Crying哭闹

　　Crying should be distinguished¹ from colic. Crying is the only means an infant has to signify distress². Causes may be mundane³ （eg, a neonate accustomed to the tight environment of the womb becoming frightened by unrestricted arm and leg movements） or serious （eg, ear infection, abdominal⁴ pain）. Often there is no obvious cause. Persistent⁵ or prolonged crying, especially with signs of illness, requires a search for a cause. Crying almost always improves by 4 to 6 mo; when it does not, providers should suspect physical pain or tension within the family.

　　应将哭闹与疝痛相区别。哭闹是婴儿表达痛苦的唯一方式。它有可能是日常原因引起的（如习惯于子宫紧密环境的新生儿会因手足运动的自由而受到惊吓）。哭闹常常无明显原因。持续、长时间的哭闹，特别是伴有生病症状，就必须寻找病因。哭闹几乎总会在4－6个月时改善。如果确实没有改善，就应怀疑是否有身体疼痛或家庭关系紧张。

　　Evaluation评估

　　History: History focuses on the amount, timing⁷, and quality of the crying as well as any signs of illness. Reports of fever or URI suggest possible otitis media. Reports of diarrhea or vomiting⁸ suggest pain from a GI process, ranging from gastroenteritis to more serious conditions. Reports of extreme parental⁹ frustration¹⁰ suggest tensions within the family that may be reflected in the infant's behavior.

　　病史：病史评估重点是哭闹数量、时间、性质及任何疾病症状。发烧或上呼吸道感染反映提示中耳炎可能。腹泻或呕吐反映提示胃肠道问题引起的疼痛，如胃肠炎甚至更严重的疾病。如反映父母极其失望，则提示家　关系紧张，并影响到婴儿行为。

　　Physical examination: Examination focuses on growth parameters¹¹ and any signs of illness. Distorted or erythematous tympanic membranes¹² suggest otitis media. Abdominal distention or masses suggest an intra-abdominal process causing pain. Fever and fussiness¹³ without an apparent cause may result from UTI.

　　体检：体检重点是生长发育情况及疾病症状。鼓膜变形或红斑提示中耳炎，腹胀或腹部肿块提示腹内病变引起疼痛。发烧或无明显原因的生气可能是泌尿道感染所致。

　　Testing: In most cases, testing is unnecessary unless otherwise indicated by history and examination.

　　化验：多数情况无需化验，除非在病史或体检中发现其他指症。

　　Treatment治疗

　　The clinician's role in managing crying is to present explanations and options to parents, who can then try different strategies to diminish the child's crying. Approaches vary with cause and age. Infants are often comforted by swaddling, ambient noise, and movement, as in rocking or swinging in a swing. Both infants and older children often respond to a ride in the car. If parents and physician are convinced that there is no serious cause for the crying, the infant may be allowed to cry for a short period （“5-minute rule”）, then parents comfort the infant and re-start the clock. Often parents are relieved to know that they can let the infant cry, and often the infant will stop spontaneously before the prescribed period is over.

　　在处理哭闹时，临床医师的作用在于为父母提供解释和处理方案，父母据此偿试用不同的方法减少小儿哭闹。所用方法因哭闹原因和小儿年龄而异。婴儿常常通过襁褓、环境声音和运动进行安抚，如摇、荡秋千。乘车通常对婴儿和幼儿都有效。如果父母和医师都确信哭闹并无严重原因，就可以任婴儿哭一小会（“5分钟规则”），然后父母再去安慰，并重复这一作法。当父母知道可以让婴儿哭时就会感到轻松，婴儿也常常会在预定时间结束前自行停止哭闹。