About this child

In pediatrics, what counts as “normal” depends on age and development — so we start here. These details stay on this device and are de-identified (no names or identifiers); they choose which screen applies and how each item is interpreted.

Reference aid only. This pediatric tool supports — and does not replace — clinical judgment, local protocol, and prescriber/pharmacy review. It is not a validated decision-support device or an order set. Pharmacologic content is off-label and limited-evidence; verify every weight-based dose against your institution's formulary.

Child context

Chronological age

Baseline mental status

Weight (kg) — optional

Wears glasses / corrective lenses — have them in place Uses hearing aids / cochlear device — have them in place

Screen

1 · Arousal — the screening gate

Score arousal first. RASS −4/−5 (or SBS −3) = comatose → record unable to assess; screen only once the child responds to voice (RASS ≥ −3). SBS is the pediatric arousal scale for intubated infants and young children.

Arousal level

2 · CAPD — Cornell Assessment of Pediatric Delirium

Rate the child over the shift against age-expected behavior. Eight items, 0–4 each (0–32 total); ≥ 9 = positive.

2 · pCAM-ICU / psCAM-ICU features

Delirium is present when Feature 1 and Feature 2 are present and (Feature 3 or Feature 4). pCAM-ICU (≥ 5 yr): verbal attention and command tasks. psCAM-ICU (6 mo–5 yr): age-adapted observational tasks.

Result

Select an arousal level to begin.

References

Pediatric ICU delirium — risk factors

PICU delirium is common (point prevalence ~25%; higher with mechanical ventilation and developmental delay) and is mostly hypoactive or mixed — easily missed. This is a review aid summarizing reported associations, not a validated predictive score. Minimizing the modifiable factors — benzodiazepines above all — is the actionable lever. Factors your child profile already implies are flagged automatically; check any others that apply.

Modifiable levers: prefer dexmedetomidine over benzodiazepines; deprescribe anticholinergics; target light, goal-directed sedation; mobilize early; minimize restraints; protect sleep and maximize family presence.

References

Clinical values carry a pediatric-clinician sign-off gate.

Treatment — a stepwise pathway

Delirium treatment is mostly non-pharmacologic. Drugs treat symptoms (short-term, refractory agitation that threatens safety), never the delirium itself, and no agent is FDA-approved for pediatric delirium. Weight-based starting doses are in Medications.

Step 1 — Treat the cause & apply the bundle (first-line)

Find and fix precipitants. Optimize analgesia; switch benzodiazepine sedation to dexmedetomidine; deprescribe anticholinergics; restore sleep and day–night rhythm; mobilize early; maximize family presence; and assess for iatrogenic withdrawal (WAT-1). This is the treatment — drugs are adjunctive.

Step 2 — If agitation threatens safety and non-pharm has failed

Consider a short course of an atypical antipsychotic (risperidone, quetiapine, or olanzapine — generally preferred over haloperidol) at the lowest effective dose, reassessed daily. See Medications for weight-based starting doses.

Off-label, limited evidence. No pediatric randomized trial supports antipsychotics for PICU delirium; the data are retrospective and observational, and a large database study linked antipsychotic use to higher mortality (confounded by indication). Use the lowest dose for the shortest time.

Step 3 — Reserve IV haloperidol

Reserve IV haloperidol for severe agitation when enteral atypicals aren't feasible. It carries higher QTc / torsades and EPS / acute-dystonia risk than the atypicals — continuous ECG, correct K / Mg, and have IV diphenhydramine or benztropine ready.

Before & during any antipsychotic — monitoring

Baseline 12-lead ECG (QTc), electrolytes (K, Mg, Ca), and review of concurrent QT-prolonging drugs (ondansetron, methadone, macrolides, azoles, certain antiarrhythmics). Act on QTc > 450–500 ms or a ≥ 25% rise from baseline (closer monitoring, dose reduction, or stop). Watch for acute dystonia / EPS (most with haloperidol — treat with IV diphenhydramine or benztropine), akathisia, and NMS (fever, rigidity, autonomic instability, ↑ CK). Over longer courses, watch weight gain and metabolic change (highest with olanzapine and quetiapine).

References

Clinical values carry a pediatric-clinician sign-off gate.

