Neobook — clinical reference

GENERAL AND SUPPORTIVE MEASURES

Ensure safety of the patient, caregivers, staff members and the environment.
De-escalation techniques are first-line to try to calm the patient.
Physical restraint should only be used to protect the patient and caregivers; for the shortest period and should be monitored every 10 - 20 minutes.
A thorough physical examination must be done.
Exclude general medical causes, e.g. intracranial pathology like encephalopathy, seizures, metabolic disease, medication adverse effects and intoxication.

Investigations to exclude medical causes:

Baseline BMI.
Baseline laboratory work-up: FBC, urea and creatinine, electrolytes, AST, ALT, TSH, fasting glucose.
Monitor for extrapyramidal side effects, e.g. acute dystonia.

MEDICATION TREATMENT

For children under the age of six years:

Sedation with psychotropic agents should only be considered in extreme cases and only after consultation with a specialist.

For children over the age of six years:

Lorazepam, oral/IM.
- 0.05 - 0.1 mg/kg/dose.
- Onset of action: 20 - 40 minutes.
- Always consider the use of oral lorazepam first.

If sedation is inadequate:

Haloperidol, IM.
- 0.025 - 0.05 mg/kg/day.
- Onset of action: 20 - 30 minutes.
- Maximum dose: 0.15 mg/kg/day.

In case of an acute dystonic reaction secondary to haloperidol:

Biperiden, IM/slow IV, 0.05 - 0.1 mg/kg.
- 1 - 6 years: 2mg.
- 7 - 10 years: 3 mg.
- > 10 years: 5 mg.

Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition

Chapter 14: Child & Adolescent Psychiatry, 14.1 Sedation Of An Acutely Disturbed Child Or Adolescent

Sedation of an Acutely Disturbed Child or Adolescent