Commenting by email, Dr. Ruth S. Gerson, Director of Bellevue Hospital Children’s Comprehensive Psychiatric Emergency Program, in New York City, told Reuters Health, “There is a profound need for new research in management of agitation among pediatric patients in the ED. Typically management of agitation involves intramuscular injection of medication while the child is physical restrained, which can be terrifying to children and dangerous for both children and staff. It’s exciting to consider intranasal administration of medication as an alternative.”

However, Dr. Gerson pointed out, “It’s also important that the physicians in this case recognized that this child had a history of anxiety, and that anxiety might be driving his dangerous behavior and attempts to flee the ED (which is a stressful place for any child), and that they then chose lorazepam to treat the agitation and the underlying anxiety. When treating agitated children in the ED it is critical to consider the cause of the agitation, just as we’d want to identify and treat the cause of pain. The lorazepam worked here because it treated the cause of the agitation.”

“Of course,” Dr. Gerson went on to say, “it’s important to note that this is a case report of a single patient, and placebo-controlled studies and head-to-head studies comparing to different medications are needed to really determine the effectiveness of this new technique. Most agitation in young children winds down fairly quickly (think about how long most tantrums last), so we can’t know for certain whether this child’s calming down was due to the medication, the normal timeline of children’s tantrums, or other factors, like placebo effect, which can be very strong in children.”