FFFDelirium in Children and Adolescents

No. 120; Updated January 2017

Delirium is a serious condition involving severe confusion and changes of behavior. Many conditions can cause delirium such as infection, fever or medication side effects. Although delirium can occur anywhere, it is more likely to happen when children are in the hospital. It is usually temporary and reversible when the underlying condition is treated. When a child or teenager is delirious, they do not act like themselves. It can be very frightening to both the child and parent. A delirious child needs medical attention immediately.

Symptoms of delirium may come and go. They can include:

  • Confusion—not knowing where they are, what day it is, who they're with or who they are
  • Agitation or restlessness
  • Picking at things that aren't there
  • Being upset and not responding to usual soothing
  • Trouble with attention or memory
  • Difficulty staying alert
  • Sleep disturbances
  • New or different behaviors like aggression, suspiciousness, or being withdrawn
  • Talking in a way that doesn't make sense
  • Seeing or hearing things that aren't real

There are many causes of delirium, including:

  • Underlying illness or infection
  • Medications
  • High fever
  • Anesthesia
  • Head injury
  • Disruption of the sleep-wake cycle
  • Not enough oxygen to the brain
  • Drugs or alcohol
  • Poisoning
  • Electrolyte imbalances

While your doctor treats the cause of your child's delirium, there are things that you can do to make your child more comfortable. Some of these things include:

  • Be calm and reassuring at the bedside
  • Remind your child gently where they are and what time of day it is
  • Provide familiar things such as a favorite blanket, stuffed animal, family pictures or comforting music
  • Don't argue with a confused child
  • Distract your child with happy thoughts or images
  • Provide glasses if needed
  • Help keep your child safe during agitation
  • Encourage getting out of bed if medically allowed and being awake during the day
  • Encourage longer stretches of sleep at night
  • Explain to your child later if they have questions or remain upset about confusion or hallucinations

If your child has delirium in the hospital, your doctor may recommend a consultation with a child and adolescent psychiatrist to help evaluate and treat your child. When a child has delirium or a serious medical illness, this experience can be stressful for both the child and the family. Sometimes continued mental health support may be helpful to address emotional or behavioral consequences even after the delirium has gone away.

Further resources:
www.iacapap.org (pediatric delirium chapter)

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