Clinical investigations from the RACP

Evaluating irritability in infants and children

Peter Hewson



There are many causes of irritability in infants and children. A ‘blinkers off’ approach is needed if the uncommon but important diagnoses are to be made.

Key Points

  • In many cases of irritability in young babies, reassuring the parents and preventing potentially damaging attachment difficulties are the main focus. In older infants and young children, serious medical and emotional disturbance may need to be identified.
  • Tending to babies and attempting to settle them in the first three months of life is associated with more settled babies at the age of six months.
  • To a parent, persistent crying in a baby or young child is both worrying and frustrating. A sensitive, ‘blinkers off’ approach is necessary if the uncommon but important diagnoses are to be made.
  • The cardinal signs of organic illness in infancy are poor weight gain, pallor and intermittent fever.
  • In the evaluation of irritability in infants and children, specific observations of posture, movement and responsiveness with repeat examinations are more useful than pathology tests.