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Behavioral changes in pediatric intensive care units.

S M Jones1, D H Fiser, R L Livingston

  • 1Department of Pediatrics, Arkansas Children's Hospital, Little Rock 72202-3591.

American Journal of Diseases of Children (1960)
|March 1, 1992
PubMed
Summary
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Critically ill children in intensive care units (ICUs) and those with prior mental health conditions show higher risks for psychological distress and behavioral issues. The Hospital Observed Behavior Scale reliably quantifies these behaviors in hospitalized children.

Area of Science:

  • Pediatric Psychology
  • Child Psychiatry
  • Critical Care Medicine

Background:

  • Hospitalized children, particularly those in intensive care, may experience significant psychological distress.
  • Understanding the frequency and severity of anxiety, depression, delirium, and withdrawal is crucial for effective intervention.
  • Preexisting mental health conditions can influence the manifestation of these symptoms in pediatric patients.

Purpose of the Study:

  • To compare the incidence and severity of psychological symptoms (anxiety, depression, delirium, withdrawal) in pediatric patients between intensive care unit (ICU) and ward settings.
  • To assess the impact of pre-existing psychopathological disorders on the expression of these symptoms.
  • To validate the Hospital Observed Behavior Scale (HOBS) as a reliable tool for quantifying behavioral manifestations in hospitalized children.

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Main Methods:

  • Prospective study of 43 pediatric patients (ages 6-17) in a tertiary care center.
  • Patients were divided into intensive care unit (n=18) and general ward (n=25) groups.
  • The Hospital Observed Behavior Scale (HOBS) was used for objective behavioral assessment, alongside the Diagnostic Interview for Children and Adolescents (DICA) and its parent version to identify pre-existing disorders.

Main Results:

  • Pediatric patients in the ICU exhibited higher rates of apprehension, anxiety, detachment, sadness, and weeping compared to ward patients, as measured by HOBS.
  • Behavioral manifestations were significantly influenced by illness severity, hospitalization duration, prior hospitalizations, and pre-existing anxiety or mood disorders.
  • The Hospital Observed Behavior Scale demonstrated good interrater reliability.

Conclusions:

  • Critically ill children in ICUs, those with prolonged or repeated hospitalizations, and those with pre-existing anxiety and mood disorders are at elevated risk for psychological trauma and behavioral problems.
  • These at-risk pediatric populations may require psychiatric intervention.
  • The Hospital Observed Behavior Scale is a reliable instrument for quantifying behavioral symptoms in hospitalized children.