Delirium in children and adolescents: A systematic review of the literature

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.…”

“…• 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…”

“…Parents worry that the changes they see in their child may be permanent, and they need frequent reassurance and anticipatory guidance about their child's behavior, delirium management, and the expected course of the condition. 2,16,17 Observing their child's dramatic and frequent changes in mental state is frightening for hospital teachers, because these care providers help maximize the child's resiliency to stress and anxiety and the ability to cope with the current situation.…”

“…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. 7,17,21 Additional reasons for administering medications to manage or decrease the behavioral expression of delirium include limiting the time the patient is in a delirious state, decreasing any associated physical or emotional trauma and distress, and reducing the hospital length of stay.…”

“…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. 7,17,21 Additional reasons for administering medications to manage or decrease the behavioral expression of delirium include limiting the time the patient is in a delirious state, decreasing any associated physical or emotional trauma and distress, and reducing the hospital length of stay. 17,22 Antipsychotics target neurotransmitter dysregulation, and their use does not imply that the child has a psychiatric disorder or that only patients who are psychotic benefit from these medications.…”