MRI/sedation/hospital stay with 5 mo. Need advice/encouragement.

[odoole]

My 5 mo will need to get a brain MRI and a 1-day hospital stay for treatment of a hemangioma above his eye. I'm not thrilled. He was a preemie, so we've already spent 6 days in the hospital with him and it was fine, but for some reason I'm terrified this time around. I guess it's because he's older and we've bonded more.

I'd love for some advice or positive stories about MRIs. That's the bit I'm most disconcerted by. He will require sedation, probably general anesthesia, which totally sucks. They also said no solids (including milk) for 7 hours before the procedure. Does Breastmilk count? Or is that a clear fluid? If they say no breastmilk, what am I supposed to do with him? (He currently eats every 2-3 hours, even at night.)

In the hospital, they will be starting him on a new medication, propranolol, and monitoring for side-effects. What will breastfeeding be like during the hospital stay? How can I make sure he's comfortable? Any advice for the IV and blood draws they will need to do with him?

Lastly, I know this treatment is relatively new and uncommon, but on the off chance -- anyone have any experience with putting their LO on propranolol?

Thanks so much for your help.

[KCMichigan]

I dont have experience with propranal or hemangiomas, but we have had MRIs and been hospitalized.


Both my DDs have had MRI w/ sedation. One DD was very hyper before falling asleep- then work up crying and upset (both MRIs she has had done) and the other DD just go sleepier and sleepier and woke up happy. I was worried both times, but it went well. They were 11months (both DDs) and 4 y (only DD1). It was harder at 4 though since she was VERY mad about not eating & taking the icky sedation medicine. At 11m they slurped the meds down since they were hungry.

Both DDs have been hospitalized overnight and one has had surgery (9 months). It was not fun, but went ok. The baby beds are kinda 'cage-like' but I spent a lot of time holding them anyway. They may also put a board on the baby's arm if they have an IV to make sure they do not pull it out. I found our local nurses to be very nice and accommodating to our (families) needs.

I found hospitalization post NICU also very stressful!! Somehow it was so different bringing them'back' after being discharged (we have had a DD hospitalized at 6m , 9m (surgery), 13 m, and 25 m).


I hope it all goes well for you and your family!

[KatWrangler]

Breastmilk is clear liquid like broth or water. It is NOT counted like milk or formula. Now I can't remember if it's 3 hours before or is it 2? Hmmm maybe one of the other ladies can remind me of what the hour are for BM. Seven hours in an infant is freaking crazy! I would raise hell with whomever told you that.

My daughter has had 6 (I think...I lost count LOL) MRI's with no trouble at all. The first being when she was 4 1/2 months old. The only one with trouble was a sleep deprivation one with the sleep drug. She woke up during the MRI and they had to stop. Most have been GA.

Good luck! You and your child will do fine!

eta - When she was 4 1/2 months old she had surgery and was flat on her back. I was able to breastfeed by leaning over into her crib. It wasn't comfortable, but I did it anyway. Both in PICU and in her room. Thankfully I have large floppy boobs. Now in PICU they finally gave me a tall chair, that helped a great deal.

If you need to pump they have pump rooms on the NICU floor. Talked with the nurse (actually talk with the nurse prior to this) about making arrangements. They didn't allow me to take my pump because of wattage or something weird like that. But they gave me tubing and supplies and I was able to pump twice right after my daughter's surgery to relieve my pressure. They then put my milk in the fridge with our name on it. They transfered it to the floor my daughter was on when she moved to a regular room.

Blood draws and stuff. Hold your child's hand, talk softly to them. Let them know you are there and how much you love them. I know how much it hurts you to see this. I know it did me, but I knew it was for the best interest of my child.

[theretohere]

Breastmilk should be counted as a clear fluid, but some hospitals just ignore that. I would print some stuff off and discuss it with the anesthesiologist. MRIs aren't a big deal, and I kind of prefer them under general- then you know that they won't wake or move so it won't need to be repeated.
it's scary, but it'll be OK!

