So, remember that shopping cart accident and all the CTs my kid had?

[Adaline'sMama]

Many of you remember that on Aug 31, my shopping cart tipped over and my 5.5 month old hit the pavement. She had a hairline skull fracture and a little epidural bleeding. We spent 2 days in the PICU, and they sent us home and told us everything was FINE.


I was filling out the forms today for my 6 month old to do a follow up ct tomorrow morning, and I found the form where theyve highlighted that I must follow the "Sedation Procedures". This includes no breastfeeding after midnight tonight. Her appointment isnt until 8am tomorrow morning! Plus, is it really safe to sedate a 6 month old?

I called my (awesome) ped for advice and she told me that CPS has called her twice. Once to make sure that there has been no sign of abuse, and the other to transfer my DD's medical records to CPS. We only vax for Dtap, so I wonder if that is going to be an issue. I was interviewed by CPS when DD was in the hospital 2 weeks ago, and they told me they had no fear of child abuse. Today, when I called my ped to ask if I should comply with this sedation, she told me that even though it sucks, and she thinks it is totally unessacary, she thinks that if i dont allow them to sedate her and she doesnt get the ct I could be charged with *medical neglect*. The kiddo is totally fine, shes has been acting totally appropriately since the accident. I thought this was a "just in case" follow up. They did 3 cts in the hospital and NEVER sedated here once.

Sorry this is totally full of typos and probably doesnt make sense. Im really upset, because besides the fact that we have to go back into a medical enviroment, now we have to do with with a starving infant. Of course she isnt going to be still, shes f*ing hungry and doesnt understand why her mommy wont nurse her! So of course they will have to sedate her. I just dont know what to do.

[AFWife]

Can you contact the dept that does the scan and ask why they're going to sedate her? Maybe you can get it changed...or, even better, get your ped to call and ask what's up! Sometimes having a fellow doctor go "Uh, this is dumb" brings things back into perspective...

On the vaxes: It is totally LEGAL to choose not to vax your child! (the only issue comes with some states not having exemptions for schools and whatnot) You can even write up a quick exemption letter to present to the worker IF they ask. AFAIK there is no law stating you must vax.

ETA: Maybe I'm just a b*tch...but I'd take in a form stating that you and your ped disagree with the sedation and if something happens to your daughter as a result that you will hold them responsible.

[Casha'sMommy]

I don't have advice regarding CPS however, when ds was 6wks old he had an MRI and biopsy for a growth in his lymph node. When I asked about food I was told bm was classified the same as clear liquid. You might consider calling the hospital you'll be going to and ask about this. Maybe you'll be able to nurse a little later into the night than you were originally told.
Also, I know it sucks to have your dc sedated but we sometimes have to do what we have to do even if it isn't ideal.
Try to be positive. I know it's all very scary, we've had 5 procedures/surgeris in 3 of our dc. Try to be positive, they feel your stress.
Please keep us posted and you'll be in my thoughts and prayers.

[Norasmomma]

Wow-I find much of this ridiculous, BUT CPS often is. My SIL was threatened with "medical neglect" when she was having her 4 child due to her refusal of a C/S. I guess this just peeves me a bit because there are so many cases of real true neglect and they get swept under the rug.

I also would contact your ped and see if you can get a form or something to waive the sedation, especially considering that she had 3 CTs and wasn't once sedated. IMO it seems more neglectful to her to not be fed.

[AFWife]

Originally Posted by Norasmomma

I also would contact your ped and see if you can get a form or something to waive the sedation, especially considering that she had 3 CTs and wasn't once sedated. IMO it seems more neglectful to her to not be fed.

Yeah...I can totally see them doing a blood sugar test or something random like that and then jumping all over you when it's low...

[blessedwithboys]

OP, I am glad your LO is doing ok now.

Breastmilk is a clear liquid and you needn't withold it prior to sedation. Don't bother to ask anyone's permission; that will only draw attention to your "refusal" to follow the mainstream. Please nurse your LO freely throughout the night, and if the sedation in going to be IV, you may even want to ask about EMLA cream to reduce the pain of the needle going in.

