Kids Health Info

Emergence delirium

  • Emergence delirium is a condition that can occur in children when they are waking up after having a general anaesthetic. Children usually require a general anaesthetic if they are having a surgical procedure.

    Emergence delirium is most common in children aged two to 10 years old – babies and teenagers are generally not affected.

    During emergence delirium your child may not be able to open their eyes, speak, or follow instructions and they may appear confused or agitated.

    Emergence delirium doesn’t last long and usually goes away on its own after a few minutes. If it lasts for longer than a few minutes, there are treatments to help settle your child if needed. Although it may be distressing for you to watch, there are no long-term consequences for your child.

    Signs and symptoms of emergence delirium

    The signs and symptoms of emergence delirium vary and can depend on the age of your child. Generally, children with emergence delirium may be uncooperative, incoherent, inconsolable or uncompromising. Your child may: 

    • appear confused (e.g. not recognise you or familiar objects)
    • not respond to your verbal cues
    • not open their eyes
    • appear distressed or unsettled (e.g. cry or scream)
    • have uncontrolled movement (e.g. kick or thrash about).

    What causes emergence delirium?

    Emergence delirium is a side effect of general anaesthesia in children. It is caused by certain types of anaesthetic medicines (e.g. the anaesthetic gas Sevoflurane).

    As a patient recovers from an anaesthetic, different parts of the brain ‘wake up’ at different rates (unlike in normal sleep) – in children this may cause the brain to be confused for a short period of time, causing the symptoms of emergence delirium.

    Research is helping to provide anaesthetists with a better understanding of what causes emergence delirium and improved ways to manage it.

    Treatment for emergence delirium

    Emergence delirium usually resolves within a few minutes without treatment. The main treatment is to keep your child safe until the delirium passes. 

    However, if emergence delirium is prolonged, your child’s movements cause a risk to safety (e.g. causing injury to themselves or to others), or they are extremely distressed, they may be reviewed by a doctor (usually your anaesthetist) and given a sedative directly into a vein (intravenous or IV therapy). Sedative medication will help to put your child back to sleep and keep them relaxed.

    Care at home

    Your child will be discharged from the recovery room once they are awake and it’s safe for them to go home or to the ward.

    Your child will not need any further care for emergence delirium once they are discharged. However, ensure you follow any instructions given to you for your child’s care after surgery.

    Key points to remember

    • Emergence delirium sometimes occurs when a child is waking up after a general anaesthetic.
    • Your child may experience symptoms such as uncontrolled movements, distress or confusion.
    • Emergence delirium usually resolves on its own but can be treated if symptoms continue for longer than a few minutes.
    • There are no long-term consequences for your child if they experience emergence delirium.

    For more information

    Common questions our doctors are asked

    Will my child remember this?

    Typically, your child will not remember experiencing emergence delirium, but you might. Be reassured that there is no evidence of long-term consequences of this condition.

    Will this happen every time my child has an anaesthetic?

    Emergence delirium does not occur every time, even if your child has experienced it before. Some children are more prone to experience emergence delirium, and there are various contributing factors (e.g. anxiety or a history of night terrors).

    If your child has experienced emergence delirium with a previous anaesthetic, it is important you inform the anaesthetist caring for your child. If the emergence delirium occurred at The Royal Children’s Hospital, an alert will be placed in your child’s electronic medical record (EMR). This will let staff at the RCH know that your child has experienced emergence delirium on a previous admission. 

    I have seen references to emergence agitation. Is this the same thing?

    Emergence delirium is different to emergence agitation, which occurs with other common treatable causes such as hunger, thirst, pain, anxiety and even low oxygen levels. These will be treated separately should they occur.


    Developed by The Royal Children's Hospital Perioperative Suite. We acknowledge the input of RCH consumers and carers.

    Developed March 2019.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.

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Disclaimer
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.