Pediatric delirium represents an acute alteration in a child’s brain function. It manifests as sudden changes in how a child thinks and behaves, often differing significantly from their typical disposition. This condition requires prompt medical evaluation and intervention, as it is not simply a behavioral issue or emotional response. It can affect children of all ages, from infants to teenagers, and its onset can be rapid or gradual, lasting anywhere from minutes to days.
Recognizing Pediatric Delirium
Observing a child for changes from their usual behavior helps recognize pediatric delirium. Signs and symptoms can begin suddenly over a few hours or develop more gradually over several days. These symptoms often fluctuate throughout the day, sometimes appearing worse at night or in the late afternoon. Children may experience reduced awareness of their surroundings, appearing disoriented or easily distracted.
Pediatric delirium presents in different forms, including hyperactive, hypoactive, and mixed types. Healthcare providers use specific tools, such as the Cornell Assessment for Pediatric Delirium (CAPD) and the Pediatric Confusion Assessment Method for the ICU (pCAM-ICU), to help diagnose the condition.
Hyperactive Delirium
Hyperactive delirium involves restlessness, agitation, rapid mood changes, or even hallucinations (e.g., picking at invisible objects, combative behavior).
Hypoactive Delirium
Hypoactive delirium, more common in children, involves inactivity or reduced motor activity, making them appear sluggish, abnormally drowsy, withdrawn, or in a daze. Lack of eye contact or decreased responsiveness may also occur.
Mixed Delirium
Mixed delirium involves a fluctuation between both hyperactive and hypoactive symptoms. A child might switch between being agitated and then appearing apathetic.
Causes and Risk Factors
Pediatric delirium can arise from various underlying medical conditions and environmental factors. Severe illnesses like infections, respiratory failure, or body chemistry changes (e.g., low sodium) can disrupt brain function and lead to delirium. Major surgery and head injuries also increase the risk.
Certain medications can contribute to delirium, including sedatives, opioids, and anticholinergic drugs, by having neurotoxic effects or disrupting brain chemistry. Withdrawal from certain medications can also be a cause. Prolonged hospitalization, particularly in an intensive care unit, can disrupt a child’s sleep-wake cycle, contributing to delirium. Lack of sleep, an unfamiliar environment, sensory deprivation (insufficient light or sound), or sensory overload (excessive noise or light) also play a role. Young children, those with developmental delays, or pre-existing neurological conditions like epilepsy may also have a higher risk.
Treatment and Management
Addressing pediatric delirium involves a two-pronged approach: treating the underlying cause and providing supportive care. This involves identifying and addressing medical factors like treating infections, correcting electrolyte imbalances, ensuring adequate oxygen, or adjusting problematic medications. Minimizing or tapering deliriogenic medications (e.g., benzodiazepines, opioids) is often a priority.
Non-pharmacological interventions are often the initial approach. Creating a calm, consistent environment helps by reducing noise and adjusting light to promote a normal day-night cycle. Encouraging family presence is highly recommended, as familiar faces and voices provide comfort and reorientation. Providing familiar objects from home (e.g., toys, blankets) also helps soothe the child. Engaging children in age-appropriate activities, promoting early mobilization (if medically permissible), and regularly reorienting them to their surroundings (time, place, situation) are also beneficial.
Medication may be considered for severe agitation or disruptive symptoms, especially if they interfere with safety or medical care. This is typically a secondary measure, with atypical antipsychotics (e.g., olanzapine, quetiapine, risperidone) or haloperidol for hyperactive delirium.
Long-Term Outlook and Support
Many children who experience pediatric delirium recover fully as their underlying medical condition improves. However, some children may experience lingering cognitive or psychological effects following an episode of delirium. These may include difficulties with attention, memory, and executive functions, potentially impacting school or usual activities.
Psychological consequences may also manifest as anxiety, depression, or post-traumatic stress symptoms, including nightmares or flashbacks of the hospital experience. Families should be aware of these potential effects and seek follow-up care. Pediatricians can provide guidance and refer families to specialists (e.g., psychologists, counselors) for ongoing support and rehabilitation. Family support groups and educational materials also provide valuable resources, helping families understand recovery and cope with challenges.