Delirium

Children and teenagers suffering from delirium do not act like themselves. These changes are usually mild, but if more severe, the changes in personality can be very frightening to both the child and the parent.

What is Delirium?

Delirium is a serious disturbance in mental abilities.  It involves changes in behavior, confused thinking, and reduced awareness of a person's surroundings.

Delirium is a serious complication of medical illness. It is caused by the presence of one or more contributing medical factors.

These may include: severe or chronic medical illness, a change in body chemistry (such as low sodium), medication, infection, surgery, or severe injury like broken bones or serious burns.  Delirium requires appropriate diagnosis and adequate treatment.

Doctors have identified three types of delirium:

  • Hyperactive delirium is probably the most easily recognized type of delirium, It may include restlessness, agitation, rapid mood changes or hallucinations.
  • Hypoactive delirium usually includes inactivity or reduced motor activity. A child may seem sluggish, abnormally drowsy or to be in a daze.
  • Mixed delirium includes both hyperactive and hypoactive symptoms. The child may switch back and forth between these states.  These changes may occur quickly or may take place more gradually.

What Symptoms Should Parents Look for?

Signs and symptoms of delirium can start suddenly over a few hours or more gradually over a few days. They often come and go throughout the day. There may be periods of no symptoms. The symptoms may get better or worse. Symptoms can last for hours or weeks.

Symptoms for children tend to be worse beginning in the late afternoon through the nighttime. Often delirium interferes with sleep. Primary signs of delirium include:

Reduced or Changed Awareness of Their Surroundings

  • Disorientation (for example, not knowing who or where you are).
  • Being easily distracted by unimportant things.
  • Being withdrawn, with little or no activity or little response to the environment.

Poor Thinking Skills (Cognitive Impairment)

  • Poor memory, particularly of recent events.
  • Loss of the ability to stay focused on a topic or even on play.
  • Getting stuck on an idea rather than responding to questions or conversation.
  • Difficulty speaking or recalling words.
  • Rambling or nonsense speech.
  • Trouble understanding speech.
  • Difficulty reading or writing.

Changes in Behavior

  • Seeing, hearing or feeling things that aren't there (hallucinations).
  • Restlessness, agitation or combative behavior.
  • Calling out, moaning or making other sounds.
  • Being unusually quiet and withdrawn.
  • Slowed movement or lethargy.
  • Disturbed sleep habits.
  • Reversal of the night-day sleep-wake cycle.

Emotional Disturbances

  • Anxiety, fear or paranoia.
  • Depression.
  • Irritability or anger.
  • Apathy or loss of interest.
  • Rapid and unpredictable mood shifts.
  • Personality changes.

What Causes Delirium in Children?

Many conditions can cause delirium including:

  • A severe burn or other serious injury.
  • Underlying new or chronic illness, including, seizures, infections, a very high fever, and/or problems with the thyroid or adrenal glands.
  • Adverse effects of medications.
  • Anesthesia, referred to as emergence delirium.
  • Head injury.
  • Disruption of the sleep-wake cycle.
  • Not enough oxygen to the brain.
  • Major surgery.
  • Poisoning.
  • Electrolyte imbalances.

How is Delirium Diagnosed?

The diagnosis of delirium starts with a review of the patient’s medical history. Input is gathered from nursing and the rest of the medical team. Then the doctor will assess the patient’s mental status by examining awareness, behaviors and thinking. These assessments often can be done informally through conversation with the child and parent.

The doctor may also want to perform physical exams and sometimes lab tests. The purpose of these exams is to check for health problems or an underlying disease that might be causing the delirium.

How is Delirium Treated?

Treating delirium starts with addressing the underlying causes or triggers. It may mean reducing the dosage or eliminating a medication until the delirium is resolved. It may mean treating an infection. When delirium is severe, a short course of medication is sometimes needed to help the brain recover fully.

Delirium is usually a temporary condition. It is reversible when the underlying condition has been treated.

When Should You Seek Help for Children with Delirium?

If you see any of the signs of delirium, talk to your child. Try to clarify what he or she is experiencing. Any child with disordered thinking or behavior should receive immediate medical and psychological evaluation.

If you are concerned, speak with your family physician or pediatrician. They will be able to refer you to a child and adolescent psychiatrist who is trained to evaluate, diagnose and treat children with emotional and behavior problems.