Melbourne Neonatal Network

Irritable infants

Many babies display irritable behaviour in the first couple of months of life. It is common for this irritability to gradually escalate from the first week or two until a peak at around 6 to 8, sometimes 10 weeks of age. This irritability is physiological (normal) and most commonly exhibits a diurnal (daily) pattern of a baby who is more settled in the morning, worsens in the afternoon and is inconsolable by evening. It is not uncommon for babies to cry for many hours during this time. They will then often have their longest sleep of the day after this time. Babies will often appear as though they are ‘in pain’, however movements such as bringing the knees up, arching the back and increased ‘wind’ are all very common and non-specific signs that have been shown in good quality studies to occur in most unsettled babies and not point towards a particular pathology (cause).

Parents and health practitioners alike spend much time and effort trying to explain or treat this irritability. The reality is that no single treatment has been shown in good quality studies to be effective in infant irritability, including medications such as ranitidine or omeprazole for ‘reflux’, infant ‘colic’ mixtures, chiropractic manipulation, naturopathic therapies and the like. Management should be focused on calming your infant, soothing and repetitive movement, massage, a safe and consistent sleeping environment and, most importantly, ensuring parental mental health is not compromised.

If the pattern of your baby’s irritability falls outside the physiological description given above, consultation with your maternal and child health nurse or general practitioner is advisable. Profuse vomiting with severe irritability, irritability focused predominantly around feeds, bright green vomiting, babies who are lethargic or cannot feed adequately, those who have high temperatures (over 38 degrees celcius), those who are not gaining adequate weight or who are losing weight should seek medical advice. If the irritability is not decreasing after 10 weeks of the baby’s life, consultation with your health professional is also advisable to consider such problems as urinary tract infections, cows milk protein intolerance, etc.

It is important to remember that the first couple of months of a baby’s life can be quite an unsettled and difficult period as they work to establish routines and teach themselves to self settle. It is therefore ideal that parents maintain a stable and consistent approach, allow some time for themselves as individuals and ensure a good support network around them.

Irritable infants

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