Loss experience in children: a guideline for primary care Everyone gets confronted with severe loss experiences during life, such as bereavement of a significant other, loss of a loved one after a divorce or loss of one’s own capabilities due to illness. Health care providers need to be equipped with substantial knowledge about children’s experiences of grief and distress in order to support family members properly. Moreover, this can influence the next generation’s capabilities to cope with stressful life events. The current article describes the characteristics of loss experiences in children up to 11 years. Developmental phases, as well as the need to explain to children the 4 fundamental characteristics of death will be discussed (i.e. finality, irreversibility, universality and causality). While grief and distress in children can generally be managed by the immediate surrounding of the child, sometimes professional support is necessary, which is also discussed in this article. Finally, the authors present 4 key principles and concrete recommendations on how adults can respond to children who lost someone so that they can regain pleasure in life.
Hyperactive delirium in an 11-year-old boy with juvenile neuronal ceroid lipofuscinosis and a SARS-CoV-2 infection An 11-year-old boy with juvenile neuronal ceroid lipofuscinosis (JNCL) is admitted because of acute agitation and hallucinations. Upon admission, the patient takes lorazepam, which does not induce the expected rest. A PCR-test had a positive result for SARS-CoV-2. Juvenile neuronal ceroid lipofuscinosis (JNCL) is a rare neurodegenerative disease in children and adolescents. Hallucinations are a known symptom in the course of the disease. In the case discussed in this article, however, the pronounced hallucinations fit within a broader clinical picture of a hyperactive delirium. A delirium is by definition provoked by a physical cause. In the presented case, JNCL was an existing risk factor for a delirium, the SARS-CoV-2 infection and lorazepam were presumably the triggering factors. Recent literature shows that an asymptomatic or mildly symptomatic SARS-CoV-2 infection can also trigger a delirium. Treatment consists of treating the physical cause (if possible), supportive measures for the patient and context, as well as medication. The antipsychotics risperidone and haloperidol are recommended. Within the context of JNCL, cautious initiation of a second-generation antipsychotic, such as risperidone, along with great alertness to possible side effects, such as extrapyramidal symptoms and neuroleptic malignant syndrome, are advised. For the young patient in the discussed case risperidone was started, supplemented with olanzapine as rescue medication. The medication had a good effect and no side effects were observed.
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