Pediatric emergency medicine trisk 4188 4188
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Depression in pediatric patients may present with either sad or
irritable mood as its predominant symptom. Unlike depressed adults,
who tend to be consistently down or sad, depressed pediatric
patients will often have moments in which they seem happy—often
when they are engaged in a preferred activity. Clinicians should not
rule out depression based on these moments of what is referred to
as mood reactivity.
Clinical Considerations
Depression involves a pervasive sad or irritable mood, accompanied
frequently by self-deprecation and suicidal ideation. Depression also implies
a change in functioning from an earlier state of relatively good adjustment.
The depressed child typically experiences a profound sense of helplessness,
feeling unable to improve an unsatisfactory situation.
The prevalence of depression in children and adolescents is around 3%. It
is higher in children with anxiety and/or behavioral or significant medical
problems. Most children with depression present to the ED with other chief
complaints (somatic symptoms, school or behavior problems); the ED
clinicians must consider the possibility of depression in all children seen
with recurrent or vague somatic complaints. A large body of evidence
suggests that a genetic predisposition exists for depression, particularly
severe depression.
Depression manifests differently, depending on the stage of development.
In infancy, depression is usually the result of loss of important attachments
and/or nurturance and is seen as a global interference of normal growth and
physiologic functioning, including apathy, listlessness, staring, hypoactivity,
poor feeding and weight loss, and increased susceptibility to infection.
In school-aged children key features include dysphoric mood, irritability,
and self-deprecatory ideation. Dysphoric mood is manifested by looking or
feeling sad and forlorn, being moody and irritable, and crying easily. Selfdeprecatory thoughts are reflected by low self-esteem, feelings of
worthlessness, and suicidal ideation. Depression in this age can also appear
as other common symptoms, including multiple somatic complaints, school
avoidance, or underachievement, including learning disabilities or ADHD,
angry outbursts, runaway behavior, phobias, and fire setting.
