CRYING BABIES & BEYOND the ins and outs & ups and downs



‘Differential diagnosis’ is the medical term for other conditions that may be the cause of the problem. These must always be considered to try to prevent the wrong diagnosis being made. When considering the differential diagnosis, doctors look at other medical conditions that can produce a similar picture to the one the person has.

When looking at distressed babies we should always look at other possible causes for each of the symptoms—what else could cause the crying, what else could cause the vomiting etc?

Mothers, it can be assumed, have already looked for most of the simpler causes of distress. However, for completeness I will include the simple causes that should be checked in these infants.

Many of the infants who present as distressed babies have several factors present, so sorting out the problem is rather like doing a jigsaw puzzle—but you have to find the pieces before you can try to fit them together.

We also need to remember that infants are not static. They are growing and maturing. Their problems change from time to time and there are many things happening in their lives and around them; they pick up viral and other infections; may have issues with teething, etc.

Added to all of this is the personality of the child and the individual response to discomfort and pain. Some infants may be extremely distressed, screaming and inconsolable for hours at a time, whilst other infants may have severe middle ear problems but do not appear as disturbed by them. Other infants have major middle ear problems—but no symptoms. We would never know that these children had a problem if we were not checking them regularly. See CHILD 2 in the chapter about Tympanograms and Audiograms……


When considering the cause of symptoms for any child it is important to think about other conditions that can show similar symptoms, to ensure that the correct diagnosis is made.

Symptoms to be considered for babies with ETI include grizzling, vomiting, feeding and sleeping problems. Other conditions discussed include colic and the current thoughts about its cause and management 

When any child is unwell without obvious cause it is important to check for infections, particularly to exclude a urinary infection, as this may be silent, but can cause long term damage to the kidneys if untreated.

Feeding and sleeping problems can have causes other than ETI and these should be excluded….

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