CLINICAL QUESTION: Has the incidence, etiology, evaluation, and management of pediatric catatonia changed over time, especially following the COVID-19 pandemic?
BACKGROUND: Pediatric catatonia is a neuropsychiatric syndrome marked by disturbances in movement, speech, affect, volition, and autonomic regulation. First-line treatments include benzodiazepines and electroconvulsive therapy (ECT). Low prevalence and variation in diagnostic criteria contribute to inconsistent recognition, which worsens outcomes. Existing data on pediatric catatonia in hospital settings is limited, particularly regarding trends in incidence, etiology, and treatment practices.
STUDY DESIGN: Retrospective chart review
SETTING: Academic, quaternary care, children’s hospital in New England
SYNOPSIS: 52 pediatric patients (under 19 years old) diagnosed with catatonia between 2018 and 2023 were identified across emergency and inpatient units. Catatonia incidence more than doubled in the latter half of the study period. Though most cases (75%) had psychiatric causes, there was a significant rise in cases with medical etiologies, most notably autoimmune encephalitis. Patients with both medical and psychiatric etiologies often had neurodevelopmental disorders. Diagnostic testing was generally consistent (electroencephalogram, brain MRI, Bush-Francis Catatonia Rating Scale), though abnormal electroencephalograms were significantly more common in medical etiologies. Treatment differed by etiology, with similar initial lorazepam doses but higher maximum daily doses in medical cases, especially anti-N-methyl-D-aspartate-receptor encephalitis, which may reflect lower responsiveness to benzodiazepines. Black patients were disproportionately represented in cases without neurodevelopmental disorders, echoing prior findings and raising questions about systemic factors and diagnostic disparities. Limitations include small sample size and institutional factors (e.g., psychosis pathway, neuroimmunology access). Findings support the need for etiology-informed treatment, prospective studies, and clinical guideline development.
BOTTOM LINE: This study reveals a post– COVID-19 surge in pediatric catatonia, especially in medically associated cases requiring higher benzodiazepine doses—emphasizing the need for urgent, etiology-informed clinical guidelines to improve recognition and management of this potentially life-threatening condition.
CITATION: Lichtor SA, et al. Rising incidence of pediatric catatonia and medical etiology: multiyear trends. Hosp Pediatr. 2025;15(9):711-720. doi: 10.1542/hpeds.2025-008373.
Dr. Hoff
Dr. Hoff is a pediatric hospitalist in the division of hospital medicine at Nationwide Children’s Hospital and an assistant professor of pediatrics at The Ohio State University College of Medicine, both in Columbus, Ohio.
Dr. Wysong
Dr. Wysong is a pediatric hospital medicine fellow in the division of hospital medicine at Nationwide Children’s Hospital and a clinical instructor of pediatrics at The Ohio State University College of Medicine, both in Columbus, Ohio.
