关键词: 婴儿不安综合征, 过度哭闹, 肠- 脑互动异常, 鉴别诊断, 分层评估

Abstract: Infant distress syndrome（IDS）is the Rome V update to the concept of infantile colic. It emphasizes that excessive crying and fussiness should not be interpreted simply as intestinal pain，but as a clinical state shaped by interactions among the gastrointestinal tract，central nervous system and psychosocial factors. In infants presenting with excessive crying，clinicians should first identify warning signs，including fever or hypothermia，poor responsiveness，bilious vomiting，bloody stool，neurologic abnormalities，impaired growth，injury or caregiving safety concerns，to avoid missing acute severe disease or non-accidental injury. Common mimics，such as gastroesophageal reflux disease，cow’s milk protein allergy，infant dyschezia，functional constipation，lactose intolerance and urinary tract infection，should then be differentiated. For infants without warning signs，with normal interval status and growth，and with a typical IDS pattern，reassurance，caregiver support and follow-up are appropriate. A stratified approach can reduce missed diagnoses while limiting unnecessary tests and overtreatment.

Key words: infant distress syndrome, excessive crying, disorders of gut-brain interaction, differential diagnosis, stratified assessment