Delirium

Causes

Delirium may be caused by:

• The underlying illness
• Infection
• Medications, such as those needed to calm or manage pain
• Disruption of the sleep-wake cycle
• Chemical changes in the brain
• Less oxygen to the brain
• Drugs and alcohol intoxication and withdrawal

Delirium usually clears up as these causes are treated or removed.

Symptoms

A delirious person may experience:

• Confusion, not knowing where they are or who you are
• Saying mixed up things
• Inconsolability, emotional upset that may not respond to usual soothing
• Difficulty paying attention or remembering things
• Sleep disturbance (too much or too little sleep)
• Reversed day/night cycle
• Behavior or emotions that are different than usual: aggressive, watchful, suspicious, apathetic or withdrawn

• Seeing or hearing things that aren’t real but seem very real
• Agitation, restless movements, pulling out lines or other important medical devices
• These signs may fluctuate (come and go)
• Memories of these experiences of confusion can be frightening

Management

Your child’s mental status will be closely monitored by your nurse and the team. Delirium usually clears up as the causes are identified and addressed. Changing medicines, improving oxygen levels, and looking for infections may all be part of treatment. While addressing these things, your child’s doctors may recommend one or more medicines to help with symptoms of delirium. Your child’s nurse will help make the room calm and help your child get on a good sleep routine, which will help his/her delirium.

How to help

• Be calm and reassuring at the bedside
• Remind your child gently where s/he is, what time of day it is
• Provide familiar things such as a favorite blanket, stuffed animal or comforting music
• Don’t argue with a confused child
• Distract child to happier thoughts/images
• Provide glasses or hearing aids if needed
• Help keep your child safe during any episode of agitation
• Encourage getting out of bed and being awake in the day, longer stretches of sleep at night
• Take care of yourself so you can be there for your child
• Explain to your child later if s/he has questions or remains distressed about confusion or hallucinations

What is pediatric delirium? 

Pediatric delirium is a change in your child’s mental state. It happens when they’re very sick. 

It makes your child very confused and changes how they think and act. These changes are sudden and can shift quickly in short periods of time. 

These changes do not often last long. As your child heals from their illness, the delirium should also get better. 

What does it look like? 

Your child may: 

• find it hard to pay attention or remember things 
• sleep too much or not enough 
• see or hear things that others don’t 
• be confused 
• be harder to soothe 
• not recognize you or know where they are 
• have strong moods that can change quickly. 

Your child’s signs of delirium may come and go. They may be worse at night. 

Why does my child have it? 

There are many things that can cause delirium in children, including: 

• illness or infection 
• changes in how they sleep 
• a head injury 
• when there’s not enough oxygen to the brain. 

Many times, more than one thing causes delirium. 

Also some medicine can add to their confusion. If this happens, we’ll find other ways to treat their illness. 

It’s common for children in the ICU to have delirium. When they get medical care 24 hours a day, it can be hard to know when to be awake and when to sleep. This can put extra stress on the brain.

How can I help my child? 

• Be calm. Talk in clear, short sentences. Ask one simple question at a time. 
• Bring in toys, pictures, or other items from home. 
• Keep their room light during the day. Keep the room dark and quiet at night. 
• Put up a clock and calendar where they can see it. 
• Play calming music at their bedside. 
• If your child is confused, don’t argue with them. Bring their attention to real events and people. 
• Remind your child where they are, what time of day it is, and what is happening. 
• If needed, give them their hearing aids and glasses. 

What should I tell my child’s health care team? 

Tell us: 

• ways that often help calm your child 
• how your child lets you know how they feel and what they need. If they use a communication device, let us know. 

How will it go away? 

As your child heals from their illness, the delirium should also get better. 

When they start to feel less confused, your child will start to be more awake and active during the day and sleep at night. 

To help them heal, your child may need different kinds of help. Your child’s health care team may include a: 

• physical or occupational therapist 
• child life specialist 
• speech therapist 
• mental health provider. 

A physical therapist, occupational therapist, or a child life specialist can help your child be more active during the day. 

A mental health provider can talk to you and give your child medicine for a short time while they heal, if needed.

What should I do after their delirium is gone? 

You should tell their primary provider that they had delirium. They can help as your child continues to heal from their illness. 

If your child is sick in the future, tell their provider they had delirium in the past. It will help with their care. 

You should also let their school and teachers know they had delirium. 

What may happen after? 

Once you’re home from the hospital, you may notice changes in how your child thinks or feels. 

Trouble thinking and focusing 

Some children find it hard to focus or pay attention. It may be hard for your child to go back to school. They may: 

• not want to go to school 
• do poorly in school 
• be unable to stay focused on one thing. 
• get in trouble. 

To help, talk to your child’s teacher and school. Ask them to let you know if your child has a hard time with their school work. They may have ideas that can help. 

If you have concerns, you can also talk to your child’s provider. 

There may be tests that can be done by their school or provider to help understand what’s going on. 

Mood and mental health changes 

Some children have anxiety, depression, or post-traumatic stress symptoms. Pay attention to how they act. 

Your child may: 

• feel sad or mad 
• feel scared or worry a lot 
• have trouble with sleep 
• have bad dreams 
• be afraid of loud noises 
• have confused memories. 

If you have concerns, talk your child’s provider. They may suggest your child meet with a mental health provider.