Delirium Clinical Pathway, CICU, PICU, and PCU – Developmental Anchors

Delirium Clinical Pathway — CICU, PICU, and PCU

Developmental Anchors to Guide Use of CAPD Tool for ≤ 2 yrs of Age

The table below outlines developmental milestones to assist in CAPD screening.

 
NB
 4 wks 6 wks 8 wks 28 wks 1 yr 2 yrs
1. Does the child make eye contact with the caregiver?
  • Fixates on face
  • Holds gaze briefly
  • Follows 90°
  • Holds gaze
  • Follows moving object/caregiver past midline
  • Regards examiner's hand holding object
  • Focused attention
  • Holds gaze
  • Prefers primary parent
  • Looks at speaker
  • Holds gaze
  • Prefers primary parent
  • Looks at speaker
  • Holds gaze
  • Prefers primary parent
  • Looks at speaker
2. Are the child's actions purposeful?
  • Moves head to side
  • Dominated by primitive reflexes
  • Reaches, with some discoordination
  • Reaches
  • Symmetric movements
  • Will passively grasp handed object
  • Reaches with coordinated
  • Smooth movement
  • Reaches and manipulates objects
  • Tries to change position
  • If mobile may try to get up
  • Reaches and manipulates objects
  • Tries to change position
  • If mobile may try to get up and walk
3. Is the child aware of his/her surroundings?
  • Calm awake time
  • Awake alert time
  • Turns to primary caretaker's voice
  • May turn to smell of primary caretaker
  • Increasing awake alert time
  • Turns to primary caretaker's voice
  • May turn to smell of primary caretaker
  • Facial brightening or smile in response to nodding head, frown to bell, coos
  • Strongly prefers mother than other familiars
  • Differentiates between novel and familiar objects
  • Prefers primary parent than other familiars, upset when separated from preferred caretakers
  • Comforted by familiar objects, especially favorite blanket or stuffed animal
  • Prefers primary parent than other familiars, upset when separated from preferred caretakers
  • Comforted by familiar objects, especially favorite blanket or stuffed animal
4. Does the child communicate needs and wants?
  • Cries when hungry or uncomfortable
  • Cries when hungry or uncomfortable
  • Cries when hungry or uncomfortable
  • Cries when hungry or uncomfortable
  • Vocalizes/ indicates about needs, e.g., hunger, discomfort, curiosity in objects or surroundings
  • Uses single words or signs
  • 3-4 word sentences or signs
  • May indicate toilet needs, calls self or me
5. Is the child restless?
  • No sustained awake alert state
  • No sustained calm state
  • No sustained calm state
  • No sustained calm state
  • No sustained calm state
  • No sustained calm state
  • No sustained calm state
6. Is the child inconsolable?
  • Not soothed by parental rocking, singing, feeding, comforting actions
  • Not soothed by parental rocking, singing, feeding, comforting actions
  • Not soothed by parental rocking, singing, feeding, comforting actions
  • Not soothed by parental rocking, singing, feeding, comforting actions
  • Not soothed by usual methods e.g., singing, holding, talking
  • Not soothed by usual methods e.g., singing, holding, talking, reading
  • Not soothed by usual methods e.g., singing, holding, talking, reading
  • May tantrum, but can organize
7. Is the child underactive — very little movement while awake?
  • Little if any flexed and then relaxed state with primitive reflexes
  • Child should be sleeping comfortably most of the time
  • Little if any reaching, kicking, grasping
  • Still may be somewhat uncoordinated
  • Little if any reaching, kicking, grasping
  • May begin to be more coordinated
  • Little if any purposive grasping, control of head and arm movements, such as pushing things that are noxious away
  • Little if any reaching, grasping, moving around in bed, pushing things away
  • Little if any play, efforts to sit up, pull up, and if mobile, crawl or walk around
  • Little if any more elaborate play, efforts to sit up and move around, and if able to stand, walk, or jump
8. Does it take the child a long time to respond to interactions?
  • Not making sounds or reflexes active as expected (grasp, suck, moro)
  • Not making sounds or reflexes active as expected (grasp, suck, moro)
  • Not kicking or crying with noxious stimuli
  • Not cooing, smiling, or focusing gaze in response to interactions
  • Not babbling or smiling/laughing in social interactions or even actively rejecting an interaction
  • Not following simple directions. If verbal, not engaging in simple dialogue with words or jargon
  • Not following 1-2 step simple commands
  • If verbal, not engaging in more complex dialogue

References

Cornell Assessment of Pediatric Delirium: A Valid, Rapid, Observational Tool for Screening Delirium in the PICU  

PDF version of Weill Cornell University Developmental Anchor Points for Youngest Patients available at the ICU Delirium and Cognitive Study Impairment Study Group website