Children Sedated in ICU Often Experience Scary Hallucinations

By Anastacia Mott Austin

A new report published this week examines the experiences of children who have been in the PICU (Pediatric Intensive Care Unit) and received sedative drugs during their stay.

The report, published in this week’s issue of The American Journal of Respiratory and Critical Care Medicine, says that almost a third of children sedated while in the PICU experienced vivid, frightening hallucinations that they clearly remembered later.

The study’s researchers asked children between the ages of 7 and 17 about their memories of their intensive-care stay, three months after their discharge. Most of the children remembered some factual information and occurrences, such as a visit from a family member.

Thirty-two percent of the children also reported disturbing, scary hallucinations.

"In the majority of cases, these delusional memories consisted of one or more hallucinations which were often frightening and which the children could still recall vividly," said lead author Gillian Colville, a clinical psychologist and head of the pediatric psychology department at London’s St. George's Hospital. "They reported seeing rats, cats, scorpions on the walls and, in some cases, crawling on the bed, and a couple of children were convinced that their parents had been replaced by imposters."

The more days the children were sedated, the more likely they were to have experienced this type of scary hallucination.

Children who received opiates or drugs in the benzodiazepine family such as Valium for more than two days were five times as likely as the other children to have visual, auditory, or tactile hallucinations.

The children who’d experienced the delusions were also those who scored the highest on post-traumatic stress screening tests, and it was their memories of the hallucinations that troubled them most, not the actual experience of being in the ICU.

"These findings are interesting because it has been assumed that the actual experiences in the PICU would be more likely to lead to posttraumatic stress symptoms following discharge," stated Colville in a press release. "However, our results indicate that posttraumatic stress symptoms are associated with delusional memories rather than factual ones."

The timing of the hallucinations coincided with when the children were being taken off of the sedative drugs.

Colville says she was interested in studying children’s experiences because, while it is well known that adults sometimes have hallucinations under sedation, there had not been any major studies looking at the reactions of children to the same drugs.

"I have worked for 16 years in pediatric intensive care and have seen a considerable number of children in distress," said Colville. "But [I] have found that there is very little in the literature about children's experiences."

The study is considered important because it could change the way intensive-care physicians use sedative drugs on their young patients. Hospitals may consider a technique known as "drug vacation," in which patients are given brief respites from continuous sedation. Or they may decide to wean patients off of the drugs more slowly, to hopefully reduce the frequency of frightening hallucinations.

Colville says the important thing is that hospitals be made aware of children’s reactions to better handle their emotional responses to sedative drugs.

Said Colville, "…above all, medical professionals and families should be made aware of the possibility that children may have these disturbing hallucinatory experiences, and greater efforts should be made to monitor their psychological adjustment after PICU."