Oral drug regimens for acute behavioural disturbance in children
Managing a patient with acute behavioural disturbance is a detailed flowchart for managing a patient with acute behavioural disturbance.
The indications for oral sedation for acute behavioural disturbance in children are detailed here.
The aim of pharmacological management is to calm the patient with a sufficient initial dose of a sedative drug. Repeated subtherapeutic doses that are inadequate to reduce the patient’s distress and calm their behaviour can prolong the risk of harm to the patient or others. This can also result in larger cumulative doses, or multiple drug administration, both of which increase the risk of adverse drug effects, especially in children. Monitor the patient closely for adverse drug effects; see Principles of monitoring patients with acute behavioural disturbance for detailed advice.
When selecting a suitable drug dose and regimen, consider patient factors, such as their level of agitation and distress (eg measured with a Sedation Assessment Tool [SAT] score), age, body size, sex, comorbidities, drug history, previous response to sedative drugs and response to treatment.
The most common sedative drugs used in children to manage acute behavioural disturbance are benzodiazepines and antipsychotics, which are used in this setting for their sedative effects. The sedative effects of antipsychotic drugs occur much sooner than the antipsychotic effects.
If a child has had a previous paradoxical reaction to benzodiazepines, or is tolerant to benzodiazepines, use oral olanzapine first line. This is especially relevant to children with developmental disability.
If oral sedation is indicatedfor a child with acute behavioural disturbance, in combination with nonpharmacological techniques, use:
1 lorazepam 1 to 2 mg orally (only for children aged 5 years or older), as a single dose1; seek expert advice if further doses are required acute behavioural disturbance, child lorazepam
OR
1 olanzapine 2.5 to 5 mg orally (for children less than 40 kg) and 5 to10 mg orally (for children 40 kg and over) as a single dose; preferably use liquid or an orally disintegrating formulation (eg wafer); seek expert advice if further doses are required acute behavioural disturbance, child (oral) olanzapine
OR
2 diazepam 0.2 mg/kg up to 10 mg orally (only for children aged 5 years or older); repeat once after 30 minutes if required; seek expert advice if further doses are required. acute behavioural disturbance, child diazepam
Diazepam for children is a liquid formulation that is considered unpalatable, but can be used when lorazepam is not accessible.
Always monitor the patient closely for potential adverse effects after administering a sedative drug for an acute behavioural disturbance (especially in drug-naive patients).