Prevalence of underlying organic causes in infants presenting with excessive crying: a 2-year follow-up study

The objective of this study is to assess the proportion of infants referred for excessive crying (EC) who were diagnosed with an underlying condition likely related to EC within 2 years of follow-up. A retrospective study reviewing the records of infants younger than 5 months with EC as the primary reason for referral. Infants with fever at presentation, acute illness, gestational age < 32 weeks, birth weight < 1500 g, perinatal asphyxia, or previously diagnosed congenital disorders were excluded. Of 1123 screened infants, 530 presenting with EC were included (53% male; mean age, 2 months). Underlying organic conditions were identified in 52 infants (9.8%). Of these, 39 (7.4%) had cow's milk allergy (CMA) confirmed by food challenge and 15 (2.8%) had other organic conditions, including developmental delay or genetic disorders (n = 9) and urinary tract infection (n = 2); two infants were diagnosed with both CMA and another condition. Clinical signs prompting early diagnosis included painful hip examination, feeding difficulties with choking, paroxysmal pain with rectal bleeding, progressive vomiting, and fever during follow-up. Later diagnoses emerged in the context of developmental delay or persistent EC, sleep or feeding problems. Initial physical examinations were normal in all infants.

In infants referred for EC, approximately 1 in 10 are diagnosed with an underlying organic condition, most commonly CMA. Although EC is often benign, persistent symptoms or emerging developmental concerns warrant careful evaluation and structured follow-up rather than reassurance alone. Future prospective studies should identify early clinical predictors distinguishing benign EC from pathology and improve timely recognition.

• Excessive crying in early infancy is a common parental concern, usually without an underlying organic condition. • Its nonspecific presentation complicates distinguishing normal behavior from rare organic conditions, challenging clinicians and often prolonging parental distress.

• This 2-year follow-up of 530 infants referred for excessive crying confirms that underlying organic conditions are uncommon. • Cow's milk allergy accounted for the majority of identified organic diagnoses, whereas other organic conditions were rare and typically identified later, underscoring the need for structured follow-up in infants with persistent crying, regulatory problems, or developmental concerns.