[odoole]

Thanks everyone; I'm feeling much better about it now. I'd still welcome more personal experiences as well.

We got further instructions and it said I can give no solids or milk beyond 7 hours, but breastmilk is ok 4 hours before and clear liquids 2 hours before. That sounds slightly better. DS has never had anything but breastmilk, but he'll be 5 and a half months so I'm thinking it'd be ok to give him a litle diluted apple juice 2 hours before to take the edge off ...

I forgot to ask-- will I get to be there in the MRI suite with him? (I have a metal plate in my wrist, so I hope that wouldn't be a problem if so.)

[APToddlerMama]

My husband sells MRs and I asked him about the metal plate thing, and he said that you probably would be able to go in, but that you DEFINITELY need to ask beforehand because obviously it could be a serious problem. He said it usually depends on the type of metal on whether or not it would be compatible. Good luck!

[MotherWhimsey]

Originally Posted by odoole

Thanks everyone; I'm feeling much better about it now. I'd still welcome more personal experiences as well.

We got further instructions and it said I can give no solids or milk beyond 7 hours, but breastmilk is ok 4 hours before and clear liquids 2 hours before. That sounds slightly better. DS has never had anything but breastmilk, but he'll be 5 and a half months so I'm thinking it'd be ok to give him a litle diluted apple juice 2 hours before to take the edge off ...

I forgot to ask-- will I get to be there in the MRI suite with him? (I have a metal plate in my wrist, so I hope that wouldn't be a problem if so.)

Each place is different but we've never been allowed back at DS's MRIs. He's had them at 2 different hospitals too. And I think the metal plate in your wrist might be an issue also. We were allowed in the prep room and then again in recovery both times. He was out by the time he left us for the 2nd, but not the first (which was at 5 mos old).

[KCMichigan]

I was allowed to go back for MRIs. I stood at the foot of the 'table' the entire time.

We have a VERY parent friendly hospital. I was even allowed to go back to the OR for one of DDs procedures (endoscope w/ biopsies) while they put her under GA- then I had to leave. They found having a parent there was comforting to the children (and parent).


Make sure you ask about the metal plate.

[Birdie B.]

s
I don't know what your hospital will allow, but my daughter recently had an MRI, and we chose not to have her sedated. She had been sedated so many times in her short life that we wanted to avoid it if possible. The staff was very encouraging and open to trying it.

We kept Meadow up late the night before and woke her up very early, so she was pretty sleep deprived. The MRI was at 6 am. I nursed her in a dark room once we got there, and swaddled her and rocked her to sleep. Then we placed her in a padded trough on the exam table and tucked her in tightly. They placed a heavy blanket over her and placed earplugs in her ears, too. She did wake up during this, but she was so sleepy and cozy that she drifted back to sleep. I climbed up on the table and kept my hands on her the whole time. She did great the whole time, and we were glad we could avoid sedating her. I don't know how long your son's MRI will take; Meadow's was only 25 min.

If your hospital won't let you try this, then be sure to nurse as close to the time limit as possible. i was really worried when I had to avoid nursing before surgery, but my daughter always did fine. I gave her a paci and rocked her, and she usually slept until it was time to go back. I always stayed with her until she was taken into the OR, and came back to the recovery room as soon as we got the alert that she was out. Babies and children really need the comfort of a parent while coming out of anesthesia. Good luck!!

[anj_rn]

I used to be a sedation nurse for a pediatric hospital, so I have some experience, but every hospital has different policies.

Feeding - Unsually the rule is no Breastmilk 4 hours before sedation and clear liquids 2 hours before sedation. Try to get a good nursing in right before that 4 hour mark. I would go with pedialyte right brfore the 2 hour mark. (I am not usually a big pedialyte user, but I have found it does not cause sugar crashes like juices do when not eating).

sedation - Type of sedation depends a lot on your child's health issues and the comfort level of providers. I have seen some babies make it without sedation, but if the MRI is with contrast, you need the sedation. Concious sedation is most common and usually done by a sedation nurse and physician or midlevel. Usually you can be in the room with the child until he/she is out, and then they will call you back before wake up time.

