Evidence-Based Reviews

Agitation in children and adolescents: Diagnostic and treatment considerations

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Establishing a therapeutic rapport with the patient, when feasible, can facilitate smoother de-escalation by offering the patient an outlet to air his/her frustrations and emotions, and by helping the patient feel understood.24 To facilitate this, ensure that the patient’s basic comforts and needs are met, such as access to a warm bed, food, and safety.25

The psychiatrist’s role is to help uncover and address the underlying reason for the patient’s agony or distress. Once the child or adolescent has calmed, explore potential triggers or causes of the agitation.

There has been a significant move away from the use of restraints for managing agitation in children and adolescents.26 Restraints have a psychologically traumatizing effect,27 and have been linked to life-threatening injuries and death in children.24

Pharmacotherapy: Proceed with caution

There are no FDA-approved medications for the treatment of agitation in the general pediatric population, and any medication use in this population is off-label. There is also a dearth of research examining the safety and efficacy of using psychotropic medications for agitation in pediatric patients. Because children and adolescents are more susceptible to adverse effects and risks associated with the use of psychotropic medications, special caution is warranted. In general, pharmacologic interventions are not recommended without the use of psychotherapy-based modalities.

In the past, the aim of using medications to treat patients with agitation was to put the patient to sleep.25 This practice did not help clinicians to assess for underlying causes, and was often accompanied by a greater risk of adverse effects and reactions.24 Therefore, the goal of medication treatment for agitation is to help calm the patient instead of inducing sleep.25

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