Delerium

Understanding and managing delirium in children and adolescents

What is pediatric delirium?

Delirium is a sudden change in a child’s mental state, causing confusion and altered thinking and behavior due to changes in brain function. It is common among hospitalized children, including infants and adolescents, typically resolving as the child recovers from their illness.

Causes of pediatric delirium

Delirium in children can be triggered by several factors, often simultaneously:

• The underlying illness
• Infection
• Medications, including those for pain management or sedation
• Disruption of the sleep-wake cycle
• Chemical changes in the brain
• Reduced oxygen supply to the brain
• Intoxication or withdrawal from drugs and alcohol

Symptoms of pediatric delirium

Children with delirium may exhibit:

• Confusion about their location or recognizing familiar people
• Speaking incoherently
• Emotional distress that is hard to soothe
• Difficulty focusing or remembering things
• Irregular sleep patterns, such as excessive sleep or insomnia
• Reversed sleep-wake cycles
• Behavioral changes (aggressive, watchful, suspicious, apathetic, withdrawn)
• Hallucinations (seeing or hearing things that aren’t there)
• Agitations, such as restless movements or pulling out medical devices

Symptoms can fluctuate, often intensifying at night. Experiences during delirious episodes can be frightening.

Managing pediatric delirium in the hospital

Monitoring and treatment:

• The healthcare team, including nurses and doctors, will closely monitor your child’s mental status.
• Treatment involves addressing the underlying causes, such as adjusting medications, improving oxygen levels and treating infections.
• Medications might be prescribed to manage severe symptoms of delirium.
• Nurses will create a calming environment and establish a good sleep routine to support recovery.

Family support:

• Stay calm and reassuring at the bedside.
• Bring familiar items (e.g., favorite blanket, stuffed animal, calming music) to comfort your child.
• Remind your child gently of the time of day and their location.
• Avoid arguing with them; instead, redirect their attention to positive thoughts or activities.
• Ensure they use glasses or hearing aids if necessary.
• Focus on safety during agitated episodes.
• Encourage daytime activities and proper sleep routines at night.
• Take care of yourself to help support your child effectively.
• Explain the delirium experience to your child once they are more stable.

Supporting your child at home post-delirium

Once home, continuous support and monitoring may be needed. Here are steps to help manage potential longer-term effects:

Recovery and kong-term management:

• Inform primary healthcare providers and future care providers of any past delirium episodes.
• Communicate with your child’s school and teachers about their delirium experience to aid in their ongoing recovery and school reintegration.

Addressing cognitive and emotional changes:

Post-hospital cognitive changes:

• Some children may struggle with thinking and concentration, affecting their school performance.
• Signs to watch for include reluctance to attend school, poor academic performance, trouble focusing, and behavioral issues.

Emotional and mental health changes:

• Monitor for signs of anxiety, depression, or PTSD, such as sadness, fear, sleep disturbances, bad dreams, fear of loud noises and confused memories.
• Consult with your child’s provider if you have concerns. They might suggest mental health support or evaluation.

Family involvement:

• Share effective calming strategies with the healthcare team.
• Provide insights into your child’s communication methods, including any devices they use.
• Incorporate familiar items and routines to create a supportive home environment.

To ensure comprehensive care for your child, integrate physical therapy, occupational therapy, child life specialists, speech therapy and mental health providers as part of the recovery plan. These professionals help address both the physical and emotional aspects of healing.

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