Alternate Names: Inconsolability

Considerations: Irritability is used specifically in regard to infants and young children who often, in the presence of illness, demonstrate increased fussiness, whining, and fretfulness despite attempts at comforting and parental responses that would normally be soothing to the infant or child.

Irritability is seen at the beginning of many infectious diseases, some metabolic diseases, head trauma, malignancies, and other types of disease. It can be a very early sign of pending problems. Although irritability cannot be taken as a symptom or sign of any specific illness, it should arouse early suspicion in the parent that something might be wrong with the infant or young child, even though there may not yet be other symptoms. Parents are very aware of their child’s normal behavior and may pick up early changes that would be inapparent to the examining health care provider. This may help in the early diagnosis of illness.

Common Causes:

• meningitis
• Reye’s syndrome
• otitis media
• acute subdural hematoma
• alcohol withdrawal state
• arteriovenous malformation (cerebral)
• beriberi
• biliary atresia
• bipolar affective disorder
• celiac disease (sprue)
• cerebral abscess
• cerebral aneurysm
• chronic subdural hematoma
• classical migraine
• colic in infants
• hereditary spherocytosis
• congenital syphilis
• diabetes insipidus; nephrogenic
• discitis
• emphysema
• encephalitis
• galactosemia
• generalized anxiety disorder
• hemolytic uremic syndrome
• hereditary fructose intolerance
• Hunter syndrome
• Huntington disease
• hydrocephalus
• hypervitaminosis A
• hypervitaminosis D
• hypoglycemia
• iron deficiency anemia
• kwashiorkor
• lead poisoning disease
• meningitis; H. influenza
• meningococcemia
• Menke’s syndrome
• metachromatic leukodystrophy
• multiple endocrine neoplasia (MEN) II
• neuroblastoma
• neurosyphilis
• non-gonococcal (septic) bacterial arthritis
• pheochromocytoma
• pinworm
• pituitary tumor
• poliomyelitis
• post traumatic stress disorder
• premenstrual syndrome
• roseola
• Rubinstein-Taybi syndrome
• schizoaffective disorder
• sleep disorders
• subacute combined degeneration
• subarachnoid hemorrhage
• syphilitic aseptic meningitis
• Tay-Sachs disease
• tetanus
• tropical sprue
• vaccine reaction

Home Care: Attempt to soothe the child with usual measures (rocking, cuddling, or whatever the child usually finds soothing). Then, watch the child for other symptoms (fever, abdominal pain, vomiting, rash, or any other unusual finding).

Call If:

• an irritable child has other symptoms.
• your child is frequently irritable, fussy, or cranky.

What To Expect: The medical history will be obtained and a physical examination performed. Tests may include a complete blood count, electrolyte analysis and blood culture.

Medical history questions documenting irritability in detail may include:

• quality
  • How severely irritable is the child?
• time pattern
  • Does the irritability persist?
• feeding habits
  • How does the child normally eat (how often, how much)?
  • How is the child eating now?
• bowel habits
  • How often does the child normally have bowel movements?
  • Does the child have problems with diarrhea or constipation?
• other
  • What other symptoms are also present?
  • Is there any fever, confusion, or pain?