Abstract
Psychomotor agitation and self/hetero-aggressiveness in children and adolescents can represent a challenge in the pediatric emergency department (ED), they are a frequent occurrence that account for up to 5% of emergency assessments in the United States. Agitation is a highly nonspecific sign, which may result from organic and/or psychiatric conditions, and requires, in its management, the adequacy of ED spaces, training of the professionals involved and an increase in mental health resources in the EDs. The initial diagnostic evaluation should lead to the most appropriate therapeutic choice, although in many situations it is necessary to intervene before finishing the diagnostic exploration. This intervention must firstly contemplate environmental and non-pharmacological measures. When necessary, pharmacological restraint can be carried out, physical restraint being discouraged at these ages. There is little literature on the correct approach to these occurrences, and there is no guideline, so that more than half of the ER professionals feel inadequately prepared in their management. This work aims to bring together the evidence and consensus available in the literature to create practical support for the approach of the agitated patient in pediatric emergency care, with a focus on non-pharmacological and pharmacological approaches, it is based on a literature review, using multiple databases of articles in English, Portuguese and Spanish. The National Institute for Health and Care Excellence (NICE) guidelines were also analyzed although they apply to aggressive and violent behavior and not psychomotor agitation, understanding the difference, but looking for overlapping and applicable elements.