- Infantile Colic.

Infantile Colic

• The conventional definition of colic is the Wessel’s "Rule of three" which mandates an otherwise healthy baby "important word" with crying spells that occur for at least 3 h a day, 3 times a wk for 3 consecutive weeks and These infants are typically healthy and thriving well.
• The recently modified definition includes all of the following:

1.  Paroxysms of irritability, fussing or crying that occur without a cause
2. Episodes lasting 3 or more hours per day and occurring at least 3 d per week for at least 1 wk.
3. Absence of failure to thrive.

- Organic Causes of Excessive Crying in infancy.

Organic Causes of Excessive Crying in infancy

Organic diseases account for 5 to 10% of infants presenting with incessant crying.
1.CNS:
– CNS abnormality (Chiari type 1)
– Infantile migraine
– ↑ICP (trauma, hydrocephalus, intracranial hemorrhage, Mass)
– Seizure
– Meningitis
– Encephalitis
2. Eyes, Ears, Nose, Throat:
– Choanal atresia
– Otitis externa
– Otitis media
– Corneal abrasion
– Glaucoma
– Teething
– Gingivostomatitis
– Thrush
– Foreign body
3.Cardiac:
– Tachyarrhythmia e.g SVT
– myocarditis,
– congestive cardiac failure
4.GI:
– Constipation
– Cow’s milk protein intolerance
– GERD
– Lactose intolerance
– Gastrointestinal obstruction (intussusception, volvulus, pyloric stenosis, Hirschsprung disease)
– Anal fissure
– Strangulated Hernia
– Abdominal trauma
– Peritonitis 
5.Respiratory:
– Airway obstruction (croup, foreign body)
– Upper respiratory tract infection
– Lower respiratory tract infection (pneumonia, bronchiolitis)
6. Genitourinary System:
– Testicular torsion
– Ovarian torsion
– Urinary tract infection
– Tight phimosis
7.Musculoskeletal system:
– Infection ( septic arthritis, Osteomyelitis)
– Fracture limbs.
– Others—pulled elbow, caffey’s disease
8.Skin:
– Cellulitis
– Impetigo
– Tourniquet syndrome (extremities, penis, clitoris)
– Dermatitis (e.g Napkin)
– Insect bites
– Minor injury
9.Other causes:
– Narcotic Withdrawal Syndrome
– Drugs (ephedrine, amphetamine, clonezepam, antihistaminics)
– Vaccine reaction
– Inborn error of metabolism
– Sepsis
– Sickle cell crisis
– Physical abuse

- Clinical grades of stridor.

Clinical grades of stridor.

1.Grade 1 (Exertional stridor) :
Stridor appears during crying or exercise.
2.Grade 2 (Continuous stridor or stridor at rest) : 
Stridor is present at rest & become worse with exertion.
 3.Grade 3 (Stridor with retractions) : 
Stridor is continuous & accompanied with suprasternal& supraclavicular retractions. The patient looks anxious, irritable, struggling for breathing.
4.Grade 4 (Stridor with cyanosis) :
 In addition to continuous stridor & retractions, cyanosis& altered consciousness occur denoting severe respiratory failure. ET intubation may be considered.

- Causes of Hematuria in Children.

 Causes of Hematuria in Children

UPPER URINARY TRACT DISEASE
Isolated renal disease

• Immunoglobulin (Ig) A nephropathy (Berger disease)
• Alport syndrome (hereditary nephritis)
• Thin glomerular basement membrane nephropathy
• Postinfectious GN (poststreptococcal GN)*
• Membranous nephropathy
• Membranoproliferative GN*
• Rapidly progressive GN
• Focal segmental glomerulosclerosis
• Anti–glomerular basement membrane disease

Multisystem disease

• Systemic lupus erythematosus nephritis*
• Henoch-Schönlein purpura nephritis
• Granulomatosis with polyangiitis (formerly Wegener granulomatosis)
• Polyarteritis nodosa
• Goodpasture syndrome
• Hemolytic-uremic syndrome
• Sickle cell glomerulopathy
• HIV nephropathy