Pharmacologic or physical restraint use for children and adolescents with mental health conditions with violent or self-injurious behavior can be dehumanizing and traumatic. To better understand restraint use in the emergency department and in the hospital, this week we are releasing three studies and a commentary in Pediatrics.
The first of these studies focuses on children with autism spectrum disorder (ASD) who were hospitalized. Calabrese et al. (10.1542/peds.2023-062172) evaluated a single children’s hospital from 2016 to 2021 that found autistic children were much more likely to be restrained compared to those without ASD (after adjusting for confounders, OR=2.3, p<.001).
A study by Masserano et al. (10.1542/peds.2023-062784) focused on pharmacologic restraint use in inpatient units categorized by primary mental health diagnosis. The authors analyzed data on 91,898 hospitalizations involving children between 5–17 years across 43 hospitals and found that 3% of the admissions and 1.3% of the patient days involved pharmacologic restraint. The authors also found that the incidence of pharmacologic restraint increased by 141% over the 5-year study period. Autistic children had the highest rates of pharmacologic restraint (7.9% of patient days).
The next study by Wolf et al. (10.1542/peds.2023-061353) assesses disparities in pharmacologic restraint for children hospitalized with mental health problems. This study, a retrospective cohort study of 61,503 hospitalizations of children ages 5 to 18 years at 41 children’s hospitals between 2018 and 2022, found that non-Hispanic Black children were more likely to receive pharmacologic restraint compared with children of other races and ethnicities. Why might this be? The authors provide some interesting insight in the discussion section.
We invited a commentary (10.1542/peds.2023-064054) from Dr. Evan Dalton from Texas Children’s Hospital and Dr. Stephanie Doupnik from Children’s Hospital of Philadelphia. They note that there is a need to standardize the definition of physical and pharmacologic restraint to better understand reasons for treatment of agitated children. They also request more information on why pharmacologic restraints are being used. They call for equitable interventions to reduce the rates of inappropriate restraint such as enhanced multidisciplinary communication, sensory modifications to the inpatient environment, and individualized patient care plans that include activities such as art and playing video games that can reduce the behaviors that trigger the need for restraints. Please do not show restraint but instead check out the three studies and commentary that in turn may lead to a reduction in physical and pharmacologic restraint use for all children hospitalized for primary mental health reasons.
