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Irritable Infant

Irritable Infant is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Most children have some period of the day when they are most irritable, usually toward the evening:
    • Normal infant crying ranges from 1–4 hr by 6 wk of age.
    • During the 1st 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 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
    • Diagnosis of exclusion

Etiology

  • 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)
  • 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
  • UTI
  • Vascular

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Citation

Rosen, Peter, et al., editors. "Irritable Infant." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307459/all/Irritable_Infant.
Irritable Infant. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307459/all/Irritable_Infant. Accessed April 23, 2019.
Irritable Infant. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307459/all/Irritable_Infant
Irritable Infant [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307459/all/Irritable_Infant.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Irritable Infant ID - 307459 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307459/all/Irritable_Infant PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -