2. Pattern of Crying & Recognizing Serious Illness

3. Rule 1-Birth details

4. Rule 2—Have you assessed Growth Feeding issues(Over/Under) GERD Lactose Intolerance CMPI

5. Rule 3 Is the Crying in the normal range and pattern? Or colic? The most widely accepted definition for colic is the Wessel criteria or the "rule of 3 ": crying lasts for more than 3 hours per day, occurs on more than 3 days per week, and persists for more than 3 weeks Paroxysmal — The first criterion is that the episodes are paroxysmal. Each "colicky" episode has a clear beginning and end Qualitatively different from normal crying — The second criterion is that episodes of crying are more intense and the acoustic characteristics of the crying are different from normal crying episodes. Associated with hypertonia — The third criterion is that the infants manifest physical characteristics that are associated with hypertonia Inconsolability — The fourth criterion is that the infants are difficult or impossible to console no matter what the parents do. Periods when the crying stops somewhat may occur, but the infant remains fussy. Relief may be noted after the passage of flatus or feces.

6. Rule 4 - Is the infant consolable? The ease of consolablity by simple measures, determines whether the irritability is physiological or pathological The more monotonous and persistent a cry is, the more probability that the condition is serious

7. Consolability

8. Rule 5 –Have you checked the eardrum?

9. Rule 6 - How is the urine stream?

10. Rule 7 - Does the baby have GI symptoms ?

11. Rule 8 - Have you undressed the baby completely?

12. Rule 9 - Have you checked the fundus?

13. What do you see here Interact!

14. Rule 10 - Is The Baby Hypoxic?

15. Rule 11 - How is the family interaction? A common observation is that if babies are admitted to hospital excessive crying improves very quickly, within days Under stimulation/Overstimulation? Post partum depression

16. Distress questionnaire Since the birth of your baby, have you felt? 1. Not a good mother Yes / No 2. Helpless Yes / No 3. Cannot satisfy your baby Yes / No 4. Baby crafty/sly Yes / No 5. Baby deliberately preventing you from having anything for yourself Yes / no 6. Feel like hitting or getting rid of your baby Yes / No 7. Other feelings of anger Yes / No 8. Exhausted/frustrated Yes / No 9. Sleeping/eating badly Yes / No 10. Quarrelsome Yes / No

17. What Do You Think?

18. Excessive crying Excessive crying is whatever the parent(s) find troublesome. It can be helped. It is the commonest trigger for physical abuse. It is the commonest reason for early stopping of breast feeding. Advice to reduce overstimulation helps. Parents must be supported until they feel they can cope McKenzie SA. Arch Dis Child Educ Pract Ed 2013;98:209–211.