"How can we ease the MRI process for our 3-year-old who has autism? Would full sedation be better than conscious sedation?"
This week’s “Got Questions?” response is from pediatric neurologist Monica Proud, of Texas Children’s Hospital and Baylor College of Medicine, in Houston. Baylor and Texas Children’s are part of the Autism Speaks Autism Treatment Network.
An MRI can be frightening for any child and family. But it can be especially difficult for a child with limited communication abilities. For starters, I’d like to ease any fears you may have about the sedation process.
First let’s define “sedation” and “conscious sedation.” Sedation is the process of using medications to produce calm or sleep. In conscious sedation, we aim to produce the calm without altering consciousness. However, the general agreement among experts is that most children need deep sedation to successfully complete the MRI procedure. This is because any movement in the MRI machine can significantly disrupt the images and make the results difficult to interpret.
Reassurance for parents: safety above all
Second, it’s important for you to know that sedation is a carefully regulated process. Procedures are based on clear guidelines set by the American Academy of Pediatrics and the Anesthesia Society of America and they’re closely monitored by the Joint Commission on Accreditation of Healthcare Organizations.
A recent large study, conducted across many medical centers, looked at all types of sedation in more than 130,000 children over a period of 4 years. The complication rate was less than one tenth of one percent, with no deaths.
As a medical team, we strive to make all our sedation procedures extremely safe. Before the procedure, we will assess your child for any medication allergies, disordered breathing, mouth or throat abnormalities or other conditions that might require extra precautions. This enables us to ensure we’re ready to help the sedated child with breathing as necessary. For instance, if your child had a history of a congenital heart problem, we would enlist a specialist in cardiac anesthesiology to monitor the procedure.
Prior to sedation, you’ll receive clear instructions on when your child should stop eating or drinking. When it’s time to administer the sedation, a team of skilled and experienced professionals will remain on hand to begin and monitor the procedure. The choice of sedative will largely depend on the child and any special risk factors. There will be an intravenous line (IV) in place, as well as oxygen and continuous monitoring of heart and lung function.
Usually, but not always, the sedative is timed to wear off quickly after the MRI. Generally, your child will return to normal within a few hours, with you on hand as he or she awakens. The staff will keep you updated as to any changes to these procedures.
Hopefully, this explanation of what to expect will demystify the process and help you feel comfortable with it. This is the most important step to helping your child relax.
Helping your child
Preparing a child with autism for any medical procedure can prove challenging. I probably don’t need to tell you that children with autism are particularly fond of routines. Your child’s routine will certainly be disrupted on the day of the MRI. You may face additional challenges if your child has difficulty communicating or has troublesome sensory issues.
I recommend preparing your child by calmly describing the sequence of events that will likely occur on the day of the appointment. Some families find it works best to have this discussion the night before. Others find that this leads to overnight fretting and wakefulness.
If you prefer waiting till the day of the MRI, I suggest waking up early enough to have an unrushed conversation. Consider using visual supports or a helpful picture book about visiting the hospital. Your explanation can even include active participation of some favorite dolls and stuffed animals. (For more information on using visual supports, download Autism Speaks “ATN/AIR-P Visual Supports Tool Kit,” free of charge, here.)
I suggest starting your “story” at the very beginning – with the drive to the hospital. Talk about the people and equipment your child may see and how he or she may feel. In our experience, many children with autism love to hear that they will be having pictures taken of their brains. Be sure to explain that this is completely painless, and that the doctor may be able to show the picture at the next office visit!
Also explain that your child will get a mask – like an astronaut or a super hero might wear – and will get to sleep through the procedure.
On the day of the MRI, dress your child in comfortable clothes. Remember that hospital rooms tend to be on the chilly side.
I suggest bringing a loved toy or object that your child finds comforting. If you have a CD or DVD player, considering bringing along a favorite disc or two to occupy your child while waiting.
You may request that hospital staff use a numbing cream before inserting the IV needle. This can make the procedure less painful. I also recommend asking staff whether the hospital has a Child Life Services department. Such departments are staffed by professionals specially trained in making the hospital experience more pleasant for children. This can include appropriate distractions (bubbles or other fun activities) during the IV insertion.
When it’s time for you to step out of the room, explain to your child that you will always be nearby and that the procedure will be over in no time. I also think it’s fine to promise a special treat when it’s all done!
Got more questions? Send them to GotQuestions@autismspeaks.org.
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