FAQ for Parents
What is sedation?
Providing sedation means a child is given medicine to make the child more relaxed. When a child is sedated, he or she will better tolerate a medical procedure and will probably not remember the procedure. If the procedure is painful, medicine to relieve the pain may also be given. Depending upon the level of sedation, the child may be conscious and able to talk to us, or may be deeply asleep but still breathing on his own.
Are there different levels of sedation?
There are three different levels of sedation that are defined by the American Academy of Pediatrics. The sedation physician will discuss the amount of sedation that will be required based on the child and the procedure being performed. Please realize that these definitions represent a range of sedation and that sedation is a on continuum rather than at clearly defined levels. The following descriptions may help in understanding sedation levels:
- Minimal sedation
The patient responds normally to verbal commands. Minimal sedation relieves patient anxiety and is the typical level for cystograms and other minor procedures.
- Moderate sedation
Patients respond to stimulation but may be drowsy. Moderate sedation is a typical level for laceration repair or other minor emergency procedures. Sedation medicine is given by mouth or intravenously depending on the test or procedure. Most EEG’s can be done with medicine by mouth but painful procedures typically require IV sedation medicine.
- Deep sedation
The patient is asleep and lies still but can be aroused by repeated stimulation. Deep sedation is the typical level for MRI, CT scan, bone-marrow tests, spinal taps and other procedures.
How does sedation differ from general anesthesia?
With general anesthesia, the patient will be completely unresponsive even to painful stimulation and may need assistance from a ventilator (breathing machine). A sedated child should react to a painful stimulus and should be breathing on his or her own. Please be aware that children who progress past the level of deep sedation described above are under general anesthesia.
Is sedation right for every child and every test?
No, sedation is only right for some children and is only needed for some tests. For example, if your child has significant medical problems, sedation may expose them to significant risk. If this is the case, it may be best for your child to receive general anesthesia with an anesthesiologist (see below). Sedation is particularly good for minimally invasive or non-invasive tests. Procedures that require more than two or three hours or procedures that involve severe pain are most often done under general anesthesia. For example, an appendectomy requires general anesthesia, but lying still for an MRI can often be done with sedation.
Also, minor tests can often be successfully accomplished without any medication. Distraction techniques and local anesthetics are often all that is needed for blood collection, insertion of an intravenous catheter, or a quick CT scan.
Does every patient and test require sedation?
No. Although sedation services are working to minimize the risks, there are risks related to sedation, so your physician will discuss with you whether they feel your child needs sedation for the test or procedure. This will depend on the age of your child, his or her medical problems and the test your child will be having. Many children will be able to undergo the test with the help of a distraction such as playing with a toy.
How can I prepare my child and myself for the sedation experience?
The following actions can be taken before sedation to help prepare your child and yourself for the experience:
- Bring a list of your child’s medications, any allergies and health problems with you to your appointment.
- Remove any metal from your child (earrings, necklace, watch, hair-ties, etc.) if having an MRI. The MRI magnet is ALWAYS on, and these objects can be harmful for your child and the medical staff.
- If your child has a favorite blanket or special stuffed animal, bring it to the hospital with you. Again, make sure it has no metal parts.
- Arrive early for the appointment for any pre-sedation procedures.
- If your child takes medication, please check with the hospital to see if you should give them their medication.
- For your child’s safety, follow all pre-sedation instructions provided to you. Some of the instructions prevent further illness and others help keep the time of the procedure to a minimum.
- Schedule your day to include a recovery period after the procedure. Depending on the medication with which your child is sedated, this may range from 30 minutes to several hours. There are important criteria your child must meet so they can be safely discharged home. Meeting these criteria may take some time, but it is important for your child’s safety.
Please DO NOT do the following before a sedation experience:
- Do not plan other commitments around the time of testing. Depending on the test for which your child is scheduled, the procedure may take 30 minutes to several hours. Please plan to be at the hospital for a while as the test cannot be rushed.
- Do not be late. Please arrive on time. Arriving late may mean the test or procedure will have to be re-scheduled.
- Do not break the rules around eating and drinking. For your child’s safety, your child must follow these instructions.
Helpful hints for MRI testing
- Before coming to the hospital, talk with your child about things he or she might experience. For example, you could play a game with your child scheduled for an MRI. Using a coffee table at home, drape a blanket over it with your child lying underneath. Make some type of noises (for example, running a vacuum cleaner, etc.)
while he or she lies still to pretend to be in the MRI. Each time you practice, have your child lie still for longer periods of time.
- Allow your child to ask questions. We want all patients to understand the testing process and feel confident and secure.
- Consider that children’s fears are different from those of adults. Most children do not experience claustrophobia (the fear of closed spaces); they are more concerned about the noise of the machine and having to lie still.
How do I care for my child after sedation?
Your child will leave the hospital with after-sedation care instructions to help you understand the symptoms your child may experience after the procedure. Your child’s nurse will go over all of the instructions before you depart. For example, your child will be drowsy when leaving the hospital, so the hospital staff will require that you carry him or her or use a wheelchair to get to your car.
Activities for after sedation often include the following:
- Please follow the directions from your hospital and ask if you have any questions
- Your child will be drowsy after the procedure. How long this lasts will depend on the medication your child receives. The sedation nurse will inform you of what to expect based on your child, the medication they received, and the procedure they had done.
