Pediatric patients seem to be especially vulnerable to toxic, metabolic, or traumatic CNS insults and are at greater risk of delirium with fever regardless of the etiology. Developmental limitations, in the areas of communication and cognition, prevent a thorough evaluation of the young patient for delirium. Only the most severe cases are identified, and the remainder is either ignored or mismanaged under incorrect diagnoses. Despite the importance of the diagnosis in the care of medically ill patients, few studies examine delirium in pediatric patients. Schieveld and Leentjens take on this task through the case reports of two young children. They describe the profound effects of delirium on the care of these patients and the emotional stability of both the child and caregiver. This study begins a discussion on delirium in very young pediatric patients and in the process raises issues that are pertinent to children in a variety of medical settings. Physicians are only beginning to understand the characteristics of delirium in young patients and expect that symptoms will depend on developmental level and medical variables. Current treatment recommendations for children, including medications, simply follow plans outlined for adults. The profession can do better.