Irritability in children with profound disability

Irritability in children with profound disability

Irritability in children can present the clinician with diagnostic uncertainty, amplifi ed in
those patients with diffi culties in communication or complex medical illness. In children with
severe cerebral palsy the following differentials should be considered:
• Muscle spasm.
• Seizure.
• Pain:
– Consider all the usual sites of infection (e.g. otitis media, urinary tract, throat, sinusitis,
respiratory tract and skin).
– Gastro-oesophageal refl ux.
– Dental abscess/caries.
– Corneal abrasion/foreign body in the eye.
– Pancreatitis.
– Renal colic.
– Surgical – appendicitis, intussusception, torted testes.
– Severe constipation.
– Subluxing or dislocated hips.
– Fractures – accidental or infl icted.
– Side effects of medication e.g. anticonvulsants.
– Gynaecological.
– Sleep deprivation (associated with pain and spasm).
– Increased intracranial pressure (many children have VP shunts).