- We would advise, if possible, that two adults be with the child to drive home. One adult to drive and one to sit next to the child to make sure they do not become nauseous or fall asleep in an awkward position.
- A child may be unsteady when walking or crawling and will need protection against injury. An ADULT must be nearby at all times until the child is fully awake.
- Older children should rest in an area where an adult can supervise. Escort the child when walking (such as when going to the bathroom).
- A child should not be allowed to perform dangerous activities, such as riding bikes, playing outside, etc., until back to a normal state of awareness.
- We advise you against taking children to daycare following a procedure. He/she may return to normal activities on the day after the procedure, once he or she has returned to a usual state of alertness and coordination.
- Follow all discharge instructions given to you by your child’s nurse.
Eating and drinking instructions after sedation
Infants under 18 months: Begin by feeding juices, formula and breast milk. If no vomiting occurs, continue with the child’s usual feeding routine.
Children over 18 months: Begin with clear liquids. If no vomiting occurs after 30 minutes, continue with solid foods.
*If your child does vomit, allow his/her stomach to settle for about 1 hour, then offer clear liquids. Do not force the child to drink. Have your child drink slowly (about 4-8 ounces over 30 minutes).
Reasons to call your doctor
- You are unable to awaken your child.
- Your child continues to vomit even after following the directions listed above.
- Your child does not return to a normal state of alertness and coordination within 24 hours.
- For ANY other emergencies, call 911.
- If you are unable to reach the doctor who performed the test, call your child’s doctor.
- If you cannot reach either and you still have concerns, come to the Emergency Department.
Can I be with my child until he or she is asleep?
Two parents/guardians/caregivers over the age of 18 may be present with children over the age of 12 months as they fall asleep, unless otherwise determined by the anesthesiologist. Although this option is offered, parents are not required to be present as their child falls asleep.
What can I expect to see as my child goes off to sleep?
Every experience is a little different. As children become sleepy from sedation, some simply close their eyes and fall asleep smoothly, while others enter a stage of excitement before drifting off to sleep.
During the "excitement stage," children are already asleep enough that they do not have control of their movements and don't remember this phase. Children may move their arms or legs. Their movements can range from gentle to more forceful, and some appear "seizure-like." Some appear dizzy, breathe noisily or cough. You may also see unusual eye movements such as eye rolling. This may be upsetting to see, but be assured that this is all very normal during this stage of anesthesia.
Your child will become limp as he or she relaxes into a very deep sleep. Once your child is asleep, you may kiss or gently touch your child before you are escorted to the same-day waiting area.
Can I be with my child during the entire procedure?
Parents are not permitted to remain present during a procedure while a child is sedated. The team and procedure providers must focus solely on your child to provide the best care possible. While parental support during the pre- and post-procedural time is extremely important, it is not a benefit to your child while he or she is asleep. It is always a concern that a parent may begin to feel faint and require medical attention, which would detract from the care of your child.
Are there eating and drinking restrictions for my child’s procedure?
YES. There are restrictions so that your child may safely receive sedation or anesthesia. When patients receive sedation or anesthesia, their bodies relax, including their digestive system. If there is any food or liquid in the stomach, patients are at risk for vomiting, which could get into the lungs and cause a life-threatening situation. Read the eating and drinking guidelines.
My child takes medicines. Can I give them as directed?
In general, medicines can be taken as scheduled with a sip of water. However, staff will call each family one business day prior to the child's scheduled appointment to discuss medicines including how and when to give them.
What happens if my child has a cold or fever?
If your child has cold symptoms, you should contact the Pediatric Sedation Program directly at (256) 265-7705. Mild cold symptoms in an otherwise healthy child may not necessarily indicate a need to reschedule the appointment. Symptoms that are concerning include, but are not limited to:
- A productive cough (coughing something up)
- Decreased tolerance for normal activities
Although your pediatrician's assessment provides helpful information, the final determination is made by the physician whether it is safe to proceed with the scheduled appointment.
How will my child awaken from anesthesia?
Everyone's experience is a little different, but in general, children tolerate anesthesia and sedation very well.
- Some children will wake quickly and may be awake before their families arrive to see them.
- Other children may remain sleeping for several minutes or hours from the effects of the anesthesia.
- Some children may thrash, cry, seem inconsolable, and have difficulty recognizing familiar objects or people. This behavior is not usually related to pain and typically children do not remember it. This is known as "emergence delirium" and will pass with time.
Please do not wake your child. In our experience, children often have a gentler and more comfortable wake-up when they wake on their own.
How will my child be after sedation/anesthesia?
It is rare that children vomit afterwards, although it does happen on occasion. With certain procedures (such as tonsillectomies) it is relatively common.
Children will not have their usual balance and coordination after sedation/anesthesia. Although young children may be persistent in wanting to walk on their own, it is unsafe for them to do so for several hours after their procedure.
You should avoid having your child do anything that may require coordination or quick response the rest of the day after receiving sedation/anesthesia. Please have your child avoid activities such as:
- Walking up or down stairs
- Riding a bike, skateboard or ATV
- Using playground equipment
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