Children are naturally active and can have a hard time remaining very still, especially for long or painful medical procedures. Anxiety surrounding an upcoming test can also add to a child’s already restless nature.
Connecticut Children’s pediatric sedation team is devoted to helping kids feel less anxious and more comfortable during their procedure or test. Our goal is to minimize physical discomfort and reduce the negative psychological impact to our patients while helping complete necessary procedures.
What is sedation?
Connecticut Children’s sedation team provides sedation (medication that calms the nervous system) prior to a wide range of tests or procedures that cause pain, provokes anxiety or requires a patient to be still. When children get sedation, that means they’re given medicine to make them feel more relaxed or sleepy. The team uses medicines and delivery methods that allow your child to have a more natural sleep state, so general anesthesia and a breathing device are typically not needed.
Medicines are administered through an intravenous (IV) line, but they can also be given orally (by mouth) or intranasally (through the nose) or inhaled. The sedation team stays with your child throughout the procedure to monitor vital signs and ensure his or her well-being. Once your child is awake and back to a baseline (normal) state, he or she typically is ready for discharge with detailed instructions for the caregiver.
When is sedation needed?
Our board-certified sedation specialists evaluate every child before a scheduled test or procedure. There are several factors that we consider to determine if a child will need sedation and what type of sedation to offer:
- Child’s age and developmental level
- Length of time it takes to perform the test or procedure
- Amount of discomfort expected during the test or procedure
- Child’s medical condition
Connecticut Children’s sedation specialists will talk with parents and families about the level of sedation needed based on the individual child and procedure being performed. There are three levels of sedation defined by the American Academy of Pediatrics:
- Level 1 Sedation (minimal sedation) is typically offered to pediatric patients who are undergoing a minor, but stressful procedure. Minimal sedation provides children with the help needed to relieve anxiety to get through the procedure while remaining alert enough to respond normally to verbal commands. Minimal sedation usually works well for non-painful procedures in older children and adolescents.
- Level 2 Sedation (moderate sedation) is usually offered to younger patients who must lie still for a period of time or who are undergoing procedures that may cause some mild discomfort or pain. Generally, these children are too young to understand that a test or procedure will benefit their health or well-being, and will need to be drowsy while the procedure is performed. Typical procedures carried out under moderate sedation are small joint injections or the drainage of skin infections.
- Level 3 Sedation (deep sedation) is offered to pediatric patients who must undergo painful procedures or a test where lying absolutely still is required. Deep sedation generally means that a child is asleep during a procedure or test, such as an MRI or spinal tap.
Common procedures that we provide sedation for include:
- Radiology exams such as CAT scans, ultrasound, a special type of X-ray imaging known as fluoroscopy, and direct arthrograms of the joints where a contrast material is injected to get a better image of the joints, steroid joint injections for arthritis
- Botox injections to temporarily paralyze muscles or prevent spasms
- Nerve blocks to decrease inflammation or block pain
- Lumbar punctures to collect and examine the fluid around the brain and spinal cord
- Biopsies to obtain tissue samples
- Hearing tests (brain stem evoked response tests)
- Incision of skin infections
- Casting and reduction of broken bones
- Dental extractions
- Removal of sutures or stitches
- Blood draws and vaccine administration
Preparing Your Child and Yourself
- Use simple words your child will understand.
- Encourage your child to discuss feelings and ask questions about the upcoming experience, but be careful not to force a discussion if your child does not seem ready.
- Be honest. If you do not know the answer to your child’s question, tell your child that you do not know, but that you will find out.
- Be aware that your visit may take a minimum of two to three hours. It is helpful to bring items to distract, entertain and comfort your child before and after sedation.
- Remain calm and take care of yourself. You will be able to provide better support for your child if you are rested and comfortable. The sedation process will be discussed during your entire visit, so there should be no surprises.
- Bring a spouse, a friend or a family member with you, but try to leave younger children at home and keep your party small to decrease stimulation in your child’s room. A second person will be very helpful during your journey home when your child is still groggy.
Sedation requires fasting before the procedure. Our triage nurse will call you several days before your child’s test or procedure to give you specific information about fasting.
The following are some general guidelines:
- Food: Your child should eat no solid foods, including applesauce, pudding, gum or candy, after midnight the evening before the procedure.
- Liquids: Your child can drink clear liquids, including water, apple juice or ginger ale, until four hours before your arrival time.
- Breast milk: Children may have breast milk until 4 hours before the procedure
- Formula: Children may have formula until six hours before your child’s arrival time. Do not add cereal. Do not use formula that has cereal already added.
- Avoid brushing teeth or chewing gum as either will stimulate your child’s stomach secretions. Please be sure there are no snacks left in or around your child’s car seat.
Note: Orange juice is not considered a clear fluid.
Morning Prescription Medicines
A child can be given prescription medicine while he or she is still allowed to take clear liquids.
