Infant Irritability

Pre-referral guidelines for primary care providers

Infant irritability ('colic') is an extremely common phenomenon, with most babies having some periods of irritability. Physiological irritability of infancy peaks at 6-8 weeks of age and is deemed 'excessive' if the infant cries for more than 3 hours per day for 3 days per week for 3 consecutive weeks.

For a comprehensive assessment and management of infant irritability, please refer to the Royal Children’s Hospital clinical practice guidelines.

Practice points

  • Infant irritability is extremely common and often does not reflect an underlying pathology.
  • It does remain important to exclude underlying medical causes for infant irritability (see RCH clinical practice guidelines for further detail), most of which can be done with careful history and examination.
  • It is crucial to assess the level of parental distress and coping when dealing with an irritable infant.
  • There is no good evidence that anti-reflux medications, colic mixtures, formula changes (except in cases of cow's milk protein intolerance) or spinal manipulation are any better than placebo in the management of infant irritability.
  • Ensuring adequate support for the family is important in management of infant irritability - see Referral Pathways below.

Referral pathways