General anesthesia will not usually let you stay in the room while they sedate.

Plate in your arm - I have worked at 2 hosp, one had not parents in the MRI suite at all. The other would let you go through if you passed the screening (but the metal plate in your wrist would have excluded you).

IVs & pokes - Ask for EMLA as soon as you arrive at the hospital (it takes 20-30 min to work), it is a topical anesthetic that will help with the owies. If you want to help hold your child while they poke, you can. If you do not feel you can help, PLEASE let the staff know. I would rather round up helpers and be done in 1 stick, than lose an IV because a parent let go of a child too early.

I hope everything goes very well for you.

[KatWrangler]

Originally Posted by anj_rn

I used to be a sedation nurse for a pediatric hospital, so I have some experience, but every hospital has different policies.

Feeding - Unsually the rule is no Breastmilk 4 hours before sedation and clear liquids 2 hours before sedation. Try to get a good nursing in right before that 4 hour mark. I would go with pedialyte right brfore the 2 hour mark. (I am not usually a big pedialyte user, but I have found it does not cause sugar crashes like juices do when not eating).

sedation - Type of sedation depends a lot on your child's health issues and the comfort level of providers. I have seen some babies make it without sedation, but if the MRI is with contrast, you need the sedation. Concious sedation is most common and usually done by a sedation nurse and physician or midlevel. Usually you can be in the room with the child until he/she is out, and then they will call you back before wake up time.

General anesthesia will not usually let you stay in the room while they sedate.

Plate in your arm - I have worked at 2 hosp, one had not parents in the MRI suite at all. The other would let you go through if you passed the screening (but the metal plate in your wrist would have excluded you).

IVs & pokes - Ask for EMLA as soon as you arrive at the hospital (it takes 20-30 min to work), it is a topical anesthetic that will help with the owies. If you want to help hold your child while they poke, you can. If you do not feel you can help, PLEASE let the staff know. I would rather round up helpers and be done in 1 stick, than lose an IV because a parent let go of a child too early.

I hope everything goes very well for you.

See now, I was in the room when she was given gas to go to sleep. Then they did the GA. This was done in the MRI room.

I have been allowed in the MRI room with her. Once she was out, I left. I was never told or felt they wanted me there. We then went up to the waiting room.

She has had MRI's at 4 different hospitals.

[jondee0]

The variations in MRI protocol are interesting. My daughter's had numerous MRIs of her spine, the first being when she was 17 months old, the most recent when she was 12. For all except the most recent, when she was able to remain calm enough to be still for the long procedure (full spine takes a while), she's had conscious sedation with various combos of IV meds. She's always been given EMLA cream on several likely IV spots before they start poking. EMLA was not the magic ticket I'd hoped, but it did help. Don't feel shy about asking if the person coming to draw blood or start an IV has much experience with babies.

Either dh or I have always been with Michaela when she's "gone under", as well as when she's waking up. At two facilities, I was welcomed into the MRI room as long as I didn't have any metal on me (I dressed for the occasion; scrubs were available if I'd needed them). I don't know if the plate in your hand would exclude you.

Ask about possible side effects from the sedation meds. Michaela had one that left her sleeping for most of the following 24 hours, one that made her very nauseous as she was waking up, and one that had very few side effects (sorry I can't remember the names). When she was nursing, it was asked that she not nurse for 4 hours prior, but could have clear liquids up to 2 hours prior. We scheduled the MRIs for first thing in the morning, so there was less chance of it being delayed.

If you do some online searching, you may find an anesthesiology association that allows breastmilk closer to the time of sedation or surgery, but that doesn't mean your particular facility will follow those guidelines. The good thing is that as uncomfortable or unpleasant as it may be, the day of the MRI will pass quickly and soon be behind you. I hope you get some helpful information out of it, and I hope it goes smoothly for your baby.

