What is pediatric sedation?

Many tests and procedures require that children hold still for anywhere from a few minutes to several hours. Pain medications & sedating medications block pain involved with the procedure, relieve anxiety, help your child remain motionless, and make procedures quicker and safer. Sedation may be used in combination with pain medication to help children remain comfortable during painful procedures.

There are several levels of sedation:

• Minimal sedation: Child is in a relaxed state in which he/she is awake and able to respond normally to questions.
• Moderate sedation: Child is in and out of consciousness and can be woken by sound or touch
• Deep sedation: Child is unconscious and does not respond to sound or touch.

Sedation medications can be given:

• Orally (your child drinks a liquid)
• Intranasally (spray injected into your child’s nostril)
• Intramuscularly (an injection into your child’s muscle)
• Intravenously (an injection into your child’s vein)
• Inhaled gas (breathing through a mask)

We provide inpatient and outpatient sedation for infants, children, and adolescents throughout the UNC Hospital facility, mainly based out of our state of the art Pediatric Sedation Unit.

Our staff of highly trained pediatric anesthesiologists, pediatric nurse practitioners, pediatric sedation nurses, and child life specialists work closely with your child and family to create the most appropriate sedation plan.

We use multiple methods to help children tolerate their procedures, including distraction, preparation, and teaching techniques followed by sedating medications. Specific medications and the levels of sedation are chosen based on your child’s age, weight, medical history, the duration of the test or procedure, and invasiveness of the test or procedure.

Some of the medications used for pediatric sedation include:

• Midazolam (Brand name: Versed): A medication used to help ease anxiety and help the child relax. It may be given in combination with other medications to help the child sleep through the procedure or test. Midazolam is administered by mouth, intranasally or intravenously.
• Fentanyl (Brand name: Sublimaze): A pain medication used to help sedate and/or relieve pain. It is usually given to help ease children to sleep during sedation with midazolam and used as needed to maintain comfort during painful procedures. Fentanyl is administered intranasally or intravenously.
• Ketamine (Brand name: Ketalar): A medication used for sedation and pain relief. It is administered orally, intramuscularly, or intravenously.
• Dexmedetomidine (Brand name: Precedex): A pain & sedating medication that is used to help a child sleep and reduce discomfort during a test. It is often used in combination with the other medications listed above. Dexmedetomidine is administered intranasally or intravenously.
• Nitrous Oxide: A gas that is used for sedation and pain relief. It may be used in combination with Midazolam and is administered by breathing the gas through a mask.

Even though a child may be “calm” or “strong”, requiring them to lay still for a few minutes to several hours may be very difficult. Sedation helps your child remain calm and relaxed and can assist us in getting the most accurate test results possible.

Procedures that may require sedation

• Bone marrow aspirate and biopsies
• Bone scan
• Botulinum toxin injections
• Computed tomography (CT) scans
• Catheter placement
• DMSA scan (special scan to assess kidney function)
• Dressing changes for wounds
• Dermatologic procedures
• Hearing evaluations (auditory brainstem response or ABR)
• Joint injection
• Lumbar puncture (also called spinal taps)
• Magnetic resonance imaging (MRI)
• MIBG scan (special scan to identify and localize certain types of cancer)
• Nuclear Medicine imaging
• PICC lines
• Positron emission topography (PET) scan
• Radiation therapy
• Renal scan/biopsies
• Various radiology procedures

Preparing your child for sedation depends on what works best for your child and family. For some children, telling them too far in advance of the procedure or test may actually increase their anxiety. In this case, the best way to help prepare them is brief, factual information the morning of the procedure, or the day before the procedure.

Other children may need more time – a few days to a week – to process information, ask questions and get help working through coping strategies.

• 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 three to four hours. It is helpful to bring items to distract, entertain, and comfort your child before and after sedation. Certain items such as stuffed animals or blankets may accompany your child with them during their procedure or test.

• 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 size 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.
• Our friendly family unit allows parents to be present for IV starts, the work up and initiation of sedation, and recovery. After your child receives sedating medications, you will be escorted by a team member back to the waiting Once your child has arrived in recovery, we will bring you to their room so you may be the first thing your child sees as they wake up.

You will receive an email 1 to 2 weeks prior to your appointment that includes specific information about arrival times and fasting instructions. You will also receive a phone call from our triage nurse to ensure your questions are answered and to check on the general health of your child.

The following are some general fasting 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, ginger ale, Gatorade, until two (2) hours before your arrival time.
• Breast milk: If your child is breastfed, they may have breast milk until four (4) hours before your arrival time. Do not add cereal.
• Formula: If your child is formula fed, they may have formula until six (6) hours before your child’s arrival time.

