Delirium

Children and teenagers suffering from delirium do not act like themselves. These changes are mild, but if drastic, 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 seeming 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.

Delirium starts suddenly and can cause hallucinations. The symptoms may get better or worse. They can last for hours or weeks.

What Symptoms Should Parents Look for? 

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

Signs and symptoms of delirium usually begin over a few hours or a few days. They often come and go throughout the day. There may be periods of no symptoms.

Symptoms for children tend to be worse after dark, when things look less familiar. Primary signs of delirium include:

Reduced awareness of their surroundings

  • Loss of the ability to stay focused on a topic.
  • Getting stuck on an idea rather than responding to questions or conversation.
  • 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  • Being withdrawn, with little or no activity or little response to the environment.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.
  • Disorientation (for example, not knowing who or where you are).
  • Difficulty speaking or recalling words.
  • Rambling or nonsense speech.
  • Trouble understanding speech.
  • Difficulty reading or writing.

Changes in behavior

  • Seeing things that don't exist (hallucinations).
  • Restlessness, agitation or combative behavior.
  • Calling out, moaning or making other sounds.
  • Being 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.
  • A sense of feeling elated (euphoria).
  • Apathy.
  • Rapid and unpredictable mood shifts.
  • Personality changes.

What Causes Delirium in Children?

Many conditions can cause delirium including:

  • Severe emotional stress.
  • Underlying illness, including migraines, seizures, infections, a very high fever, and 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.
  • Drugs or alcohol.
  • Poisoning.
  • Electrolyte imbalances.

How is Delirium Diagnosed?

The diagnosis of delirium starts with a review of the patient’s medical history. Then the doctor is likely to assess the patient’s mental status by screening for awareness, attention and thinking. These assessments can be done informally through conversation.

The doctor may also want to perform physical and neurological exams. 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.

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.