Delirium in the Pediatric Intensive Care Unit (PICU)
Delirium is a severe state of confusion that
may involve changes in thinking, attention
and perception. It often occurs quickly and
can come and go. Usually this lasts for only
a short period of time.
What are the causes of delirium?
Patients in the ICU are at high risk for
developing delirium. Experts think delirium
is caused by a change in the way the brain is
working. There are many factors that can
contribute to the development of delirium,
including: severe illness, infections,
decreased oxygen, lack of sleep, certain
medicines and other treatments that are
needed while in the ICU.
If your child is critically ill they often will
need tubes or masks to help them breathe,
IV’s to give them medicines, and other
uncomfortable procedures. It is often hard
for children to understand what is happening
to them, which can be distressing. Distress
can lead to delirium and confusion that may
cause patients to pull out important
breathing tubes or IV lines. To prevent
patient distress, we often treat their
discomfort with medicines to help decrease
pain and anxiety. Unfortunately, these
medicines can sometimes cause confusion
and delirium as well.
What are the signs of delirium?
The ICU staff is trained to know and treat
delirium. Signs of delirium may change
from day to day. Patients may:
• Be confused and may not seem like
• Be inconsolable and agitated
• See or hear things that are not there
• Be unable to think clearly
• Be unable to pay attention
• Be tense & restless
• Slur speech or use bad words
• Have trouble staying awake or mix
up day and night
How is delirium treated?
Treatment depends upon the cause of
delirium. The health care team works
together to treat delirium. When patients
become more medically stable, we try to:
keep patients comfortable yet alert, review
the need for medical devices (breathing
tube, bladder catheter, or central line) each
day and remove them as soon as possible,
and get patients out of bed. Sometimes it is
necessary to keep patients on pain and
sedations medicines for a short period of
time and slowly decrease their dose to
prevent delirium that can be caused by
suddenly stopping certain medicine.
What can I do to help?
You are vital to your child at this time.
While staff provides a safe setting, you can
help support your child and help them feel
safe. Observe quiet hour rules in the PICU
to help patients sleep. Often, children
become distressed when their parents are
distressed. Although it can be very hard to
remain calm and comforting when your
child is ill, helping them feel safe and
comfortable is important. Let nurses know
how your child normally reacts to pain.
Talk with the staff about what you can do.
In the ICU:
• Reduce noise by turning off the TV
• Sit with your child. Hold your
infant or toddler if it is OK’d with
the medical team. Familiar faces
and voices are especially important
to making a child feel safe and
• Speak in a calm voice and use
simple words to help your child
know what is going on.
• Talk with your child about familiar
things that interest him or her such
as family, friends, pets & hobbies.
• Bring in familiar books to read,
family photos, or known items that
comfort your child. Do not bring
• Use good lighting. Keep the lights
on during the day and into the early
evening to prevent confusion of
voices and sounds. Dim the lights
during quiet hours and at night.
• When your child is confused, it is
ok to say “yes, you are confused
right now.” Let them know it will
likely go away.
• If your child has a normal routine
when he or she is well, please
share this with the nurse. We will
do our best to incorporate this
routine into your child’s care if we
After the ICU:
• Talk about what happened during
your child’s time in the PICU.
This can help him or her sort out
which memories are true and those
that are not.
• Let your child’s primary doctor
know that your child had delirium
in the hospital.
Seeing your child with delirium can make
you upset and leave you feeling helpless.
Talk with the nurse or doctor about any
concerns you may have. We are here to help
you and your child.
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 3/2017 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7968