[jsh7809]

Yeah, if it were me, I would probably just breastfeed anyway. That might be dangerous (in terms of the "if she vomits she could choke" thing, which I think is mostly BS anyway), but seems more dangerous to have the baby suddenly not get what she needs for comfort..
Then again, supposedly babies are biologically ready for sleeping through the night without eating by this age. Maybe you could just let her suck on your pinky or a pacifier?
ugh, I'm so so sorry, mama! Good luck, I'm sure everything will work out ok.

[Adaline'sMama]

Thanks everyone. I finally got in touch with the neurology ped and he said sedation would be our last resort. He agreed that it would be better if we could do the CT without her being sedated, and said I could nurse up until 4 hours beforehand. He said that if I absoultely refused sedation, they would have to reschedule if she couldnt be still. So, DH and i have decided that I will nurse throughout the night and into the morning as much as she needs. If they want to sedate her, I will tell them that *oops* I nursed her because she was screaming her head off and *sorry* I guess well have to reschedule.

They clearly stated to wait
2 hours juice, pedalite, water, or other clear liquid
4 hours breastmilk
8 hours solids

so, I dont think I could argue breastmilk as a clear fluid

[tallulahma]

breastmilk should always be considered clear iiquid. grr.

breastmilk usually clears the stomach in well under 2 hours... they are classifying your bm as formula/milk.


poor practice... outdated as well.



>

[ErinYay]

I'd go ahead and bf her before the scan anyhow.

I've had V spit up yogurt and other stuff many, many hours after the fact; it's not as though they'll know you nursed her even if (God forbid) she does vomit.

And if bf isn't a clear fluid, I'd sure love to see the clear OJ they have on the market now...

[SaveTheWild]

DON' T do the CT scan!! This may sound alarmist, but it isn't at all. Most medical associations are saying the same thing now. Too late for my daughter, but not for yours.

CT scans give incredibly high doses of radiation. The equivalent of hundreds, yes hundreds of x-rays. And the risk is highest for children. The younger the child, the higher the risk. I say this from experience. My 6 month old daughter had a CT scan for suspected seizures and, without a doubt, it is the decision I regret most in my life. I think about it almost every day, about the unnecessary radiation I exposed her to and the very real and measurable increaesd risk of cancer she now will have to live with. They believe it is somewhere between 1 in 100 to 1 in a 1000 chance that a person will die from cancer as a direct result of getting a CT scan.

There have been a lot of reports lately about the risks of CT scans and how they should be used only when really necessary, in a true emergency, and where other less harmful options are not available, such as MRI. I have to log off soon, but do a google search for CT scan, radiation, children and a bunch of recent stuff will come up. Repeat scans are especially to be avoided and the cancer risk is directly associated with the amount of exposure, and by giving her two CT scans in a short period of time, it increases the risk.

On the sedation, that too is risky. Sedatives are linked to memory loss (again, I once had all this at my fingertips but don't right now. google it). CT scans are fast, and often done in an emergency so there is no real need to sedate. I am surprised they would want you to, unless she is rally active. I didn't even let them sedate my daughter for an MRI, which takes significantly longer and is really loud. I just bf'd her to sleep, bf'd her while she was strapped into MRI machine before the test started, and she stayed asleep.

You get to decide what is done to her. If they think you are unreasonable, so be it. You can put it off for a few days to think about it. I sent the children's hospital where my child was going to have her MRI a long letter about why I was refusing the sedation and that I was willing to accept the consequences (theat the test wouldn't work and I would have to pay for a second one). It is worth it to not risk her health.

sorry if this scares you to read this. but I wish someone had talked to mea botu the CT risks first. The docs on call jsut said "yes tehre are some radiation risks, just like with an x-ray." They didn't explain just how severe and real those risks are, nor how much radiation they subject kids to.

[SaveTheWild]

As a follow-up to my above post. Ask them if it can be an MRI instead. If not, press them as to why? a hairline fracture and no further problems? Doesn't sound like a true need for the CT scan. Tell them you need to reschedule tomorrow for whatever trumped up reason, then wait a few days or a few weeks and take some real time to think about this, talk to doctors, etc. and find out your options.

and I did a quick search for some links: here is one http://www.npr.org/templates/story/s...ryId=121436092

[mrsdocmartin]

I don't have any advice, just .

