Medicalizing normality? Management of irritability in babies

The aims of this project were to identify the scources and quality of the health advice provided to parents with irritable infants; to assess the efficacy of a residential programme in the diagnosis and management of irritable infants; and to assess the intermediate term outcome for such infants and their mothers.

All mother-infant pairs admitted during a 3 month period to a residential setting with the primary concern of infant irritability were asked to participate in the study. Pre-admission and 3 month post-discharge health-care advice, investigations and treatment details were collected. Maternal mood at admission and 3 months post-discharge was measured using the Edinburgh Postnatal Depression Scale (EPDS). On admission, infant medication for proposed cause of excess irritability was ceased, with parental consent, if it was appropriate and following full medical assessment. Individual case plans were designed by the admitting child health nurse in consultation with the mother. These included education as to normal infant behaviour, settling techniques, and establishment of routine; family issues were also explored.

Fifty-one consecutive mother-infant pairs consented to participate and formed the cohort, 48 (94%) were available for follow-up interview 3 months post-discharge. The average age on admission was 13 weeks (range 4-28 weeks), 32 (62.7%) were male, 34 (66.7%) were first born and 45 (88.2%) lived with both their parents. A multiplicity of health professionals had been involved in the pre-admission care, and 48 of the infants had been or were currently on medication for gastro-oesophageal reflux disease and or colic. At the end of admission, diagnoses made were predominantly behavioural (22) and feeding problems (20). Nine infants were felt to have an organic cause for their irritability. Maternal mood improved significantly on EPDS from the time of admission (45 (86.2%) of mothers with scores > or = 12, mean score 16.5) to post-admission follow up (9 (18. 8%) with scores > or = 12, mean score 7.2).

There is evidence that a proportion of babies with 'normal' irritability are being incorrectly diagnosed as having an organic disorder exposing them inappropriately to medication, which may be harmful, and potentially creating lifelong problems for these infants and their families.