Please be sure there are no snacks or drinks left in or around your child’s car seat.

For their safety, if your child arrives and has not followed the above guidelines their test will be delayed or rescheduled. If your child is sick with a fever or cold symptoms or has been on antibiotics for an illness within the past 2 weeks, please call our scheduler at 984-974-6732. For your child’s safety, you may need to reschedule.

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, needs, or past experiences.

Some suggestions that have worked for other patients and families:

• Favorite book
• Favorite toy
• Favorite “snuggly” (blanket, pacifier, doll or stuffed animal)
• Favorite cup (for use in recovery)
• Communication device, if your child uses one (PECS book, iPad, Dynavox, iTouch)
• Activities to keep your child busy independently
• A drink or snacks for after the procedure is complete (if your child has specific preferences)

A typical visit to NC Children’s Hospital Pediatric Sedation Unit lasts a minimum of three to four 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 pediatric anesthesiologist or pediatric nurse practitioner
• Have medications ordered and double checked by the pharmacy
• Allow the sedation medications to be administered and take effect
• Allow for an IV catheter to be placed

Your nurse will provide an estimated 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 a second adult who will be able to remain with the second child in the waiting room.

A pediatric sedation nurse will join you and will go over the sedation process with you. A pediatric anesthesiologist or pediatric nurse practitioner will examine your child before sedation begins. They will also ask for your written consent for the procedure.

Sometimes, a Child Life Specialist will help prepare your child for his/her medical procedure by using age-appropriate education and supportive activities.  If you would like more information on the services Child Life may provide please see https://www.uncmedicalcenter.org/uncmc/care-treatment/rehabilitation-therapies/recreational-child-life-therapy/.   Please let your nurse know on your arrival to the Pediatric Sedation Unit if you would like a Child Life Therapist to visit with your child.

Most procedures last approximately 30 to 60 minutes. Your nurse will be able to provide a time frame for you. The nurse will also ask for your cell phone number, if you have one, so that you may be updated when your child returns to recovery.

Once the procedure or diagnostic study is completed, your child will recover in his/her Sedation Unit room. Recovery time is variable, but the average time is about 1 hour.

Your child will be asked to eat and drink prior to being able to leave. The IV will be removed before your child goes 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 telephone 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. Please be aware that your child may be sleepy for several hours, they may feel nauseated or vomit, and they may have some difficulty with balance.
• Some children also have challenging behavior for a few hours after sedation.
• Wheelchairs are available to help get your child back to your car once you are discharged. Feel free to bring a stroller if your child is small.

If your child has significant challenges in the hospital setting or other similar settings, we encourage you to let the nurse know during the triage phone call for your child’s appointment or during the phone call with final instructions the day before your child’s procedure. Our team uses 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.

The address for UNC Hospitals is 101 Manning Drive Chapel Hill, NC.  Click here for a map.

Important things to remember:

• Do not eat anything after midnight before your procedure.

• If your child is formula fed, they must stop all formula (including baby cereal or other thickeners) 6 hours before your check in time.

• If your child is breast fed, they must stop all breast milk 4 hours before your check in time.

• All children may drink clear liquids until 2 hours before your check in time

Clear liquids ALLOWED: Water, Apple Juice, Pedialyte, Sodas (ie. Sprite, Gatorade, Ginger Ale)

If your child has a cough, running nose, fever or you have questions about this appointment, please call the Pediatric Specialty Care Team at (984) 974-6732 or at (984) 974-8080.

A dirección de UNC Hospitals es 101 Manning Drive Chapel Hill, NC.  Haga clic aquí para ver un mapa.

Cosas importantes para recordar:

• No coma nada después de la medianoche antes de su procedimiento.

• Si su hijo se alimenta con fórmula láctea, debe dejar de tomarla (incluidos los cereales para bebés y otros espesantes) 6 horas antes de la hora de registro.

• Si su hijo se alimenta con leche materna, debe dejar de tomar leche materna 4 horas antes de la hora de registro.

• Todos los niños pueden tomar líquidos transparentes hasta 2 horas antes de la hora de registro.

• Líquidos transparentes PERMITIDOS: agua, jugo de manzana, Pedialyte y refrescos (por ejemplo, Sprite, Gatorade, Ginger Ale)

Si su hijo tiene tos, goteo nasal, fiebre o si tiene preguntas sobre esta cita, llame al equipo especializado en atención pediátrica al (984) 974-6732 o al (984) 974-8080.