Delirium

What is delirium?

Delirium is a sudden change in mental state or the way a patient thinks, feels, or behaves that is caused by a medical condition or treatment. Delirium can cause your child to be confused, agitated, or sleepy. They may have trouble understanding what is happening around them or might see or hear things that are not actually there.

Delirium that is not treated can cause you and your child more distress and confusion. It can increase your child’s risk of injury or death. Delirium can interfere with treatment or cause your child to stay in the hospital longer.

Treatment for delirium includes addressing the causes of the delirium, giving medicines, or controlling the patient’s surroundings.

Signs of delirium

Let a care team member know if you notice an unusual change in your child’s thoughts, emotions, personality, or behavior. If your child has delirium, they might:

• Act confused, such as not knowing where they are or who you are
• Say things that don’t make sense
• See or hear things that aren’t there; have hallucinations
• Be upset, agitated, or angry, especially if the usual ways you calm them down don’t work
• Sleep too much or too little, or sleep a lot in the daytime and stay awake at night
• Act different than usual such as scared, depressed, jumpy, restless, watchful, suspicious, or disinterested
• Refuse medicines, pull on IV lines, or not cooperate or not listen to instructions

Causes of delirium

Possible causes of delirium for children who are sick or in the hospital include:

• An infection or fever
• Medicines, such as some chemotherapy drugs, steroids, pain medicines, and sedation medicines (ones that make them sleepy)
• Being admitted to the intensive care unit, or ICU
• Breathing problems, including getting a breathing tube put in
• Problems with the body’s chemical balance. You might hear the doctor or nurse call this “electrolytes” or the “electrolyte balance.”
• Sleep problems
• A change in surroundings

Treatment for delirium

Your care team will watch your child’s behavior closely. This includes checking if your child is confused, restless, or has other signs of delirium.

Delirium can come and go quickly. Sometimes, it can last several days or weeks. Treating delirium often involves finding the main causes and treating them. The care team can do things to help your child, including giving medicines and changing their surroundings if needed. Your child’s doctor may ask the mental health care or psychiatry team to help treat your child’s delirium.

Mental health services for delirium

Mental health care providers are trained to find the causes of delirium and help stop it or keep it from getting worse. For example, a psychiatrist can prescribe medicine to treat delirium symptoms. They can also check your child’s regular medicines to learn if any of them could cause delirium.

Delirium does not mean your child is mentally ill. It means their physical illness is affecting their thinking, behavior, or emotions.

How to prevent or manage delirium

Try these strategies to help your child. You can remember them with the words “CARES FOR.”

Activity

Try to keep usual activities, and encourage your child to do things for themselves if possible. Avoid using physical restraints, such as using a “seat belt” to keep them in bed.

Re-orient

Remind your child where they are, who you are, and what day and time it is. “Re-orient” means to remind them, even if you think they should know. For older children, have a clock or calendar where they can see it.

Environment

To help your child stay focused, avoid having lots of things happening around them at the same time. Make sure your child’s room is light during the day and dark at night. Try to keep the room quiet when your child is calm or resting. Avoid having the TV on when your child is not watching. If your child wears glasses or hearing aids, make sure they have them.

Sleep

Try to keep a regular day-night routine. Help your child stay awake most of the day if possible. Your child might not always stay awake during the day because of medicines or procedures. But sleeping less during the day helps your child sleep more at night.

• During the day, help your child stay awake:
  • Keep the blinds wide open to have natural light.
  • Encourage your child to take part in activities and move around as much as possible.
  • Have friends and family visit your child if it is allowed.
• At night, help your child sleep:
  • Try to copy your child’s regular bedtime routine.
  • Turn off the TV.
  • Stay quiet and keep lights dim.

Familiar things

Give your child familiar things, such as a favorite comfort item or toy. Play soothing music they know. Bring pictures or objects from home to your child’s room. Avoid having visitors your child does not know well. Ask your care team if the same staff members can care for your child as much as possible.

Out of bed

Encourage movement and mobility. Help your child sit up in bed, get out of bed, and walk around as much as possible. Be aware that delirium can increase your child’s risk of falls. Read more about early mobility in the ICU.

Reassure

Reassure and comfort your child. Speak to your child in a calm and soothing manner. Tell them they will be OK and that they are safe. Let them know you or another loved one will stay with them.

Find more information

If you believe your child may have delirium or your child has an unusual change in behavior, tell your doctor or nurse as soon as possible.

If you have questions about delirium, please speak with your care team.

For more information on delirium and intensive care, visit these websites: