Within Yale Medicine’s Department of Radiology & Biomedical Imaging, the doctors in the Pediatric Radiology Program have tremendous expertise and access to the most sophisticated magnetic resonance imaging (MRI) scanners and ultrasound probes specially designed to treat children.
Yet, they face a challenge every day that has nothing to do with the power of their machines or the complexity of the cases that come before them. “The big challenge with pediatric imaging is getting the kids to stay still,” says Rob Goodman, MD, chief of Pediatric Radiology. “Figuring out how to make them comfortable really helps.”
Below are some ways our section helps put children and their parents at ease before medical imaging.
Setting the scene: One way the team helps make imaging a positive experience for patients is by making children feel like they’re somewhere else: at the beach. Our pediatric MRI scanner is decorated to look like a sand castle and is set in a room with a seashore motif. “Children love it. Parents love it,” Dr. Goodman says. “It really makes for a very pleasant, very child-focused environment.”
Working with child-life specialists: Children having an MRI or an intravenous (IV) tube placed for contrast dye procedures may work with a certified child-life specialist to help reduce apprehension before and during pediatric medical imagining. “My goal when working with patients is to help them feel less anxious or scared by providing developmentally appropriate preparation information,” says certified child life specialist Kat Pullen, MS, who works with pediatric patients at Yale New Haven Hospital. She meets with patients and families once they have been checked in at the reception desk and tries to stay with them throughout the duration of their visit to provide support and offer real-world explanations.
“During wait times, I build rapport with patients and families by engaging in conversation about their interests, and if they are younger children, I engage in play with them to help build trust, normalize the environment and facilitate coping,” she says.
She commonly explains to young patients that an MRI is “a fancy way of saying that we take pictures using magnets” or that head coil for a brain MRI “looks like a Storm Trooper helmet.” With the right support, children who are having MRI scans—which require them to stay very still in a tight space with strange noises—can often do so without being sedated. “I have had success with children as young as 4 in completing an MRI scan without sedation or anesthesia,” says Pullen, who makes it her practice to tell children how important it is to be very still so the pictures won’t be blurry. “For younger children, I tell them to be still like a statue,” says Pullen.
Providing interactive toys: Our section is also filled with toys to help children relax and become acclimated. Some of the toys even have an educational purpose. For example, a toy scanner allows children to practice scanning dolls and stuffed animals.
Harnessing the power of distraction: While undergoing tests, one effective way to help kids feel comfortable when undergoing imaging tests is to distract them with entertainment. Inside the MRI scanner, children can wear goggles to watch a movie. The goal is to entertain and calm them, so they don't have to be sedated. “Once a child is watching Frozen, they’re out for the count,” Dr. Goodman says. This is particularly helpful with MRI scans, which take about 45 minutes and, says Dr. Goodman, “can be very boring." (For young toddlers and babies, doctors will usually use sedation.)
Delivering child-size doses: In some cases, the physicians use adult-scale equipment, but provide child-size doses of radiation. For children, computerized tomography (CT) scans are mostly used after a trauma—such as a car crash or a blow to the head—because they create such detailed images. “A few years ago there was a lot of concern in the popular press about the radiation dose,” Dr. Goodman says. “We explain to parents that if their child needs a CT scan, they’re getting one of the lowest doses in the United States."
Reassuring parents: Staffing the department and Yale Medicine’s area clinics with pediatric imaging specialists has been a priority for Dr. Goodman. New staff members include an attending physician who focuses on pediatric cardiology imaging. Another doctor concentrates on interventional radiology, which uses image-guided, minimally invasive techniques to perform procedures such as biopsies and inserting catheters into blood vessels. All doctors know they need to cater to patients and their families.
“We try to meet with the parents after every ultrasound, for example,” says Dr. Goodman. “It’s really the parents you need to work with to make sure their kids understand what’s happening.”