Joni and kids, incl. Michaela , 12, w/a funky spinal cord, and Gabe , 10, w/Down syn. and autism

[Monkeypants]

My DD has had several brain MRI's and she needed IV sedation until she was 2. Now she had oral sedation (she gets an MRI every year to monitor the giant cyst in her brain). Since she was (is) breastfed and (was) pudgy, it was hard to get an IV into her- they had to call the IV special pediatric team to stick her and it involved tournicates and hot packs and stuff. Definitely the most traumatic part of the whole thing for us. If your child is pudgy, have the special IV team do it- they have more experience and probably will get it right the first time. My DD came out of the sedation fine, but now that she has oral sedation meds, they make her a bit sick after and she vomited a few times when we got her home- but she was fine. She has an MRI next week and we will see if the medicine affects her the same as it did last year. She is still breastfed and we can't nurse for 4 hours before, but she can have clear liquids 2 hours before. We have never gone in with her, but are always with her when she is going to sleep and waking up.
We go to Children's Hospital in Boston and they are always, kind, helpful and compassionate. When she has had to stay in the hospital (we were there for shunt surgery when she was 6 months old, and a week when she was 18months for an unexpected seizure) I slept next to her in her cage bed. The nurses were very understanding and said many parents do that. They were supportive of our breastfeeding relationship. Even in the PICU the nurses let me sleep with her. Good luck!!

[kmorris97]

My DS had his first MRI yesterday and they sedated him with gas. No IV was needed. His is 4 though, so that might make a difference. I held while they sedated him, but was not spresent during the MRI. I'm have not idea on the medal plate. They did sedate him in the room that MRI was being done and I had to take all medal off me.

About the night at the hospital, are letting you spend the night in the room? When mine have spent the night in the hospital, they have always let me sleep in the rrom. I hope every thing goes smoothly.

[odoole]

Thanks everyone. The MRI went very well and according to plan, and thankfully, there were no vascular lesions or other abnormalities in the brain.

We just got home from the hospital. It ended up being a 3 full days in the hospital. They wanted to add a 4th day, but DH and I basically put our foot down and said enough is enough. They added on all sorts of tests and exams that we felt completely unnecessary (we are both in the medical field so have some experience with this), and we eventually had to put up a stink and tell them to leave DS alone. They were all very nice about it; I think they were just so excited to be able to treat him with this new treatment, and since it was a teaching hospital, he was starting to become a bit of a guinea pig.

The main problem was that DS just didn't get ANY sleep while he was there. I'm sure you all have experienced this with your children as well. DS is so easy-going and smiley and sweet, but after a few days of getting half as much sleep as usual, he was starting to lose it. I don't understand why hospitals don't put more emphasis on children getting sleep. They are so rigid with their schedules for things like taking vitals and getting blood draws and administering medicine, but there is absolutely no time set aside for sleep. There were people coming into his room every hour to do stuff. And when he wakes up, he doesn't go back to sleep very easily -- especially when he's overtired.

It just doesn't make sense. Everyone knows that sleeplessness has a huge impact on our immune systems. Sleep is the best medicine, right? It's stressful for anyone to not get the sleep they need, let alone an infant -- I can't believe how overlooked that is in the hospital. I eventually had to tell the nurse that, schedules be damned, no one was allowed to come into the room while he was sleeping. Again, they were very nice about it, but completely oblivious to his need to sleep and baffled by how adamant I was that we be left alone!

Anyway, it was an interesting experience, to say the least. All the advice I got here really guided me and helped me feel more confident going in, so thanks so much!

[2boyzmama]

YES, I hear you on the sleep thing. I was 8 weeks pregnant the last time Connor was in the hospital (he was there 5 days with Rotavirus) and after day 3 I said "look, I'm pregnant, puking, exhausted, and stressed because he's so sick. For MY well being, you HAVE to let us sleep!!"

I'm glad it all went well