Urgent question re CT for a 2 year old

[CTquestion]

Due to have a CT on Monday which hospital have kindly booked urgently for us so we have info on a surgery date sooner

But, there is some confusion as to whether sedation is needed and I'm a bit worried as it's Friday and scan is for Mon morning. If sedation is needed I imagine it will need to be rebooked for another day as it's a different process, which is ok

The doctor and clinical team nurse I spoke to who booked it said it would probably need sedation, radiology have said it's not been requested so clinical team must think it's not needed, but it was the clinical team who said radiology would assess need and then call us. That makes more sense to me as radiographer will presumably know length of scan and how likely a 2 year old would lie still long enough?

We don't want to sedate necessarily so don't want to feel like I'm being pushy one way or the other but equally don't want to go and use up the appointment and find that sedation should have been requested

My husband took her for last x rays as I'm pregnant and thinks there is no way she'd stay still for longer than a couple of minutes and would be very distressed, and I know what he means. We practiced x rays for months as she has standing ones in EOS machine but he said it did take about 15 mins to get her in machine and then she only has to be there for ten seconds. He said they were incredibly patient

It's a spine CT, does anyone have any experience? I've emailed spinal team as they are understandably so busy on phones, and radiology said they'd call back

should say don't want to sedate unnecessarily

I am a children's nurse, and, in my experience, 2 year olds very rarely lie still for a CT without any sedation. I hope you get answers from your teams later today, because me saying sedation would probably be needed doesn't help you if your teams aren't working together to consider it.

CTs are super fast these days - literally holding still for 10s would do it. For any procedure they would much rather not sedate, and would rather give it a go with a 2 year old to see if they can manage.
For the CT, she'll just lie down on their special bed, and then it will move through quite a thin (less than a ruler depth) but large widthways hole in the machine. If your dh takes some ribbon with him, she can hold one end and he holds the other while it whizzes through so they are holding hands

Thank you both

I suppose the worst case scenario for us would be that she moves midway and the radiation dose has to be repeated

Also like to avoid sedation although they do have a particular sedation technique there she responded very well to before which is considered probably less detrimental than say GA

I guess I'll just see what they say. Good idea with ribbon, is it worth practicing with an ironing board or something?! I've seen what it looks like

Radiology yesterday said it could take up to 30 mins but I got the impression she was speaking of scans in general and not of our particular scan

My DS had sedation for an MRI brain scan. They wouldn't do it without. It was needed and in fact he started to come round as he was being wheeled out of the scan area back to the ward. It wasn't anymore unpleasant than giving medicine to a child who doesn't want it then waiting to see if it worked. It was absolutely necessary as at aged 2 he couldn't lie still without moving for a second let alone 5 mins. He had to be nil by mouth before which was the hardest bit. Took him for a big breakfast afterwards and he was fine. Hope you get some answers.

My daughter imagines the CT scanner is a doughnut and she is the jam going in. So before each scan we discuss what flavour jam she is going to be. And how shes having a ride on the magic bed. It is really quick so they may be wanting to try without sedation 1st to see if she will manage it.

a ct scan is very quick.
it takes seconds.
when my dc needed one though I was not allowed in due to the radiation. my dc was a young primary school age and was fine on their own for 3 minutes though. that's probably very different with a toddler!

good luck and crossed fingers for you and dc!

Maybe they just want to try first then. I'm quite happy with that (provided they are reasonably confident before they start so that the radiation isn't doubled) but just hope someone can confirm that's the plan as feel a bit uneasy them saying we don't know whether it should be requested or not

The appointment slot would be 30 minutes, but just like having an x ray is a 10 minute slot, but the actual radiation is only on for 0.1s, there is always a lot of faffing about to get onto the bed, laid down straight, moving the bed to the right height and so on.
There's lots of childrens CT videos on youtube, so it would be worth watching those, pretending with teddy, then you have a pretend, she does it, daddy gets it wrong so she gets to tell him what to do etc.

I love the idea of being the jam! Might be worth a hefty bribe of doughnuts in your bag for afterwards :-)

Good ideas! Thank you, this is making me feel much better

It did look quick on the YouTube videos we watched

The scan itself takes seconds so she doesn't need to stay still for long. MRIs take a lot longer so I'd expect sedation for those.

