Case examples are provided below to help clinicians interpret behaviors that can be affected by the child’s age, developmental level, trauma history, and current psychosocial stressors.
Constant reassessment is needed during episodes of agitation to monitor severity and implement appropriate interventions.
| Level |
Case Example |
Assessment |
| Mild |
- 7-year-old boy presents to ED with impulsive behavior, now been in ED for two days
- Behavior:
- Smashing food on the floor
- Trying to color on the walls
- When asked to stop, he says, "Try to make me." When offered a ream of paper to hang on the wall to make his own mural, he happily complied.
|
- Child responds to instructions to be de-escalated without medical intervention
- Behaviors are redirectable; child is willing to engage in using coping skills to manage feelings of frustration, anxiety, fear and anger.
- Triggers for behaviors are typically apparent and can be mitigated to avoid future escalations.
- Consider Child Life to provide extra support through activities and develops a daily schedule to reduce the potential for further escalations.
|
| Moderate |
- A male child with ADHD and ODD is admitted for aggressive behavior.
- Staff are called to bedside because he is jumping on his bed and yelling profanities.
- It is 2 hrs past his scheduled bedtime, and he refuses to get ready for bed.
- His psych tech and nurse cannot calm him down by talking to him.
|
- Verbal redirection is more challenging or needs additional time to process.
- Behaviors are riskier, and child comments are now targeting specific individuals.
- Child is reluctant to process thoughts or feelings verbally and will respond best to a single person engaging them and helping them use coping skills.
- Child may benefit from additional supports or consults and prn medications.
|
| Severe |
- A male teenager is admitted to the hospital for altered mental status.
- Staff are called to his room because he is pacing, yelling, and trying to leave his room.
- He begins to push the door and screams, “I’ll kill you!”
- He runs towards the security officers with his fists raised.
|
- Behaviors are intended to harm and place the child and others at risk of injury.
- Child is no longer responsive to verbal redirection, limit setting, or attempts to emotionally process.
- Child’s personal space is 2-3 times larger than at baseline (size of their room, for instance)
- Do not approach unless necessary.
- Security or additional staff are needed to ensure safety.
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