Winter 2009
Effective EUA Preparation
The Global Eye.
Welcome
Eye Contact
Go Ape for Jeff Healey
Camp Sunshine
Rb of Minnesota
Rb of New England
ISGEDR Meeting
Research Matters
Psychological Impact of Rb
Eyes on the World
International Patients
In the Spotlight
Jaymee
Ernest
Rati's Challenge
1st Annual KNRbS Meeting
Focused Care Q&A
EUAs
The Art of Child Life
Preparing for EUA
Snap Shot
Planning an Awareness
Campaigns
World Rb Citizen
Sylvia Sharples
Kids Corner
Winter Crafts
Points of View
Have Your Say
Diary Dates
Upcoming Events
All children - even the youngest infant - will be examined by their pediatrician and anesthesiologist to determine whether they are able to safely undergo the sedation necessary to perform an EUA.
Since many children are booked for an early morning EUA, you will typically be instructed to not allow any food or drink to be taken by mouth after midnight. Please listen closely to the medical staff as they explain these restrictions, and ensure you follow them completely. If you do not follow these instructions and you do allow your child to take something by mouth within 6 hours of the EUA your child’s EUA could be postponed until a later time or day.
Parental anxiety
A parent’s actions, reactions and responses to an upcoming EUA will directly affect a child’s actions, reaction and responses. A parent who is experiencing stress and anxiety about the EUA needs to take the necessary steps to ensure their own needs are met.
A child is constantly watching and taking their cues for how to respond to a situation, interaction or treatment procedure directly from their parent’s actions and responses. If a parent is demonstrating anxiety and upset, the child will often respond with anxiety and upset too.
Please ensure that you seek out the support you need to assist you in reducing your own stress about the upcoming EUA, and take the necessary steps to ensure you remain calm during the period leading up to the EUA. Some helpful stress and anxiety reducing strategies are deep breathing, yoga, meditation, exercise, listening to music, participating in a favorite hobby or activity, talking to a counselor or therapist and in some cases medication may be necessary to assist you with parental anxiety.
Be aware that your phone conversations and any discussions about EUAs with family, friends or adults are also being watched and/or listened to by your child.
Ages and stages: preparation for the sedation mask
The main goals of preparatory mask play is to familiarize the child to the sedation mask, demonstrate that the mask will not hurt them and show them the steps they will be going through when being sedated for their EUA.
Infants 0-6 months
Sensitize the infant to the mask by placing it on the infants face, over the nose and mouth, gently while relaxing together. Sing a gentle song or count up to 10 or down from 10 to demonstrate the length of time the mask will be on the infants face before they are fully sedated.
7-18 months
Slightly older infants are naturally curious and want to touch and explore everything around them. The sedation mask is something an infant would like to touch, taste and manipulate with their hands. At home you can allow your infant to safely explore the mask through play, while you supervise them. Your infant's play will most likely include banging it, throwing it, placing it in their mouth and touching and squeezing it with their hands.
Infants like to mimic the actions of their parents (remember how much fun peek-a-boo is), so after allowing your infant to play with the mask, demonstrate correct use of the mask on your face. You can say aloud “Mask on Daddy’s face”, “Put on”, “Over Mommy’s nose and mouth” to verbally explain the actions you are doing. Repeat this a number of times to ensure your infant understands the action. Reach over and place the mask on your infant's face. Then pass the mask to your infant and encourage them to copy your actions. Say aloud “Your turn, put on”, “Nose and mouth”, “Mask on (Baby’s Name)”.
As your infant masters this action, you can add another demonstration to your mask play – demonstrate taking a deep breath and blowing out. Older infants should be able to mimic this breathing action, while younger infants may take some time to coordinate the breathing/blowing action.
The final addition to your mask play would be to add counting to 10 or singing a short song that would be a similar length of time for the successful sedation of your child before the EUA.
18 months to 2.5 years
Toddlers typically want to do things “their way” or not at all. Many toddlers also like to show people around them that they have learned and mastered a specific skill, and they look forward to receiving praise for successfully performing that skill.
Set your toddler up for success by incorporating mask play into normal playtime. Practice placing the mask on Mommy or Daddy’s face, and then place the mask on your toddler's face. Taking turns is fun for a toddler, so be prepared to practice this many times, over and over again.
Use simple language to label and explain each step (as mentioned in the earlier section), including practicing over the nose and mouth, breathing in and out and counting to 10. When your toddler goes through all the steps, praise them loudly and give them hugs and positive attention.
Additional preparatory methods:
All medical preparation play should be offered well before the scheduled EUA, throughout the day during normal play opportunities. Try not to single out a specific “medical play time”, and give your child a chance to invite you into medical play when they want to explore it. Have the mask and any story books and medical toys mixed in with all the other toys.
There are many children’s books available at mainstream book stores about going to the hospital. Reading stories about hospital experiences help a child become familiar with the people they may come in contact with on the medical team, and also lets them know the steps that they will go through on the day of their EUA.
