Whether it is an X-ray, an ultrasound, a magnetic resonance imaging (MRI) or a CT scan, the medical imaging of children is very different from that of an adult.
Indeed, the exploration techniques must be adapted to the patient’s age and the health personnel must take into account the psychology of the child but also the feelings of the parents.
Dr. Béatrice Leloutre, radiopediatrician at the Lenval hospital in Nice, details the means used to reduce the anxiety of families and gives advice on how to calmly face an examination.
In paediatrics, are imaging examinations frequent?
Yes, these are invaluable tools that help spot possible abnormalities in the body. They help us to guide the diagnosis and then the treatment. At Lenval Hospital, the pediatric radiology team performs around 200 x-rays and 50 ultrasounds per day. Several MRIs and scans are also performed daily. These examinations can concern 26-week premature newborns as well as older children or adolescents.
What are the main anxieties?
First of all, for the parents, there can be a fear of the exam but also of the result. Seeing your baby undergo a CT scan or an MRI can be very impressive and unsettling.
It happens then that an imaging examination brings up deep anxieties in a parent (mourning, illness, etc.). This is why the radiopediatrician must accompany the parents and reassure them regarding the course of the examination. It requires a particular listening and a response adapted to each situation. The other difficulty concerns the young patient. For example, placing a vein for the injection of contrast medium or the prolonged immobility required during the MRI or CT scan can be challenging for a toddler. In addition, it is sometimes necessary to manage the physical pain of a child, for example, when positioning his arm or his broken foot to carry out an x-ray.
Added to this are situations that can be intimidating for them. I am thinking, for example, of cystography. This examination analyzes the bladder and the urethra, filling the bladder with a catheter and looking for reflux towards the kidneys.
So, how to adapt the support?
At the Lenval hospital, information through games is offered to children: the mime of the examination on dolls, a colorful and musical mobile above the ultrasound table, a game case filled with soap bubbles or funny whistles as well as comforting stuffed animals in the X-ray room… To prevent pain, Emla patches are placed before a venipuncture. One can also use Méopa, a medicinal gas having an analgesic action during the time of administration. For babies, pods of sweet serum with a teat are offered during an unpleasant gesture. Parents are also partners in care. Thus, if the child has a particular passion, such as cars or animals, “hypnotic” language can be used to relax him. Thus, during the examination, we discuss with the child his interests in order to temporarily divert his attention to something more positive.
What regarding MRI, a delicate examination that requires you to be perfectly still?
For ten years, the hospital has had a rocket-shaped simulator. The children then follow an original route. They go through the MRI simulator first (view the photo) then earn a “voucher” to get on the big rocket: the real MRI. This tool has significantly reduced the number of exam failures.
In 2020, 251 children had followed Lenval’s “rocket course” and there were 40 MRI failures. In 2022, 436 children boarded the rocket and there were only 39 failures. Reducing this number of failed images is very important. Because a failure of the MRI means a much heavier examination, under general anesthesia, and it is sometimes necessary to wait 6 months before having an appointment! In recent years, these gentle and playful methods have considerably improved the care of children and the support of parents.
How to prepare your child?
1. Tell your child regarding it
For toddlers, the exam process can be explained in simple, positive words. “We can, for example, tell him that the doctor is going to take pretty pictures of his arm or his leg to describe an X-ray. For an older child, you can ask him if he has any questions. If the parent has the feeling that the child does not want to learn regarding the subject, it is best not to insist. When the time comes, the parent will be able to answer questions if necessary.
2. Rely on explainer videos
There are websites such as “Ludomedic” or “srapadrap” which help the child to better understand the interest of the examination, via explanatory sheets and playful videos.
3. Do not hesitate to confide your own fears
“Parents often have fears and apprehensions regarding the exam. They should not hesitate to tell us regarding it because this anxiety can compromise the examination by affecting the child,” advises Dr. Leloutre.
4 on D-Day, provide a “resource” case
On D-Day, parents can prepare a bag with reassuring objects: the favorite toy or book, the cuddly toy, music or a film that he likes to see… Bringing everyday objects allows the child to the link between his familiar world and that of the place of care or the hospital that he discovers or dreads.
