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Irritability In Children

Definition

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.

Risks

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 diapers, and the need for attention may all cause mild irritability.
Medical conditions can also cause irritability. These include (roughly, from most common to least common):
  • infections of any part of the body, such as upper respiratory infections or acute otitis media
  • reaction to medications or vaccines, such as the pertussis vaccine or antibiotics
  • colic, with excessive crying in an otherwise normal baby
  • disorders causing emotional or mental impairment, such as depression, anxiety, and abnormal grief
  • child abuse
  • any other new or chronic illness
  • autism, a developmental disorder affecting the brain and personality
  • poisoning from toxic substances, such as lead poisoning
  • hormone imbalances, such as diabetes and hyperthyroidism
  • head injury, meningitis, intracerebral hemorrhage, and increased intracranial pressure, or pressure inside the skull
  • tumors or cancer, such as a brain tumor
  • fetal alcohol syndrome, a collection of birth defects due to the mother drinking alcohol during the pregnancy
  • defects present at birth, such as congenital heart disease
  • any serious illness, such as liver disease, chronic obstructive pulmonary disease, kidney disease, or heart disease
  • vitamin or mineral deficiencies, such as iron or folate deficiency
  • inborn errors of metabolism, such as aminoaciduria

Prevention

What can be done to prevent the condition?

Avoiding people with infections may reduce the risk of irritability due to these causes. Many cases cannot be prevented.

Diagnosed

How is the condition diagnosed?

Sometimes, the cause of the irritability is obvious to the healthcare professional from the history and physical exam. In other cases, he or she may order tests such as:
  • a complete blood count (CBC) 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

Long Term Effects

What are the long-term effects of the condition?

The effects depend on the cause. For instance, 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.

Other Risks

What are the risks to others?

Irritability itself is not contagious. If an infection is the cause, the infection may be contagious.

Treatments

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.

Side Effects

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 can be complicated by infection, bleeding, or reactions to anesthesia. Chemotherapy can cause many side effects.

After Treatment

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.

Monitor

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 healthcare professional. A child with HIV or leukemia may need to be monitored with repeated blood tests. Some medications require monitoring with blood tests to make sure the level in the person's body is correct.

Sources

Your Child's Health, Schmitt, 1991

Current Pediatric Diagnosis and Treatment, Hathaway et al., 1993

Illustrated Guide to Diagnostic Tests, Springhouse, 1998

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