Using de-escalation techniques to prevent violent behavior in pediatric psychiatric emergencies: It is possible

Abstract

The use of de-escalation techniques have been proposed to be effective and are recommended as first line treatments for the management of acutely agitated patients. Even though guidelines for management of agitation in children usually follow the adult guidelines, few have been published on de-escalation of pediatric patients, its practical application and results. We describe the successful management through de-escalation of agitated and potentially violent behavior in an 8 yearold African American male patient, who presented to the emergency department with aggressive behavior. With a strong rapport, patient and provider were able to negotiate together and complete tasks that were labeled improbable by nursing staff. Very little has been published in the scientific literature in this subject, but the emphasis in avoiding coercive methods is clear in adult guidelines. Our approach follows the domains of de-escalation, demonstrating that those domains, can apply to pediatric patients as well.