We spoke to a few more people last week and they said it wouldn't be necessary. I was and remain comfortable with their explanation as agree we would not want her sedated unnecessarily, although we did say we thought she would be very distressed and not remain still

DD had her scan this morning and unfortunately as we thought she was extremely upset and thrashing about even though she was strapped down. DH said it was about 5 mins and the radiographers have said the images are blurry and may not be suitable for surgical planning and she may need to return for sedation and have the scan repeated completely so double the dose of radiation which is not insubstantial for a two year old

I still understand and respect their clinical decision but do feel frustrated as when my DH said that we'd mentioned we didn't think she'd be able to and we asked about sedation the radiographer sounded skeptical and asked who we'd actually spoken to which was annoying as I spent much of the day on the phone about it to various departments. I think if they'd said we understood you raised this but it's our procedure for good reason I'd be quite happy with that, but the implication was that if we anticipated a problem we should have raised sedation which of course we did

She's still quite upset now and if we even say the word hospital becomes hysterical

Obviously we're careful not to talk negatively of the hospital in front of her, we just asked about the animals on the screen

How frustrating OP. I'm a radiographer and I always recommend sedation for a two year old. 1-2 years is the worst age for getting a scan without it. The scan takes five seconds but for a toddler that is an eternity! It's often the doctor, and sometimes the parents, that doesn't want the sedation and wants to try without. But when it fails, that's extra radiation like you said. When they come back, sometimes they are so scared from the first attempt the sedation doesn't work.

I get that it's a tough clinical decision because there are risks with sedation in general but also because of the emerging data on neurotoxicity in young children. Our hospital used a sedation technique for her for her MRI using a drug which is perhaps less associated with that effect but it's by no means yet proven, although we were very glad she could have it at the time since I think it's the only hospital offering it. I'd spoken to a couple of US based anaesthetists about it and it was on that basis we were pretty comfortable with that side of sedation risks, though I appreciate there are others. I also get that policy needs to be based on likelihood so if every 200 kids can get through the scan without it they aren't risking that 1 in whatever that may react to sedation.

That said, this was the worst outcome for us because the images are critical for surgical planning of major surgery but for other reasons specific to her situation we've been extra cautious about radiation and I'm very reluctant to repeat. Apparently they said it was the last set that might be blurry - will this be a particular area or will it render the whole scan useless, as surgeon needs to construct a 3D model I believe to plan? It was her spine scanned.

I'd still be comfortable with their explanation if it was discussed honestly because as I say I understand and respect policy and that they are the professionals but to imply we should have raised it is frankly infuriating given the correspondence trails I have and lengths I went to in order to make sure the need for sedation was evaluated. I even had a personal assurance from a senior radiographer that the scan would be overseen carefully although in the event it was arranged short notice and I don't suppose it was possible especially in the pandemic. It wasn't really expected for him to offer that, but he did. He probably couldn't have done anything about it either which is fair enough but I just feel so unheard and this is a big deal for us.

They did arrange it urgently which I'm very grateful for, but I feel although the hospital contains many individually excellent people the communication between departments is very poor. We're at one of the main children's hospitals. DH also said they weren't really that patient, which is disappointing if so, but I did wonder if they were just wanting to get on with it as DD distressed.

I'm really struggling with this and upset about it but it is what it is. Again obviously not in front of DD, just while she naps.

It was a tense wait for consultant to evaluate CT as it was but not knowing if the radiation dose will need to be repeated as well is really upsetting.

Objectively, I recognise risks are small but I'm absolutely gutted that a known risk is being doubled completely unnecessarily.

I think pregnancy and other life stressors at the moment are probably making this harder but have been concerned about CT for some time and this was the worst outcome for it.

Sorry to hear the scan didn't go well OP. I guess I just want to reiterate what you already know - yes it'll be double the dose, but double a small risk is still a small risk. Sounds like if they do need to repeat it will only be one bit the need to repeat though so it wouldn't even be double the dose.

You can ask the hospital to calculate the dose and risk if you like - this is a general risk and shouldn't really be applied to individuals, but at least allows you to but they risk into context with similar risks.