“Definition and Subtypes of Pediatric Delirium” by Chani Traube for OPENPediatrics

“Definition and Subtypes of Pediatric Delirium” by Chani Traube for OPENPediatrics


Definition and Subtypes of Pediatric Delirium
by Dr. Chani Traube. Delirium is acute brain dysfunction. It’s a behavioral syndrome that occurs as
a result of an underlying serious illness, or as a side effect of treatment for that
illness. The hallmarks of delirium is that it needs
to be acute and fluctuating, and involve a disturbance in two things; one is awareness
or attention, and the other is cognition. Importantly, delirium is almost always reversible. Just like when you are severely ill, it can
affect your kidneys or your liver, so too when you’re severely ill it can affect your
brain. So the behavioral syndrome that we note is what
we call delirium. There are different subtypes of delirium. So there’s the hyperactive subtype, which
I think comes to mind most often when we think about delirium. That’s the agitated, restless child who interferes
with our ability to care for them. So those kids tend to get our attention. The much more common subtype of delirium is
the hypoactive subtype. That involves the apathetic child with decreased
responsiveness. Those kids, very often, don’t rise to the
level of our awareness without routine screening. If you think about it, the child who just
lies there in her bed and allows us to do whatever interventions are necessary to care
for her without protesting much. That child, we like. We call her a good patient. We don’t necessarily recognize how inappropriate
her behavior is developmentally. And we don’t necessarily recognize her as having
hypoactive delirium unless we have a high index of suspicion. The mixed delirium subtype are the children
who vacillate between the two subtypes over the course of the day. And the more pediatric delirium research we
do, the more we’re coming to recognize that the vast majority of delirium in children
is hypoactive, or mixed, and the hyperactive, dramatic, agitated subtype is really only
the tip of the iceberg.

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