Many hospitals have pre-surgical colouring books that they give out to prepare children for what they will see and encounter on the day they come to the hospital for a procedure. Many of these books discuss the sedation mask, the operating room and the recovery room. Ask a child life specialist or someone on your medical team about a preparation colouring book.
Some hospitals offer Pre-surgical tours. These can be a nice way for a child to explore the events that will take place on the day of their EUA. They often include a tour of the operating room and some facilitated medical play.
Lastly, and most importantly, let your child overhear you “bragging” to someone about their success with practicing with the mask. Let the nurses and doctors on the medical team know about your child’s great ability to place the mask on themselves and do 10 deep breaths. Encourage your child to share this amazing skill with friends and family, as long as you feel comfortable sharing too.
The Day of the EUA:
Upon arriving at the hospital, you will need to register your child and they may be required to change into a hospital gown or pajamas. Different hospitals have different policies for EUAs and sedation for a child.
All hospitals require some waiting, so please ensure that you pack appropriate toys and personal items that will assist your child in managing through the sometimes long wait. Some hospitals allow children to bring their special toy, stuffed animal or blanket, and the staff will often place a hospital bracelet on that personal item.
If you have a successful family method for eye drops that your child prefers, you should mention this method, and advocate with the nurse to have her use this position, or allow you to administer the drops yourself to your child.
If you and your child have struggled with eye drops, practice repeatedly in the weeks leading up to the EUA and take turns with your child (with real and pretend eye drops) to find the method you and your child prefer.
Many children (and adults) do not feel comfortable lying on their backs during any medical procedure, and eye drops are no exception. Lying on their back can make a child feel open, exposed and upset. Explore and try different comfort positions (see pictures), and practice supportive language or pick a special song that you want to sing during eye drop time.
Allow your child to practice dropping plain water drops (or artificial tears) into your eyes or into a doll or stuffed animals eyes in the different positions you practice. This promotes a more positive experience and assists a child in gaining familiarity and mastery.
Older children receiving an EUA can also practice with water drops or artificial tears and work their way up to administering eye drops on themselves whenever possible.
Some hospitals give pre-anesthesia medication to a child when they appear anxious or upset about the upcoming sedation and procedure. This medicine is given to relax a child, and can be administered via an oral liquid or through an injection. Not all children need this medicine.
If you feel your child may be anxious or upset the day of the EUA, check with your hospital about what medicines they can give to your child prior to the procedure. Ask how this medicine is administered, and then practice this method with your child through play in the weeks leading up to the EUA.
If the medicine will be administered orally, (usually with a syringe), practice giving your child juice with a medication syringe at home. If the medication will be administered via an injection, please refer to the past DECF newsletter article on Positions for Comfort, and select the position you and your child feel most comfortable with for receiving an injection.
Many hospitals, but not all hospitals, are allowing a parent to be present during their child’s sedation. Often these programs are called “Hug and Hold” programs, or “Parental Presence” programs. Typically, a
parent is given a large sterile white suit to ware that goes over their clothes, and the parent walks or carries their own child into the OR and hugs and holds their child while the anesthesiologist places the mask on the child and administers the sedation. Once the child is sedated, the parent leaves the OR.
In hospitals that do not allow a parent to be present, a nurse or member of the medical team often comes to collect the child from the waiting room. Many hospitals allow a child a chance to select their mode of transport into the OR – walking, being carried, and sometimes children can ride a large plastic car or wagon into the OR.
Parents need to stay positive and greet the nurse or medical team member. State aloud that your child will be going with them into the OR, and remind your child to look for the mask in the OR and show the nurse/doctor that they know how to use the mask. Many children are so excited to show off their skills with the mask that the fear of separation is avoided completely as they strain to get into the OR and find the mask!
The Recovery Room:
After the procedure, your child will be taken into the recovery room. Some hospitals allow parents to be present while their child is waking up from the sedation, while other hospitals require a parent to wait until their child is awake before they are allowed to enter the recovery room.
Some children do sleep for about an hour after the procedure is completed. This is normal, and your child will be closely monitored by skilled nurses while they sleep.
Sometimes when a child is waking from the sedation medication they may cry, be confused, upset and/or restless. This is a normal side effect of the medicine as it wears off. Crying and breathing deep actually helps the child’s body process and removes the sedation medicine from their body.
The best thing you can do for your child is to try to comfort them with gentle words, gentle touch and hold them while waiting for them to become more alert.
Children are often hungry and thirsty following the EUA. The nurses will offer clear fluids – juice and sometimes popsicles, and breast fed babies can be given breast milk at this time. Not all hospitals offer a variety of juices, so if your child has a favorite clear drink, you might want to bring it with you as a special treat to look forward to after the EUA.
If your child just received an EUA, she or he will most likely return home the same day. If surgery or treatment was performed at the same time as the EUA, your child may need to stay overnight at the hospital.
Privacy | Terms Of Use | Disclaimer | Site Map | About This Site
Your computer must be running Java to view certain elements of this website.
Please click here for information about how to switch on Java.