University of Wisconsin–Madison Medical College of Wisconsin

Pediatric COVID-19 Delirium: Case Report of 2 Adolescents

Sarah Corey Bauer, MD; Francesca Moral, MD; Erin Preloger, MD; Alexandrea Spindler, DO; Marisa Roman, MD; Ashley Logan, DO; Scott J. Sandage, DO; Colleen Manak, MD; Michelle Mitchell, MD

WMJ. 2021;120(2):131-136.

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Introduction: Neurological complications of COVID-19, including delirium, are emerging in the adult population but have not been well described in pediatrics.

Case Presentation: We report the cases of 2 adolescent males, ages 16 and 17, who presented with delirium secondary to an acute COVID-19 infection in the fall of 2020 at Children’s Wisconsin in Milwaukee, Wisconsin. The foundation of our treatment strategy was the triad of alpha-2 agonists (clonidine, dexmedetomidine, guanfacine), antipsychotic agents (quetiapine, haloperidol, olanzapine), and melatonin. Discharge planning required involvement from inpatient psychiatry, case management, social work, and the family. Both patients showed improvement after several weeks.

Discussion: We believe these are the first reported cases of COVID-19-associated delirium in children outside of multisystem inflammatory syndrome in children (MIS-C).

Conclusion: Pediatric COVID-19 delirium is a new manifestation of the COVID-19 disease. Treatment guidelines are emerging and lessons regarding therapies and discharge considerations are described in these 2 unique cases.

Author Affiliations: Medical College of Wisconsin (MCW), Department of Pediatrics, Section of Hospital Medicine, Milwaukee, Wisconsin (Bauer, Moral, Preloger); Advocate Aurora Health, Milwaukee, Wisconsin (Spindler); MCW, Pediatric Residency Program (Roman, Logan); MCW, Department of Psychiatry, Milwaukee, Wisconsin (Sandage, Manak); MCW, Department of Pediatrics, Section of Infectious Diseases, Milwaukee, Wisconsin (Mitchell).
Corresponding Author: Sarah Bauer, MD, Children’s Corporate Center, 999 N 92nd St, Suite 560, Milwaukee, WI 53226; phone 414.337.7050; email; ORCID ID 0000-0002-9994-4110.
Acknowledgements: Both guardians provided written consent to publish a case report. The authors would like to acknowledge the patients and families involved, as well as Kelsey Porada for her assistance with the manuscript.
Funding/Support: None declared.
Financial Disclosures: None declared.
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