Delirium in Children and Adolescents

Abstract

Rarely reported in pediatric patients, the characteristic symptoms and course of delirium are well known in adults. This retrospective study was undertaken to describe the clinical presentation, symptoms, and outcome of delirium in children and adolescents. Eighty-four patients age 6 months to 18 years were identified with delirium, from 1,027 consecutive psychiatric consultations during a 4-year period. Mortality was high (20%), and length of stay was prolonged. Symptoms of psychosis and disorientation were less characteristic, but overall the presentation and course of delirium were similar to adults, and the current Diagnostic and Standard Manual of Mental Disorders (DSM) criteria were found applicable in the pediatric population.

Delirium in Children: Identification, Prevention, and Management

“…17,18 Prevention and management of delirium in children may benefit from a holistic, interprofessional approach that first focuses on identifying, modifying, and, when possible, correcting a patient's underlying medical conditions that may be contributing to the delirium. 7,[19][20][21] Because of the complexity of a critically ill child's condition and the required management, completely modifying or correcting the underlying condition is not always possible, so equal attention must be paid to minimizing the risk for the development of delirium and modifying the PICU environment to better support a delirious patient. 4,7,[19][20][21][22] Finally, providing psychosocial support to a delirious child and the child's family is essential.…”

“…• Room in a quieter part of the pediatric intensive care unit, away from unit traffic and activity for child with hyperactive or mixed delirium 2,17 • Room near more active area of the unit, with ageappropriate interactions with surroundings, for child with hypoactive delirium 2,17 Decorate room with familiar pictures of home, family, friends, and favorite pets 7,24,25 Have on hand favorite toys, blankets, music, and personal items 11,17,23,28 Use physical restraints as a last resort; their use may increase agitation and create additional problems, such as loss of mobility and prolonged confusion 20,23,[28][29][30] Children who need glasses or hearing aids should wear them when possible…”

“…2,[19][20][21]27,41 Pharmacological intervention may be necessary when a child's psychomotor symptoms interfere with the child's safety, especially when the medical condition causing or contributing to the delirium cannot be immediately remedied. 2,16,17,19,21,23,27,28 In these situations, medications to help manage the signs of delirium may be appropriate to enhance the child's safety and to support brain function.…”

Hearing the Child's Voice: Their Lived Experience in the Pediatric Intensive Care Unit

“…They generally have longer stays; however, it is not clear whether longer stays lead to children's developing delirium, or whether delirium results in longer hospital stays Grover, 2012;Smeets et al, 2010;Turkel & Tavare´, 2003).…”

“…Symptom onset is usually acute with intensity of symptoms fluctuating with delirium duration (Turkel & Tavare, 2003). Hypoactive delirium is characterized by apathy, decreased responsiveness and withdrawal with patients perceived as not thinking clearly.…”