The diagnosis and treatment of delirium in children

Abstract

Delirium is commonly encountered in the setting of paediatric consultation-liaison psychiatry. However, it is commonly misdiagnosed as current operational diagnostic criteria may be difficult to apply in children. We present a practical approach to eliciting the signs and symptoms of delirium in children and a proposed treatment algorithm which elaborates a variety of environmental management strategies and includes explicit thresholds for the use of antipsychotic medications.

Delirium in Children: Identification, Prevention, and Management

“…15 Delirium is a fluctuating condition, so serial assessments are of great value, because the timing of the assessment may play a crucial role in detecting the presence of delirium. 16 The frequency with which delirium screening should be performed has not been established.…”

“…They also experience excessive noise, bright lights, and ongoing activities that make maintaining a normal sleep-wake cycle difficult. 16 This sensory overstimulation, coupled with sleep interruptions, may further exacerbate a delirious child's thought misperceptions, disorientation, and inattention. 4,7,16 Nurses are in a prime position to modify and manage this environment in the best interest of a delirious child.…”

“…16 This sensory overstimulation, coupled with sleep interruptions, may further exacerbate a delirious child's thought misperceptions, disorientation, and inattention. 4,7,16 Nurses are in a prime position to modify and manage this environment in the best interest of a delirious child. Table 5 describes specific modifications that can be made to the PICU environment to further support a child with delirium.…”

“…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.…”