What is Emergence Delirium?

First published September 2013
Updated October 2026

As a pediatric anesthesiologist, I thought the hardest part would be handing my child over for their procedure. I prepared myself for the waiting, the worry, and the recovery. I expected tears when he woke up, some discomfort, and maybe a little confusion from the anesthesia. What I wasn’t prepared for was watching my child become completely inconsolable.

When he emerged from anesthesia, he was intensely agitated and no amount of comforting helped. He cried, thrashed, pushed us away and seemed trapped in a state of fear that we couldn’t reach. As a parent, it was heartbreaking. The nurses reassured us that what we were seeing wasn’t uncommon, but in that moment, it felt anything but normal. I knew what my child was experiencing was postoperative pediatric delirium, sometimes called emergence delirium. I had guided many other children through this, but it was difficult to experience it firsthand.

What Is Emergence Delirium?

Emergence delirium is a temporary period of confusion and altered awareness that can occur as a child wakes up from general anesthesia. During this time, they may appear awake but are not fully aware of their surroundings. Instead of gradually becoming alert, some children experience intense agitation, crying, restlessness, or fear. They may:

• Be inconsolable despite their parents’ presence
• Cry or scream uncontrollably
• Push away family members
• Appear terrified or confused
• Not recognize familiar faces for a short period
• Try to climb out of bed or remove IVs or monitors

These behaviors are caused by the brain adjusting as anesthesia wears off- not because your child is intentionally acting out. Although it is frightening to witness, the episode is temporary and usually resolved within minutes to an hour.

Why Does It Happen?

Nobody fully understands why some children experience emergence delirium and others do not. It has been seen with all types of anesthetic medications, and the incidence varies widely in reporting. There are a few factors that appear to increase the risk including younger age (especially children between 2-6 years old), certain types of surgeries including ear, nose, throat, and eye procedures, and anxiety before surgery. While pain is considered one of the factors that contributes to emergence delirium, we even see it after non-painful procedures like MRIs and other imaging studies.

What Parents Should Know

Parents are often the first to witness these episodes. Simply knowing what emergence delirium is can help you feel more prepared and confident during your child’s recovery and can help families respond with patience while allowing the medical team to assess whether additional treatment is needed. It is important to remember that this reaction is not caused by anything you could have prevented or did wrong.

Every child is different and the medical team will decide the best approach for treating emergence delirium. Depending on the situation, some strategies may include:

• Treating pain promptly
• Providing a calm, quiet recovery environment
• Allowing parents to be present during recovery when possible
• Using medication when severe agitation poses a safety risk

Sometimes, when facing a particularly robust bout of emergence delirium, we will give extra sedating medications. You can think of this as a soft reset for your phone or computer. We put the child back “to sleep” and allow them to “wake up” again which nearly always works.

Emergence delirium is real and it can be frightening to witness. While we may not completely understand why it happens, we are prepared and skilled at treating it. Most importantly, most children recover quickly and there are no lasting effects.

What Can Parents Do?

• Talk to your child before their procedure. Knowing what will happen and what to expect the day of surgery can help them feel prepared and more in control.
• Bring comfort items with them to the hospital. A favorite toy, blanket, or stuffed animal can help them feel safe.
• Try to control your own nerves. We know pre-operative parental anxiety is a factor in development of emergence delirium. Feel free to ask questions and let us know how we can help!
• Stay calm and try to minimize overstimulation. Speak in a gentle, reassuring voice, use familiar words, and try to keep the environment quiet and dim to reduce sensory overload.