- 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.

- Newborn with Focal colonic fits.

Newborn aged 3 days delivered by Caesarean section with history of perinatal asphyxia and prolonged resuscitation and need intubation in delivery room admitted into our NICU on mechanical ventilator and show right upper limb colonic fits.

- Causes of stridor In pediatrics.

Causes of stridor according to site of obstruction.

-Nose and pharynx: (by laryngeal compression)

• Lingual thyroid or thyroglossal cyst 
• Macroglossia(Beckwith-Wiedemann syndrome, hypothyroidism, Pompe disease, trisomy 21, hemangioma).
• Micrognathia (Pierre Robin syndrome, Treacher Collins syndrome,DiGeorge syndrome)
• Hypertrophic tonsils/adenoids
• Retropharyngeal or peritonsillar abscess / hematoma
• Tongue teratoma or dermoid 
• Masses: e.g. cystic hygroma or other malformation

-Larynx:
Not acute:

• Laryngomalacia
• Congenital subglottic stenosis
• Vocal cord paralysis
• Laryngeal atresia/web 
• Congenital Subglottic hemangioma
• Vascular ring compression syndrome.
• Laryngocele/cyst
• Laryngeal papillomas 
• GERD

- Infant girl with whooping cough (Video)

Infant girl with whooping cough

Mother holding infant girl in Intensive Care Unit. The baby has pertussis (whooping cough) and is coughing severely.

- Baby with viral croup (video).

2 years old female presenting with barking cough, stridor

The child have:

• stridor at rest 
• Subcostal and suprasternal retraction 

As classified by Westley score  minimally she has Moderate croup