Pediatric emergency medicine trisk 0393 0393
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support system to control the child’s behavior and prevent further emotional and
physical harm should be documented. If the support system is adequate and
timely and appropriate treatment is available, referral to outpatient treatment may
be appropriate. When the support system is not adequate and/or appropriate
outpatient treatment options are not available, psychiatric hospitalization may be
necessary, especially in the context of particularly dangerous behaviors such as
fire setting, elopement, escalating aggressiveness, or failure of prior or current
outpatient treatment. For reference, the Joint Commission 2019 National Patient
Safety Goals for Behavioral Health recommends that as part of assessment and
disposition planning, providers conduct a risk assessment of the individual or the
environment that may increase or decrease the risk of suicide; address the
patient’s immediate safety needs; and provide suicide prevention information
(such as a crisis hotline) at the time of discharge.
If a child is already in treatment, every effort should be made to contact the
child’s providers in order to obtain their assessment as to the appropriate
disposition and to attempt to arrange for follow-up as close to ED discharge as
possible. The physician who discharges a child for outpatient psychiatric
treatment should help the family develop short-term measures to support the child
until outpatient psychiatric treatment commences.
Suggested Readings and Key References
Autism/Pervasive Developmental Disorders
Maclean MJ, Sims S, Bower C, et al. Maltreatment risk among children with
disabilities. Pediatrics 2017;139(4):e20161817.
McGonigle JJ, Vekat A, Beresford C, et al. Management of agitation in
individuals with autism spectrum disorders in the emergency department. Child
Adolesc Psychiatr Clin N Am 2014;23(1):83–95.
Delirium
Turkel SB, Tavaré CJ. Delirium in children and adolescents. J Neuropsychiatry
Clin Neurosci 2003;15(4):431–435.
General
Chun TH, Katz ER, Duffy SJ. Pediatric mental health emergencies and special
health care needs. Pediatr Clin North Am 2013;60(5):1185–1201.
Dolan MA, Fein JA; Committee on Pediatric Emergency Medicine. Pediatric and
adolescent mental health emergencies in the emergency medical services
