irritability in childrenDefinition
Irritability is a state of being overly sensitive to stimulation. Children who are irritable may, for example, cry easily.
What is going on in the body?
A child who is irritable may be responding to something that causes pain, fright, or discomfort. Some children are more sensitive to stimuli than others and may become more easily irritated. In some cases, a serious medical condition can cause irritability.
What are the signs and symptoms of the condition?
Symptoms depend on the cause of the irritability. The doctor may ask:
Other questions may be asked about the child's eating, drinking, and sleeping habits, and activity level.
- if there is a known cause
- how the child is acting
- when it began
- how long it has been going on
- whether it is constant or comes and goes
- what the child's usual response to problems or pain is
- if anything makes the child better or worse
- if it occurs only at certain times of the day
- if there are any other symptoms, such as fever, stomach upset, pulling on the ear, pain, injury, depression, sadness, or poor development
- if there is any history of any other illnesses, conditions, allergies, or surgeries
- what medications the child takes, if any
What are the causes and risks of the condition?
The cause is of irritability is harder to figure out in very young children who cannot talk. Being overtired or hungry, teething, having soiled nappies, and the need for attention may all cause mild irritability.
Medical conditions can also cause irritability, including:
What can be done to prevent the condition?
- infections of any part of the body, such as upper respiratory infections or acute otitis media
- head injury, meningitis, intracerebral haemorrhage, and increased intracranial pressure, or pressure inside the skull
- tumours or cancer, such as a brain tumour
- reaction to medications or vaccines, such as the pertussis vaccine or antibiotics
- foetal alcohol syndrome, a collection of birth defects due to the mother drinking alcohol during the pregnancy
- autism, a developmental disorder affecting the brain and personality
- defects present at birth, such as congenital heart disease
- child abuse
- colic, with excessive crying in an otherwise normal baby
- any serious illness, such as liver disease, chronic obstructive pulmonary disease, kidney disease, or heart disease
- disorders causing emotional or mental impairment, such as depression, anxiety, and abnormal grief
- hormone imbalances, such as diabetes and hyperthyroidism
- poisoning from toxic substances, such as lead poisoning
- vitamin or mineral deficiencies, such as iron or folate deficiency
- any other new or chronic illness
- inborn errors of metabolism, such as aminoaciduria
Avoiding people with infections may reduce the risk of irritability due to these causes. Many cases cannot be prevented.
How is the condition diagnosed?
The doctor begins the investigation of irritability with a history and physical examination. This may be all that is needed to make the diagnosis. In other cases, the doctor may order tests such as:
- a full blood count, or FBC, to detect infection or blood cancer
- x-ray tests, such as a chest x-ray, to help diagnose some infections and cancers
- thyroid function tests to check for abnormalities with the body's metabolism
- psychological testing to check for mental or psychological impairments
What are the long-term effects of the condition?
If an infection is causing the child's irritability, antibiotics may cure the infection and there are usually no long-term effects. A child with cancer may need lifelong treatment.
What are the risks to others?
Irritability itself is not contagious. If an infection is the cause, the infection may be contagious.
What are the treatments for the condition?
Infections causing irritability are often treated with antibiotics. A child who has colic may be treated with comfort measures, such as rocking. Treatment for autoimmune disorders may include medications to reduce inflammation and suppress the immune system. If a medication causing the irritability, it may be stopped.
A child with cancer may need surgery, Chemotherapy, or radiation therapy. Some conditions, such as heart defects present at birth, may be treated with open heart surgery. Medications are often used for mood problems, such as depression.
What are the side effects of the treatments?
Side effects depend on the treatments used for the underlying cause of the irritability. For example, antibiotics can cause stomach upset and allergic reactions. Surgery poses a risk of infection, bleeding, or allergic reaction to anaesthesia. chemotherapy can cause many side effects.
What happens after treatment for the condition?
In many cases, treatment "cures" the child's irritability. In other cases, the cause cannot be cured and needs further treatment.
How is the condition monitored?
A child with a mild illness or infection can often be monitored at home by the caregiver. Any new or worsening symptoms should be reported to the doctor. A child with HIV or leukaemia may need to be monitored with repeated blood tests. Any medications used may also need monitoring, often with blood tests.
Author: Eileen McLaughlin, RN, BSN
Reviewer: eknowhow Medical Review Panel
Editor: Dr JohnHearne
Last Updated: 7/1/2005
Potential conflict of interest information for reviewers available on request