1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 10 Pediatric Radiographic Considerations

2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins The Pediatric Patient Age: Infancy to 15 years of age Requires safety and communication techniques for an effective outcome Requires a sensitive approach toward the parent or guardian Establish a rapport with the parent and child Explain the exam to the child when applicable Establish eye level contact

3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Caring for Children During Radiographic Procedures Infants (Birth – 12 months) Toddlers (1-3 years) Preschooler (3-5 years) School age (6-12 years)

4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins High Risk Newborn Infant NICU Hand hygiene Appropriate clothing attire including gloves Cleanliness of portable Consult with infant’s nurse prior to exam Never image an infant without assistance Provide lead shielding to nurse and self Shield the infant

5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins The Adolescent or Older Child Use effective communication Identify the patient Explain the procedure Educate the patient Maintain the patient’s concern for privacy Provide after care directions

6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Transporting Infants and Children Standard Precautions must be followed during transportation ID the patient Portable incubator Crib Gurney Wheelchair

7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Immobilization and the Anxious Child Immobilizers are used when a child is not able stay in place long enough for a successful diagnostic procedure Immobilizers should be used only when no other means are safe or logical Images should be of high quality May require the help of the parents and other technologists

8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Immobilizers Commercial: Pigg-o-stat, Papoose Sheet Immobilizers Mummy-Style Sheet Wrap Immobilizer Commercial Immobilizers and Other Positioning Aids –Posi-tot –Tam-em board –Infantainer –Sandbags

9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Radiation Protection Radiation Protection is a priority for infants and children because of the radiosensitivity of their rapid and changing cell growth. The radiographer is responsible for using effective radiation protection measures during pediatric imaging procedures. ALARA should always take place Use of appropriate gonadal shielding

10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Child Abuse Child abuse is any act of omission or commission that endangers or impairs a child’s physical or emotional health and development. Child abuse includes the following: –Physical abuse and neglect –Emotional abuse –Sexual abuse

11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Indicators of Physical Abuse History –The child states the injury was caused by abuse –Knowledge that a child’s injury is unusual for a specific age group –Parent is unable to explain the cause of injury

12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Cont. Behavior Indicators –Child is excessively passive, compliant, or fearful –Child is excessively aggressive or physically violent –Child or caretaker attempts to hide injuries –Child makes detailed and age-inappropriate comments regarding sexual behavior

13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Radiographer’s Responsibility It will be the radiographer’s ethical and legal obligation to report child abuse to the person at the institution who makes the enquiries and the required reports in such cases. Each institution has a protocol that dictates the method of processing suspected cases of child abuse. In most states, the health care worker who reports suspected child abuse is protected from legal action if the report proves to be false.

14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Medication to the Pediatric Patient in Radiographic Imaging Medicating children can be life threatening and must not be undertaken by the radiographer. However, if a registered nurse is unavailable to administer contrast media to patients under 18 years of age, with proper education and certification, the radiographer may administer the contrast media under the Radiologist’s approval. Drug absorption, biotransformation, distribution, use and elimination are different in infants, children and early adolescents in comparison to adults.

15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Questions Before Administration of Contrast Media –Drug or food allergies –How does the child respond to medicines –In what form are medicines administered in the child’s home? –Will the parent be able to supervise the child after the exam? –Any unusual circumstances with medication in which the physician should be notified? –Is the parent educated in the action of any possible reactions to the drug?

16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins The assessment and care of the child is usually performed by a registered nurse who works in diagnostic imaging. Before the child receives a contrast agent or sedating medication is discharged, he must be assessed by the nurse or physician and given authorization to leave with a parent or guardian after the exam.

17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Catheterization of Pediatric Patients Catheterization may be required for a cystography procedure, which may include a voiding cystourethrography. Catheterization of pediatric patients is recommended by registered nurse or physicians who have specialized education in pediatrics.