Irritable Infant

Basics

Most children have some period of the day when they are most irritable, usually toward the evening:
- Normal infant crying ranges from 3 hr/d at 6 wk of age and decreasing until 16 wk of age
- During the first 6 mo of life, 1-mo olds have the highest prevalence of crying
Irritability is based on a comparison with the child's normal behavior pattern
Colic or excessive infant crying of unknown cause, is the most common cause of inconsolable crying in infants, occurring in as many as 25% of healthy children:
- Episodes of paroxysmal screaming accompanied by drawing up knees and oftentimes passage of flatus
- Usually begins at 2–3 wk and may continue through 12 wk, 3 hr/d
- Diagnosis of exclusion

Bites: Spider/insect bite
Burn
Cardiac (supraventricular tachycardia, congestive heart failure, aberrant left coronary artery, coarctation of the aorta, endocarditis, myocarditis)
Child abuse
Corneal abrasion/foreign body (eyelash) in eye
Diaper pin
Diphtheria, pertussis, and tetanus (DPT) and other vaccine reactions
Endocrine/metabolic (inborn errors of metabolism, metabolic acidosis, hypernatremia, hypoglycemia, hypocalcemia, hyperthyroid – direct or by transplacental passage of maternal thyroid-stimulating immunoglobulins)
Foreign body, fracture, tourniquet (hair around digit or penis)
Gl (gastroenteritis, colic, gastroesophageal reflux, esophagitis, volvulus, malrotation constipation, cow's milk protein intolerance, anal fissure, intussusception, appendicitis)
Genitourinary (incarcerated hernia, testicular torsion, genital tourniquets, urinary retention) or localized
Infection: Systemic
Iron deficiency/anemia
Medications/toxins: Aspirin, antihistamines, atropine, adrenergics, home remedies, new prescription, mercury)
Meningitis
Minor acute infections (upper respiratory infection, otitis media, thrush, gingivostomatitis)
Neurologic (increased intracranial pressure: Mass, hydrocephalus, intracranial hemorrhage, hematoma – subdural, epidural, skull fracture)
Osteomyelitis
Parental anxiety
Pneumonia
Sickle cell crisis
Splinter
Teething
Trauma: Nonaccidental, SDH, fractures, shaken baby
UTI
Vascular

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