Delirium

 DO

• Engage parents and involved caregivers to diagnose delirium, especially in the home setting. An important question is: Does the child show the behaviours recognisable to the child? 

• Consider consultation with a child and adolescent psychiatrist before making the diagnosis.
• In the home situation, consider low threshold use of observation lists CAP-D, SOS-PD and PAED.
• With signs of apathy, consider diagnosis of hypoactive delirium.

 DO

• Screen critically ill children daily for modifiable risk factors and treat them.

 DO

• Deploy, whenever possible, non-medical interventions focused on prevention, orientation, communication, matching stimuli, and safety to treat paediatric delirium.
• Involve parents in the child's care as much as possible.
• Delirium is an intense experience for all involved. Provide adequate (after) care for the child and family, environment, and caregivers (in the form of training).

 Consider
 

• In children with delirium, consider treatment with medication if non-drug interventions do not have a sufficiently rapid effect.
• Depending on the adverse effects profile, drug interactions and available routes of administration, a choice may be made between risperidone or haloperidol.
• In case of non-response or adverse reaction to first administered drug (haloperidol or risperidone), consider switching drugs or administering quetiapine.
• When starting antipsychotics, be alert to side effects including extrapyramidal symptoms and prolongation of QT interval.
• For severe acute dystonia as a side effect of medication requiring treatment, consider biperidene. 

 Consider

• In children in the terminal phase with refractory delirium, consider palliative sedation.

 
 DO

• Evaluate the effect and side effects of the treatment instituted at the appropriate time, and adjust treatment as needed. Involve child and family in this process.