diagnosis 17 & 24

Amelia, a 4-week-old newborn is brought into the family medicine office by her mother who is concerned about her nightly fussiness for the past 10 days.

Uncontrollable cries

Patient’s mother tested negative for Group B Streptococcus (GBS) infection was negative

Mother stopped smoking after she found out she was pregnant.

Amelia pulls her knees near her chest

Father is a smoker

Familial history on Father’s side of milk allergy.

Crying is more frequent at night

Physical Examination is unremarkable.

She dribbles a small amount of breast milk after she has been fed.

Normal weight gain in 4 weeks.

The baby cries continuously for 2 to 3 hours a day

Temperature was 37.5℃

No emesis or projectile vomiting.

Absence of a palpable “olive”.

PR is 132 beats per minute, RR is 42 breaths per minute, SpO2 is 98 % to 99%

90th percentile for height, 60th percentile for weight.

Breast fed every 3-4 hours during the day and 4-5 hours per night

Normal BM, color, consistency, and frequency

Ms. Arlington brought Amelia, a 4-week-old baby, to the family medicine office because she is concerned about her daily fussiness for the past two weeks. Ms. Arlington claims that she has also been crying uncontrollably for some time. Every evening, the crying begins and, depending on the volume, lasts between two and three hours. Also, she claims that nothing seems capable of soothing her during this moment of wailing. According to her mother, her urination and breastfeeding are typical. Her bowel habits are regular and normal. The mother of the patient also denies vomiting or fever. Amelia is gaining weight appropriately one pound since her two-week visit, and breast feeds very well.

Cries uncontrollably

Temp 37.5℃, PR is 132 beats per minute, RR is 42 breaths per minute, SpO2 is 98 % to 99%

Amelia pulls her knees near her chest

90th percentile for height, 60th percentile for weight.

Crying is more frequent at night

Absence of a palpable “olive”.

She dribbles a small amount of breast milk after she has been fed.

Physical Examination is unremarkable.

The baby cries continuously for 2 to 3 hours a day

Normal weight gain in 4 weeks.

No emesis or projectile vomiting.

Great latch during breastfeeding assessment with audible swallow and gulping noises.

Breast fed every 3-4 hours during the day and 4-5 hours per night

Normal BM, color, consistency, and frequency

Cries uncontrollably

Temp 37.5℃, PR is 132 beats per minute, RR is 42 breaths per minute, SpO2 is 98 % to 99%

Amelia pulls her knees near her chest

90th percentile for height, 60th percentile for weight.

Crying is more frequent at night

Absence of a palpable “olive”.

She dribbles a small amount of breast milk after she has been fed.

Physical Examination is unremarkable.

The baby cries continuously for 2 to 3 hours a day

Normal weight gain in 4 weeks.

No emesis or projectile vomiting.

Great latch during breastfeeding assessment with audible swallow and gulping noises.

Breast fed every 3-4 hours during the day and 4-5 hours per night

Cries uncontrollably

Temp 37.5℃, PR is 132 beats per minute, RR is 42 breaths per minute, SpO2 is 98 % to 99%

Amelia pulls her knees near her chest

90th percentile for height, 60th percentile for weight.

Crying is more frequent at night

Absence of a palpable “olive”.

She dribbles a small amount of breast milk after she has been fed.

Physical Examination is unremarkable.

The baby cries continuously for 2 to 3 hours a day

Normal weight gain in 4 weeks.

No emesis or projectile vomiting.

Great latch during breastfeeding assessment with audible swallow and gulping noises.

Breast fed every 3-4 hours during the day and 4-5 hours per night

Normal BM, color, consistency, and frequency

Thorough history and physical including reflexes

May help in determining the etiology of fussiness, as there are psychological contributors (Turner & Palamountain, 2021)

Check stool for occult blood

To rule out an allergy to cow's milk (Cash & Glass, 2020)

Laboratory test and radiographic tests is not required

Since Amelia is gaining weight normally and her physical examination is normal, there is no need for concern (Cash & Glass, 2020).

May consider Urinalysis

To rule out UTI. The test is inexpensive, and many insurance policies may cover it (Cash & Glass, 2020).

If breastfeeding, consider 5 drops of lactobacillus reuteri dsm 17938.

Lactobacillus reuteri administration to breastfed infants significantly reduces crying and fussiness in infants with colic (Sung et al., 2017).

Encourage Ms. Arlington to create a diary of crying and fussing spells.

For evaluation and to help clinicians in identifying crying and fussiness patterns (Cash & Glass, 2020).

Encourage Ms. Arlington to take time away from Amelia.

This will enable Ms. Arlington to recover the energy she needs to deal with Amelia's wailing (Cash & Glass, 2020).

Educate the family about Colic

Assure them that colic will subside with time, there is nothing physically wrong with the infant, and that they are doing an excellent job as parents. Examine symptoms of abdominal emergencies, such as fever, vomiting, diarrhea, and a painful abdomen (Turner & Palamountain, 2021).

Soothing techniques

Experiment with what works, such as music, white noise, a pacifier, or a front-carrying baby carrier. The process of elimination will be well worth the effort (Turner & Palamountain, 2021).

Follow up office appointment

Instruct the parents to return in two weeks so that Amelia's weight and symptoms can be monitored (Turner & Palamountain, 2021).

Educate Ms. Arlington when to seek emergency care.

Symptoms consisting of fever, pallor, sweating, vomiting, and diarrhea (Cash & Glass, 2020).