The critically ill child or adolescent

Illness leading to critical care causes an emotional crisis for the patient, the family, and the staff in the PICU. It challenges the coping abilities of the patient and the family. The stressors encountered may unmask a primary psychiatric disorder or precipitate a secondary psychiatric disorder. The management approach to the mood and behavior of patients and parents depends upon whether the response is normal or disordered. Four types of interventions - environmental manipulation, education, pain control, and supportive psychological techniques - will help most children better adjust to the PICU. Delirium and dementia, when encountered, require special attention and treatment. Psychiatric consultation is often required. The parent with a major psychiatric disorder may also need the services of a psychiatric consultant. Suicidal, abused, or dying patients present special problems for the PICU staff. The multi-problem family is especially challenging and a multidisciplinary approach is needed.