Not an order set. Pharmacologic content is off-label and limited-evidence. Doses below are weight-based starting points from the pediatric literature — verify every dose against your institution's formulary and a current pediatric reference (Lexicomp Pediatric / Harriet Lane) before prescribing.

Sedation & sleep

Agent	Pediatric dose	Notes
Dexmedetomidine preferred	0.2–1 mcg/kg/hr IV infusion, titrated to a light goal; a loading bolus is often omitted in the PICU to limit hemodynamic effects.	Delirium-sparing — preferred over benzodiazepines. Bradycardia, hypotension (biphasic BP); caution in cardiac disease / AV block. Rebound agitation/hypertension if stopped abruptly after prolonged use — taper. No analgesia or amnesia. Off-label < 18 yr.
Benzodiazepines (midazolam, lorazepam)	Limit / avoid as continuous sedation.	Independent, dose-related delirium risk. Do not escalate to treat delirium-related agitation. Reserve for specific indications (status epilepticus, sedative / alcohol withdrawal, procedural need).
Melatonin	0.5–3 mg PO at bedtime (younger); up to 3–5 mg (older children / adolescents).	Sleep / circadian support — not a delirium treatment. Limited pediatric ICU evidence. Confirm product (immediate- vs extended-release).

Antipsychotics — off-label, limited evidence (short-term, refractory agitation only)

Agent	Pediatric dose (enteral unless noted)	Notes
Risperidone	< 5 yr ~0.1 mg q12–24h; ≥ 5 yr ~0.2 mg q12–24h. ≤ 2 yr ~0.01–0.04 mg/kg/day (mean ~0.02). Titrate; maintenance up to ~2 mg/day.	Often first-line oral. QTc (least among atypicals — still monitor), EPS / dystonia, hyperprolactinemia, sedation, metabolic. Baseline + follow-up ECG.
Quetiapine	~0.43–0.7 mg/kg/dose q8h (≈ 1.5 mg/kg/day); reported median ~1.3 mg/kg/day.	Sedating (useful at night); often chosen in the cardiac ICU. QTc prolongation reported; orthostasis, metabolic. Baseline + follow-up ECG.
Olanzapine	Age-banded start: infants ~0.625 mg; toddlers ~1.25 mg; older / severely agitated ~2.5–5 mg, once–twice daily. ODT useful if swallowing is difficult.	Prominent sedation and metabolic / weight gain; anticholinergic effects; QTc.
Haloperidol reserve	Reserve for severe agitation when enteral atypicals aren't feasible. IV (off-label): load ~0.025–0.1 mg/kg/dose, may repeat; maintenance ~0.015–0.15 mg/kg/dose IV q6–8h. Oral liquid available.	High caution. Dose-dependent QTc prolongation / torsades — continuous ECG, correct K / Mg; IV use carries an FDA torsades warning. More EPS / acute dystonia than atypicals in children (have IV diphenhydramine / benztropine ready). NMS; lowers seizure threshold. Avoid in long-QT, significant hepatic impairment, Parkinsonism.

Deliriogenic medications — review & minimize

Benzodiazepines (strongest modifiable risk) · anticholinergics (diphenhydramine, atropine / glycopyrrolate, scopolamine) · high or escalating opioids (analgesia first, but cumulative dose is a risk) · corticosteroids (dose-related neuropsychiatric effects) · other CNS-acting / GABAergic agents.

References

Weight-based values must map to Lexicomp Pediatric / Harriet Lane (edition pinned at sign-off). All doses carry a pediatric-clinician + pharmacist sign-off gate.

Institution & unit

Facility-level settings — they persist on this device and print on the report, and are kept when you start a new child.

Hospital / PICU unit

Protocol version

Default arousal scale

Screening frequency

Pediatric approvals

PICU governance roles. Unlike adult units (medical director + nursing), the off-label weight-based dosing carries a pediatric pharmacist sign-off.

PICU medical director / attending intensivist

PICU nurse leader

Pediatric pharmacist — dosing sign-off

Last reviewed

Next review due

Settings also auto-save in this browser.

Generate Documents

A one-page, de-identified summary of this assessment — child context, screen result, flagged risks, medications given, and your unit governance — generated on this device. No data leaves the browser.

Assessment time

Assessed by (name or initials)

The report prints these as Assessed (time and clinician), alongside Generated (when you create it); the file is named with the generation timestamp.

Medications given this shift

Check any agents in use — they print on the report with their starting dose.