to the paediatric department or AE today. Her friend has advised her that her baby needs Ranitidine. She is also furious that the surgery issued a prescription for Epimax cream instead of Aveeno, which she had requested.
Shanaya cries throughout the consultation and is difficult to examine. Mum starts crying and starts phoning her husband during the consultation, but only gets an answerphone. He is busy at a meeting.
- What should you do?
(Discussion of pertinent history and examination and possible causes of crying infant
Physical discomfort cold/wet/hungry
Nappy rash
Intussuseption/volvulus/hernia
Reflux oesophagitis/lactose intolerance/constipation. CMPA
Parenting skills or anxiety)