Children in Pediatric ICU May Be Traumatized by Hallucinations

Nearly a third of children admitted to pediatric intensive care units (PICUs) will experience delusions or hallucinations, which places them at higher risk for post-traumatic stress symptoms.

Researchers at Great Ormond Street Children's Hospital (London, UK) followed children over the age of seven who were discharged from the 21-bed PICU over the course of 18 months. Each child's medical condition and treatment was noted and they were given a psychological interview three months after discharge to screen them for post-traumatic stress symptoms in relation to their memories.

The results showed that of the 102 children who completed interviews, two in three recalled something factual about their stay at the PICU, and half of these had only fragmentary, single memories, mostly images of family members. But one in three children reported delusional memories of their stay in PICU, including hallucinations. Those children reported delusional memories that had a significantly higher score on the post-traumatic stress-screening test than others. The timing of the hallucinations appeared to coincide with the period during which the children were being weaned off benzodiazepines and opiates--sedatives commonly prescribed in the PICU--and the children were five times as likely to report having had delusions or hallucinations if they had been prescribed opiates and benzodiazepines for more than two days. The study was published in the May 1, 2008, issue of the American Journal of Respiratory and Critical Care Medicine.

"These findings are interesting because it has been assumed that the actual experiences in the PICU would be more likely to lead to post-traumatic stress symptoms following discharge,” said lead author clinical psychologist Gillian Colville, B.Sc., M.Phil. "However, our results indicate that post-traumatic stress symptoms are associated with delusional memories rather than factual ones. The hallucinations children reported were overwhelmingly disturbing and frightening, similar to those reported by adult intensive care patients and heroin addicts going through withdrawal.”

The authors suggest that additional research is needed to establish whether alternative types of sedation or the introduction of ‘drug holidays' might produce fewer traumatic delusional memories. The authors also suggest altering the physical environment and providing psychological orientation cues for children in the PICU, such as demarcating day and night, to help reduce these symptoms.


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Great Ormond Street Children's Hospital