Do not give a child medication with apple sauce or pudding. These are considered solid foods. Jell-O can be used as an alternative but only up to two hours before the procedure. Medications that are to be taken later in the day may be given after the child has completed the procedure and recovered from sedation.
What to Bring
To make sedation as easy as possible for you and your child, please bring anything you think will be comforting or entertaining during expected wait times. In addition, please remember to bring any communication systems your child may have. Our staff also wants to know of any ways we can support you and your child, so please tell us about your child’s likes and dislikes, concerns and needs.
Some suggestions that have worked for other patients and families:
- Favorite book
- Favorite toy
- Favorite “snuggly” item (such as a blanket, binky/pacifier, doll or stuffed animal)
- Favorite cup (if your child has a preferred cup)
- Communication device, if your child uses one
- Activities to keep your child busy independently (such as puzzles, handheld devices and coloring books)
- Sensory objects that are soothing for your child (such as squishy balls, teething/biting toys and sound-minimizing headphones)
- A drink for after the procedure is complete if your child has specific preferences
On Appointment Day
We are located on the ground floor of Connecticut Children’s Medical Center in 1G. Valet parking is available at the front of the hospital. A typical visit to Connecticut Children’s Sedation Unit typically lasts a minimum of two to three hours. This includes registration, the procedure and recovery.
Please arrive 1 hour (60 minutes) before your child’s scheduled procedure. Our team needs this time to:
- Complete the insurance registration
- Provide time for your child to be examined by a nurse and doctor
- Have medications ordered and double checked
- Have the sedation pre-medication take effect
- Allow for the IV catheter to be placed if needed
Most procedures last approximately 30 to 60 minutes. Your nurse will be able to provide a time frame for you depending on your child’s procedure.
Recovery will also last approximately one hour. However, each child is different, and some children wake earlier while others require longer recovery times.
We suggest siblings stay at home to minimize distraction. If this is not possible, please bring toys, coloring books and favorite snacks to keep children entertained.
After registration, one of our staff members will guide you and your child to an assigned sedation room. This staff member will measure your child’s weight and vital signs (heart rate, blood pressure, oxygen saturation and temperature).
A registered nurse (RN) will join you and will go over the sedation process with you. A physician will examine your child before sedation begins. They will also ask for your written consent for the procedure.
A Child Life Specialist will help prepare your child for his medical procedure by using age-appropriate education and supportive activities. A Child Life Specialist is a professional trained to speak with children about the procedure.
- Ask to be present before your child wakes from sedation, if allowed.
- When medically cleared, offer a preferred snack (approved by staff). Bring this item from home.
Once your child is ready to leave, the nurse will give you instructions on how to care for your child at home. The nurse will also give you a number to call for any questions or concerns that arise after you go home.
- Many children can have side effects from the sedation medication for up to 24 hours after their procedure. Be aware that they may be sleepy for several hours, they may have vomiting, and they may have some difficulty with balance.
- Some children also have challenging behaviors for a few hours after sedation.
- Some children may need to stay home from school the next day, so a plan should be in place just in case.
- Wheelchairs are available to get your child back to your car once you are discharged. Feel free to bring a stroller if your child is small.
- We discourage public transportation (bus or train) for your ride home for the following reasons: your child may vomit, and your child may require mild confinement to maintain her safety. A car seat or seatbelt is ideal.
All children, including those with special developmental needs including Autism Spectrum Disorder, may benefit from special calming techniques and equipment for their procedure. Our sedation suite has a wide selection of toys and equipment specially designed to calm children before, during and after their procedure.
If your child with special needs has a very rigid daily routine and needs pediatric sedation for a procedure or test, please tell the Sedation Unit scheduler.
We may be able to provide:
- An early appointment to make it easier to manage fasting
- A later appointment to lessen the disruption to your child’s daily routine.
If your child has significant challenges in the hospital setting or other similar settings, we encourage you to let the nurse know when they call to complete your child’s intake process or when they call with final instructions the day before your child’s procedure. Our team can use this information to better prepare for your visit and to connect your family with a Child Life Specialist prior to the hospital visit if you are interested.
We also encourage you to share your child’s strengths and challenges with care providers during the visit, as well as the best ways to approach and work with your child.
Items to Bring
Here are a few ideas about items you may bring from home to help your child with his hospital experience:
- Distracting items (such as toys, books, DVD players, video game players)
Comforting items (such as stuffed animals, blanket, binky/pacifier, music, noise-blocking headphones, sensory stimulation items)
- Any communication aids your child uses
- Reinforcers your family uses with your child
- Special items your child may need, such as a specific cup to drink from or specific drinks for after the procedure
- Other specific items that may be helpful to bring for when your child is asleep after their sedation (such as fingernail clippers, facial hair razor, etc.)
If you’re the parent or guardian of a child with special needs, please let us know what will help your child feel most comfortable during your stay.