Pediatric Patients

Pediatric Care

Is your child an intensive care unit (ICU) survivor? Do you notice that your child isn’t quite back to normal? This is common after a child is very sick and requires ICU care.

What is Post-Intensive Care Syndrome?

  • Post-Intensive Care Syndrome (PICS) is a term used to describe the health problems someone may have after being in the ICU.
  • Adults and children who are sick in the ICU may develop new difficulties that continue even after they are discharged from the ICU and hospital.
  • These problems are usually related to physical strength, coordination, thinking, and mental and emotional health.

Physical Issues

Symptoms

  • Children can be very weak after an ICU stay.
  • Babies and young children may not be able to do all the developmental activities they could do before they got sick.
  • Children may get tired very fast doing small things like sitting up and walking a few steps. Basic tasks like brushing teeth or tying shoes can exhaust your child, and they may become irritable or frustrated.
  • Some children may have difficulty with balance and coordination.
  • Some children, especially those who previously required the ventilator for breathing, may have difficulty eating and talking afterwards.

Treatment in the hospital

Your child may work with physical therapists, occupational therapists, and speech therapists.

  • Physical therapists are specialists in how the body moves.
  • Occupational therapists focus on performing everyday activities and smaller movements.
  • Speech therapists help with speaking and eating.

These therapists often work together to treat your child.

When you go home

The hospital team will assess your child and their post-hospital needs.

  • Some children will need intensive therapy for weakness at another type of hospital called an inpatient rehabilitation facility. The hospital team will help determine if your child needs inpatient rehabilitation.  
  • Other children will keep working with physical therapists, occupational therapists, and speech therapists after discharge in an outpatient setting.
  • Your child may be referred to see a special type of doctor called a Physiatrist who specializes in building strength.

Make an appointment with your pediatrician in the first week home so they can assess your child.

If you are concerned your child is very weak, or not improving, talk to your pediatrician about a referral for one of the therapies listed above.

Be patient with your child as they work on getting stronger. They may be frustrated; encourage them to work hard and celebrate small gains in strength.


Thinking or Cognitive Issues

Symptoms

  • Your child may have difficulty paying attention or you may notice it takes them longer to process information.
  • Your child may have difficulty remembering things.

Treatment in the hospital

  • While in the hospital your child may work with a speech therapist, psychologist, or psychiatrist to help with thinking problems.
  • Children who require sedation medications often take days after medications are stopped to clear them from their bodies.

When you go home

  • No one specific treatment exists for cognitive issues in children after an ICU stay, but there may be strategies that can be used to help your child with cognitive tasks. Many children will improve with time, but some will need assistance from their parents and school.
  • Watch your child for decline in grades or test scores, difficulty completing schoolwork in usual amount of time, or dislike of school when they have enjoyed school in the past. Your child may seem irritable or frustrated and may have trouble sleeping. If symptoms are severe or persistent, meet with your child’s pediatrician, teacher or school to discuss ways they can get extra help, tutoring, or extra time to complete tasks at school. Your child’s teacher may also suggest things you can work on at home to improve their thinking.
  • Some children will need to follow-up with a psychologist in an outpatient setting for further testing and monitoring.

Emotional or Psychiatric Issues

Symptoms

  • Many children will experience delirium while in the ICU. Delirium is a condition of sudden confusion and difficulty with attention. Delirium affects children in different ways, some children will be very sleepy and unresponsive while others will be overly active. Children suffering from delirium may see or hear things that are not real.
  • The most common mental health problems children have after being in the ICU are anxiety, post-traumatic stress disorder, and depression.

Treatment in the hospital

  • Delirium can be caused by an underlying medical condition, like an infection, or as a side effect of the ICU environment itself. As a child’s illness improves, delirium should improve as well. It is also treated with exercise and activity during the day and good sleep at night.
  • In the hospital, the psychiatry team may see your child and recommend other therapies for delirium, anxiety and stress disorders. Once the delirium has resolved the psychiatry team will assess for ongoing anxiety and stress disorders.
  • Your child may benefit from working with a child life specialist to work through their feelings and frustrations. A child life specialist is specially trained to help children and families cope with the stress of an illness and hospitalization.
  • Many children will find support through talking with a hospital chaplain, family members, or other familiar support members from home.

When you go home

  • Watch your child for :
    • Fear or worries
    • Difficulty being away from you or other family members
    • Nightmares or flashbacks to the ICU
    • Poor sleep
    • Overly emotional behavior
    • Changes in mood, including sadness and loss of usual playfulness or happiness with things that used to make your child happy
    • If you notice your child is having any of the issues above, talk to your pediatrician about a referral to see a psychologist, psychiatrist, or counselor.
    • Your child may find support talking to family, friends, teachers and spiritual or religious mentors about their feelings and fears.

PICS-Family

Family members of children or adults cared for in the ICU can also experience PICS.

Common symptoms of PICS-Family include anxiety, post-traumatic stress disorder, and depression.

If you are experiencing difficulties, please seek help for yourself.

  • Talk to your healthcare provider.
  • Find support from family, friends, spiritual or religious groups.
  • Consider seeking help from a counselor, psychologist, or psychiatrist.

Siblings of sick children often experience fear, anxiety, guilt, and feelings of detachment.

  • While your child is in the hospital, consider working with a child life specialist at the hospital on ways to explain your child’s illness to siblings and how to help siblings cope.
  • Talking with a hospital chaplain or other community spiritual or religious mentors may give your child another way to express their concerns or feelings in a safe manner.
  • Siblings may benefit from keeping a routine as much as possible and upholding normal boundaries and expectations for their behavior.
  • Talk to your pediatrician - siblings may also benefit from support services like counselors or psychologists.

Further resources