[SaveTheWild]

ok, one more follow-up post. Since I worry I am going to cause sadness about the CT scans that she has already had. Given the accident she had and the real risk to her of not knowing how her brain was doing after teh head trauma, having a CT scan at the time of the accident was, of course, what you needed to do. If something had been seriously wrong and you didn't do it, you wouldn't have been able to forgive yourself. But things are different now. You know she isn't showing any signs of trauma, there is no emergency, and they should be able to do something other than expose her to more radiation. We can't reverse the past, and there is no use dwelling, but you can make a decision now with the information you have.

hugs to you and so sorry for all of this.

[2xy]

I'm sure they were able to diagnose skull fractures and deem one "healed" prior to the invention of CT?

CT does give off a ton of radiation. She's already had three in less than a month? I would try to get out of it.

Hospitals and physicians try to use the cheapest technology that's appropriate to diagnose the condition. That's why they're using CT over MRI.

[PatioGardener]

Originally Posted by SaveTheWild

They believe it is somewhere between 1 in 100 to 1 in a 1000 chance that a person will die from cancer as a direct result of getting a CT scan.

I need to read more about this - please share your source. Thank you!

[hildare]

Originally Posted by PatioGardener

I need to read more about this - please share your source. Thank you!

here's a direct quote "In summary, there is direct evidence from epidemiologic studies that the organ doses corresponding to a common CT study (two or three scans, resulting in a dose in the range of 30 to 90 mSv) result in an increased risk of cancer. The evidence is reasonably convincing for adults and very convincing for children."

this is from an article in the New England Journal of Medicine. The link is full text online, here.
Here's the citation
Brenner, D., & Hall, E.. (2007). Computed Tomography -- An Increasing Source of Radiation ExposureCurrent Concepts:. The New England Journal of Medicine, 357(22), 2277-84.

In light of this, if it were me, I would contact the awesome pedi once more with concerns and get it in writing that you won't do the CT scan (sounds like that is what you were thinking about doing, since your lo is fine) for this reason + sedation. That's a risk I really wouldn't take. I think if you have the child evaluated by a medical professional, then it won't leave an opening for CPS to pursue.

[WildKingdom]

To the OP-

Just to set your mind at ease regarding the potential risk of cancer from CT scans- the PP who said that there is a 1 in 100 chance of dying from cancer from the CT scans is really overstating things. First of all, brain CTs deliver much less radiation than many other types of scans (like chest and abdomen). Second of all, you can go to this site: http://www.xrayrisk.com/calculator/calculator.php

and calculate out real risk. I took the liberty of calculating your DD's increase risk of cancer from her three head CT scans- a whopping increase of 0.215%.

In other words, I would do the scan. It's the recommended follow up for the fracture and the risk is negligible. I would not request an MRI. Although that has no radiation, your DD would definitely have to be sedated and that does carry risk.

[katelove]

Originally Posted by jsh7809

That might be dangerous (in terms of the "if she vomits she could choke" thing, which I think is mostly BS anyway

It's not so much choking which is a concern as aspiration (inhalation of stomach contents into lungs). Aspiration pneumonia is definitely a serious problem and a well known risk fator for anaesthetic or sedation. However, as other's have mentioned, fasting a fully BF'ed baby for 8 hours is excessive.

As far as CT vs MRI, it really depends what one is looking for. MRI is great for soft tissue but not so good at showing fractures. If you want to look at a healing fracture then a CT is the right test to choose. If you want to look for a bleed or damage to underlying structures the MRI is probably the way to go.

[cycle]

(mod edited: quoted a UA violation)

Originally Posted by WildKingdom

To the OP-

Just to set your mind at ease regarding the potential risk of cancer from CT scans- the PP who said that there is a 1 in 100 chance of dying from cancer from the CT scans is really overstating things. First of all, brain CTs deliver much less radiation than many other types of scans (like chest and abdomen). Second of all, you can go to this site: http://www.xrayrisk.com/calculator/calculator.php

and calculate out real risk. I took the liberty of calculating your DD's increase risk of cancer from her three head CT scans- a whopping increase of 0.215%.

In other words, I would do the scan. It's the recommended follow up for the fracture and the risk is negligible. I would not request an MRI. Although that has no radiation, your DD would definitely have to be sedated and that does carry risk.

ITA, do the scan. The follow up is important.