DIAGNOSIS CHECKLIST
for Irritability

Why: to determine if acute or chronic.

Why: if so, there are specific causes to consider.

Why: e.g. whimpering high pitched cry with meningitis, weak feeble cry with botulism or infantile myasthenia.

Why: e.g. illness during pregnancy, gestation when baby born, smoking during pregnancy, alcohol ingestion during pregnancy.

Why: e.g. labor, mode of delivery such as normal vaginal, caesarian, forceps.

Why: e.g. special care nursery admission, bruising, jaundice, seizures, lethargy.

Why: e.g. breast fed or bottle fed, time of weaning.

Why: e.g. genetic disorders.

Why: e.g. milestones.

Why: from birth to 3 weeks many babies sleep a lot, the crying periods do not last long and are usually easy to resolve; from 3 weeks onwards things may change, sometimes dramatically with babies crying more and sleeping less. Unexplained crying for a short period every 24 hrs is normal for about 80% of all babies. A small number of babies (about 20%) cry a lot for large parts of the day and night. These babies sleep poorly, wake early, cry and draw up their legs a lot. Things slowly improve between 3 and 6 months. The majority of crying babies are healthy babies who do not have a clearly defined, treatable medical problem.

Why: questions specifically about relationship, family, children, social support, occupation, general physical health and financial stresses. Significant stressors may cause irritability or may increase the risk of depression and insomnia.

Why: certain mental illnesses known to cause irritability include depression, anxiety, schizophrenia, mania and personality disorders.

Why: Alcohol abuse may cause irritability and also increase the risk of major depression.

Why: many illicit drugs may increase the risk of irritability and personality change.

Why: e.g. wet or soiled nappy, hungry, thirst, teething, too cold, too hot, tired, lonely, scared, noisy environment, lights too bright.

Why: may help determine if irritablity is due to hunger.

Why: suggests infection e.g. urinary tract infection, viral gastroenteritis, viral upper respiratory tract infection, ear infection, meningitis.

Why: e.g. irreducible tender lump in the groin - the hernia can become clamped off by the tight muscles in the groin which is called strangulation and causes intense pain.

Why: e.g. weight loss, pallor, vomiting, sudden change in the babies bowel movements, drawing legs up and an alarming sudden change in the baby's behavior. Spasms tend to last for 2-3 minutes and occur at intervals of about 10-15 minutes - these conditions are very rare.

Why: e.g. failure to thrive, poor feeding, vomiting, diarrhea, thick smelly urine, may be discomfort with passing urine, fever.

Why: may suggest viral gastroenteritis which can contribute to an irritable, crying baby.

Why: e.g. runny nose, mild fever, mild cough - can contribute to a irritable, crying baby.

Why: may suggest sore throat, congenital syphilis.

Why: e.g. flushed cheeks, increased saliva - teething does not cause persistent unexplained crying in healthy babies.

Why: e.g. attacks in the first few weeks of life of screaming, drawing up of legs and refusing to be comforted. The cause of colic is poorly understood and invariably disappears by the 4th month of life.

Why: e.g. frequent vomiting, crying especially after a feed and if laying flat, wakefulness, back arching, breast or bottle refusal, sometimes complicated by failure to thrive and vomiting blood.

Why: e.g. rashes, excessive mucous, abdominal cramps, diarrhea, swelling or vomiting. - research yields very conflicting results about the incidence of excessive crying and irritability being caused by food allergies or intolerance.

Why: e.g. fever, pallor, vomiting, lethargy, excessive irritability, refusing feeds, may have a whimpering and high pitched cry, rash is often a late sign.

Why: e.g. depressed mood, crying spells, irritability, anhedonia (loss of interest or pleasure), increase or decrease in appetite (usually decreased), weight loss or gain, insomnia or increased sleeping (usually early morning waking), fatigue, loss of energy, feelings of worthlessness, feelings of excessive guilt, poor concentration, difficulty making decisions, low libido, thoughts of death or suicide attempt.

Why: e.g. episodes of depression (often psychotic in intensity) and at other times episodes of psychotic excitement (mania or hypomania). Symptoms of psychotic excitement may include elevation of mood, increased activity, grandiose ideas, irritability, disinhibition (which affects social, sexual and financial behavior), rapid speech and racing thought, delusions (persecutory or grandiose) and sometimes hallucinations.

Why: e.g. nervousness, shakiness, tremor, restlessness, irritability, insomnia, poor concentration, heart palpitations, racing heart, sweating, dizziness, diarrhea, lump in throat and frequency of urination.

Why: e.g. hallucinations, delusions, disordered thought - may assist in differentiating schizophrenia, bipolar affective disorder and severe psychotic depression.

Why: e.g. headache, dementia, seizures, stroke-like symptoms, irritability, depression.

Why: e.g. hot flushes, night sweats, heart palpitations, lightheadedness, dry vaginal, dry skin, headaches - Menopause may also present with depression and irritability.

Why: e.g. impaired memory, impaired judgement and thinking, impaired verbal fluency and impaired ability to perform complex tasks. Personality may change, impulse control may be lost and personal care deteriorates. People with dementia may also have psychiatric symptoms such as delusions, paranoid ideas, hallucinations, mood disturbance and behavioral disturbance.