Pharmacologic management of behavioral instability in medically ill pediatric patients

Purpose of review: Behavioral instability in children and adolescents is a vexing problem faced by many clinicians. This dilemma is magnified when it presents in a child with an acute medical condition. Effective treatment in these cases with medications may help to reduce morbidity and facilitate appropriate medical care for the underlying condition. Recent findings: There are many reviews, but few studies examine the treatment of behavioral instability in the pediatric population. There are even fewer that address behavioral instability in the presence of a comorbid medical condition. Many effective agents may worsen a given condition or interfere with the treatment of that condition. There are no prospective studies addressing this issue. Summary: Many psychotropic medications must be considered when treating behavioral instability in medically ill children. Antihistamines, benzodiazepines, and antipsychotics may be of particular benefit. Definitive research is lacking and necessary to develop appropriate clinical guidelines. This article considers the most current literature and provides an overall summary of the topic.