Original Publication
Open Access

Altered Mental Status in a Toddler

Published: February 27, 2015 | 10.15766/mep_2374-8265.10020

Included in this publication:

  • Instructor's Guide.docx
  • Cerebral Sinus Thrombosis.docx
  • Appendix A-Labs.docx
  • Appendix B-Fundus.docx
  • Appendix C-CXR.docx
  • Appendix D-Brain CT.docx
  • Appendix E-Brain MRI MRV.docx
  • Appendix F-Actor's Script.docx
  • Appendix G-Nametags.docx
  • Appendix H.docx
  • Appendix I-Evaluation Form.docx
  • Appendix J & K-Branch Points.docx

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


Introduction: There are many causes of mental status changes in a 2-year-old. To help pediatric emergency medicine fellows identify some of the more rare causes, we created this simulated case of a child who had cerebral sinovenous thrombosis as a complication of iron deficiency anemia and dehydration. Methods: Prior to the case the three actors were provided with scripts to review. The simulation took place in a simulated emergency department, facilitated by two faculty. Learners had 25-30 minutes to perform a physical exam and were provided with lab values and images as they were requested. The ample time provided not only an opportunity for learners to make a correct, albeit difficult diagnosis, but also an opportunity for feedback on communication styles of the trainee as they communicate with family members. Results: This simulation was successfully implemented on two separate groups of pediatric emergency medicine fellows. The first group was comprised of senior and junior fellows. The second was comprised of two new fellows, one with a background in pediatrics and the other with a background in emergency medicine. Discussion: This case is not an easy diagnosis to make. In the debriefing session, it is important to tell the trainee that this was a tough scenario and why good communication is important. While written for written for pediatric emergency medicine fellows, this could be used for any advanced trainee in pediatrics or emergency medicine.

Educational Objectives

By the end of this session, learners will be able to:

  1. Recognize and stabilize an acutely ill child.
  2. Generate a comprehensive differential diagnosis for altered mental status in a toddler.
  3. Perform a thorough neurologic exam including fundoscopy.
  4. Demonstrate effective team leadership.
  5. Communicate effectively with a patient's family.

Author Information

  • Michele Carney, MD: University of Michigan Medical School
  • Margaret Wolff, MD: University of Michigan Medical School
  • Whitney Cabey, MD: Children's National Medical Center
  • Sally Santen, MD, PhD: University of Michigan Medical School

None to report.

None to report.


Carney M, Wolff M, Cabey W, Santen S. Altered mental status in a toddler. MedEdPORTAL. 2015;11:10020. https://doi.org/10.15766/mep_2374-8265.10020