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Pharmacologic Management of the Agitated Child

Marzullo, Laurie R. MD, MS

doi: 10.1097/PEC.0000000000000112
CME Review Article

Agitation is a chief complaint that causes many children and adolescents to present to emergency medical attention. There are many reasons for acute agitation, including toxicologic, neurologic, infectious, metabolic, and functional disorders. At times it may be necessary to pharmacologically treat the agitation to prevent harm to the patient, caregivers, or hospital staff. However, one should always be mindful that the differential diagnosis is broad, and a complete although timely assessment with targeted testing must be done before concluding that the agitation is rooted solely in nonorganic causes. There are various pharmacologic choices for the treatment of agitation, and they will be reviewed here. While treatment of agitation may be necessary to keep the patient as well as staff safe, as well as to facilitate medical evaluation in some cases, care must be taken to treat the patient with compassion, never using pharmacologic treatment for reasons of punishment or staff convenience. The focus is on the pharmacologic management of acute agitation of patients in the pediatric age group, in the context of a full evaluation for possible nonfunctional causes of agitation. Goals, risks, and benefits of medication use will be reviewed.

Assistant Professor of Pediatrics, Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Children’s of Alabama, Birmingham, AL.

The author and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interest in, any commercial organizations pertaining to this educational activity.

Dr. Marzullo has disclosed that the U.S. Food and Drug Administration has not approved the use of Haloperidol, Risperidone, Ziprasidone, or Olanzapine for the treatment of agitation in the pediatric population as discussed in this article. Please consult the product’s labeling for approved information.

Reprints: Laurie R. Marzullo, MD, Office of the Division of Pediatric Emergency Medicine, Children’s Park Place, Suite 110, 1600 7th Ave S, Birmingham, AL 35233 (e-mail:

© 2014 Lippincott Williams & Wilkins, Inc.