An important issue regards the diagnosis of pediatric delirium in critically ill children <16 months, since, at the pediatric intensive care unit, 80% of children are <36 months, and 50% are <12 months. The DSM-IV-TR section on children does not mention pediatric delirium. Whereas diagnosis of delirium in adults relies heavily on neurocognitive symptoms, diagnosis of delirium in children relies more on behavioral symptoms, given the difficulty of assessing neurocognition in infants. The five Pediatric Anaesthesiology Emergence Delirium criteria: eye contact, awareness of surroundings and caregiver, purposeful actions, inconsolability, and restlessness may represent appropriate diagnostic criteria in DSM-5.11 Another issue is that the DSM-IV-TR flow chart “Differential Diagnosis of Mental Disorders Due to a General Medical Condition” has two omissions.9 First, there is no consideration of the fact that nearly all pediatric intensive-care unit patients already have disturbances of consciousness and cognition—due to sickness behavior and analgo-sedation, and, thus, already have pre-delirium. Furthermore, for a flow chart to be of use in a (pediatric) intensive-care unit context, its starting-point should be the everyday occurrence of 1) “a sudden emotional and behavioral disturbance in a critically ill patient” and/or 2) “refractory agitation,” rather than the current entry cue of “symptoms that are due to the direct physiological effects of a general medical condition.” The flow chart should discuss in logical order of clinical importance the differential diagnoses of the underlying causes: major somatic complications, discomfort causes, psychosocial deprivation, delirium, and medication-related causes: withdrawal/tolerance/paradoxical excitation. Also, the sequential order of the current flow chart—although logical in itself—seems inadequate, as, in critical illness, several causes frequently operate simultaneously. Our proposed change for DSM-5 is to devote a section to “Emotional and Behavioral Issues in the Critically Ill (Child),” combined with a novel flow chart and pediatric delirium criteria.