If pediatric patients are to understand imaging exams as positive experiences—or at least minimally negative ones—radiologists and their departmental team members need to see things from a kid’s eye view.
The goal is patient cooperation. And it can be a stiff task to get there, not least because many children, even infants, instinctively—and often loudly—recoil from medical activities aimed at them.
Meanwhile, most radiology residents are assigned just a short stint in pediatric imaging.
The resulting unpredictability can unduly stress out not only patients and parents but also imaging staff.
With these and other common challenges in mind, Richard Gunderman, MD, PhD, of Indiana University, has taken to the pages of Academic Radiology, laying out an overview that provides some helpful do’s, don’ts and how-to’s.
Here are six key pointers from the article, which was co-authored by medical student Michael A. Trevino.
1. Use interactive aids to prepare pediatric patients for the encounter.
Prepping kids via participative activities can be done at home, using widely available coloring books and videos that describe imaging people, equipment and overall care environment. This readiness work can be reinforced in the radiology department “using such aids as a doll on which the procedure can be demonstrated or a mock computed tomography or magnetic resonance table on which the patient can lie down,” write Gunderman and Trevino. “Equally important is the ability to tailor such education to the developmental level of the patient.”
2. Don’t be surprised if the parent is even more nervous than the child, with “contagious” consequences.
Well-prepared and calm parents can be highly effective reducers of the pediatric patient’s distress. The trick is getting the parents ready. One way to reduce parental anxiety is to informally deputize parents as assistants, suggest Gunderman and Trevino. “Most patients will be more reassured being held by a parent than by a stranger,” they state. “In many cases, enabling parents to participate in their child’s care benefits not only the patient but also the parents, who feel less useless and helpless than they otherwise might.”
3. Distract, distract, distract.
The object is not to pretend that nothing medical is happening but to draw the patient’s attention away from what’s scary, boring or otherwise un-fun about the imaging experience. Gunderman and Trevino suggest such simple measures as singing a song with the child or bringing in toys, games or video players. Distraction is an “incredibly effective tool for decreasing pain and anxiety during procedures,” they write, but point out that it “is no substitute for educating patients and family members and making sure that their questions have been answered.”
4. Use drugs if you need to.
Gunderman and Trevino acknowledge that the use of sedation complicates pre-procedure workups, drives up costs and introduces a number of risks and potential complications. Still, when needed, sedative pharmacologic approaches can give the care team “a much greater degree of control over the procedure, largely eliminating uncertainty over how the patient will respond.” Often enough, they point out, sedation can be avoided through as simple a technique as sleep deprivation. “[A]wakening patients several hours early ensures that many will sleep through their examination.”
5. Whenever feasible, call in a child life specialist.
These trained professionals may contact the family prior to the day of the procedure, get a handle on the patient’s level of development, provide targeted educational materials, answer questions and, in general, guide both patient and family in making the experience go more smoothly. “During the procedure, child life specialists can maintain a focus on the patient and the family while the radiologist’s attention is drawn elsewhere,” Gunderman and Trevino write. “Once the procedure is over, they can help the patients and the family process what happened.”
6. When finished imaging, put a positive spin on what just happened.
“One point to emphasize, at least with family members and older patients, is the rationale and potential benefits of the procedure. Another is to praise the good work patients and family members are doing in helping to make the procedure a success,” write the authors. “In many cases, such encouragement can become a self-fulfilling prophecy, helping everyone involved do an even better job.”
Lastly, participation prizes can make a big difference, write Gunderman and Trevino.
“Simply put, unnecessary anxiety, discomfort and pain should be avoided in patients of every age, and every effort should be made to make the pediatric patient’s radiology experience as positive as possible,” they conclude. “For this to happen, however, radiologists need to develop their capacity to look at the radiology department and the procedures performed within it from the patient’s and the family’s point of view.”