Infant Sedation

Infant sedation involves giving medicine to babies and young children to help them stay calm, relaxed, or asleep during medical tests and procedures, ensuring safety and comfort while allowing healthcare providers to complete necessary examinations.

Table of contents

• What is Infant Sedation?
• When Sedation is Used for Infants
• Levels of Sedation
• Common Sedation Medications
• Preparing Your Infant for Sedation
• What Happens During Sedation
• After the Procedure
• Safety and Risks

What is Infant Sedation?

Infant sedation is the use of medicine to help babies and young children relax, feel less anxious, or fall asleep during medical tests or procedures^[1]. This approach uses different types of medications called sedatives (medicines that make you sleepy or calm) to make infants and young children more comfortable during examinations that might otherwise cause distress^[3].

Sedation helps babies stay still during procedures that require no movement, keeps them free from pain during tests that may be uncomfortable, and reduces anxiety in situations that might be frightening^[1]. The medicine can be given in several different ways, including by mouth as a drink, breathed in as a gas through a mask, squirted into the nose, or given through an injection into a muscle or vein^[4].

It is important to understand that sedation is different from general anesthesia (a deeper state where the patient is completely unconscious)^[1]. During sedation, babies usually can breathe on their own without assistance from a breathing machine, though they are carefully watched throughout the procedure^[2].

When Sedation is Used for Infants

Sedation is commonly used for infants and young children who need medical imaging tests or procedures but may become distressed or have difficulty staying still^[2]. Healthcare providers use sedation when babies need to remain completely motionless for tests or when procedures might cause discomfort or pain^[3].

Common imaging tests that may require infant sedation include MRI (magnetic resonance imaging, which uses magnets to create pictures inside the body), CT scans (computed tomography, a special type of x-ray), and certain nuclear medicine studies^[2]. MRI can be especially challenging for young children because it is noisy and requires lying still in an enclosed space for up to one hour^[2].

Sedation may also be used for minor procedures such as fixing broken bones, dental surgery, or taking samples of body fluids^[3]. The decision to use sedation depends on several factors, including the infant’s age and developmental level, how much discomfort is expected, and the type of test being performed^[2].

Levels of Sedation

Healthcare providers use different levels of sedation depending on what the infant needs^[1]. These levels exist on a continuum, meaning they blend into each other rather than being completely separate stages^[5].

Minimal sedation means the child is in a relaxed state where they are awake and able to respond normally to questions or sounds^[1]. This level simply helps reduce anxiety and is used for minor procedures^[5].

Moderate sedation means the child is in and out of consciousness and may not remember the procedure^[1]. At this level, patients can still respond to touch or verbal commands and can breathe without assistance^[2]. This is commonly used for procedures like repairing cuts or minor emergency procedures^[5].

Deep sedation means the child is asleep and lies still but can be awakened by repeated stimulation^[5]. Children under deep sedation can usually breathe on their own without a breathing machine^[2]. This level is typically used for longer tests like MRI or CT scans, bone marrow tests, or spinal taps^[5].

The sedation team carefully selects the appropriate level based on the infant’s age, developmental stage, medical condition, and the type and duration of the test or procedure^[1].

Common Sedation Medications

Several different medications can be used to sedate infants, and the choice depends on the individual child and the procedure being performed^[4].

Nitrous oxide is a gas that infants breathe in through a mask^[4]. Sometimes called laughing gas, it has been used safely in children for many years^[4]. This gas makes children sleepy and provides pain relief, works quickly, and wears off quickly^[4]. Different flavors can be added to the mask to make it more pleasant^[4].

Midazolam is a medication that makes children sleepy and helps them forget the procedure, but it does not provide pain relief^[4]. It can be given as a drink, squirted into the nose, or given directly into a vein through an intravenous line^[4].

Ketamine is a strong sedative and pain reliever commonly used in hospitals for sedation and pain relief in children^[4]. It is given by injection into either a muscle or a vein^[4]. Children receiving ketamine may have their eyes open but will not be aware of what is happening and will not remember the procedure^[4].

Chloral hydrate is given as a drink and makes children drowsy^[4]. It is useful when a child needs to be very still for 20 to 60 minutes^[4]. It can take 10 to 30 minutes to work^[4].

Preparing Your Infant for Sedation

Proper preparation is essential to keep your infant safe during sedation^[6]. The most important preparation involves following strict instructions about when to stop feeding your baby before the procedure^[6].

You must stop giving food or drinks at specific times before the appointment^[6]. Clear liquids like water or special infant drinks must be stopped 2 hours before the procedure^[6]. Breast milk must be stopped 4 hours before^[6]. Infant formula or other types of milk must be stopped 6 hours before^[6]. These rules prevent your infant from having an upset stomach and vomiting during the procedure, which could be dangerous^[6].

The doctor or nurse will ask questions about your infant’s health and medical history before sedation^[4]. You should tell the healthcare team about any medicines your baby takes, any allergies, and any recent illnesses^[6]. If your baby has symptoms like a stuffy nose, frequent coughing, fever, or vomiting within 24 hours of the procedure, you should call the doctor, as it may not be safe to proceed with sedation^[6].

As the parent or caregiver, you will need to give your permission before your infant receives sedation^[4]. Make sure you understand the reasons for sedation and ask about any concerns you have^[4].

What Happens During Sedation

When you arrive for your infant’s appointment, you will typically check in about an hour and a half before the scheduled procedure^[1]. The sedation team, which includes specially trained doctors, nurse practitioners, registered nurses, and sometimes child life specialists, will meet with you^[1].

A pediatric sedation specialist will explain the process and answer your questions^[1]. They will review your infant’s health information to ensure sedation can be given safely^[1].

The sedation medicine may be given by mouth, through the nose, by injection into a muscle, through a vein, or by inhaling a gas through a mask^[4]. If an intravenous line is needed, a numbing cream can be used to make your infant more comfortable^[6]. For some procedures, parents are allowed to stay with their child during the entire process, while for others, parents will be directed to a waiting area after the infant falls asleep^[6].

Throughout the procedure, the healthcare team will closely monitor your infant’s vital signs to ensure safety and comfort^[6]. This careful monitoring includes watching heart rate, blood pressure, and oxygen levels^[2].

After the Procedure

After the procedure is complete, your infant will wake up in a recovery area where the care team continues to monitor them until they are ready to go home^[6]. If you were in a waiting area, a team member will bring you to your infant so you will be there when they wake up^[6].

It is normal for babies to feel sleepy for several hours after sedation^[6]. A baby might sleep more than usual or be harder to wake up^[6]. Your infant may also be unsteady when sitting or crawling, as it takes time for the medicine effects to wear off^[6].

Common side effects after sedation include feeling sleepy, being irritable or fussy, dizziness, or nausea^[6]. These effects are usually temporary and should improve within a few hours^[6]. Some babies may have nightmares or trouble sleeping for up to 24 hours after sedation^[6]. If your infant is hungry after waking up, age-appropriate snacks and drinks can be offered^[6].

The nurse will give you specific instructions before you leave about when your infant can return to normal activities^[6]. You should plan to stay with your infant and provide extra care at home as they recover^[6].

Safety and Risks

Sedation for infants and young children is safer than it has ever been^[8]. Specially trained pediatric healthcare providers have made it possible for millions of children, including very young babies, to safely undergo necessary medical procedures^[8].

For most infants, sedation is very safe when performed by trained professionals^[8]. However, like any medicine, sedatives carry some risks^[8]. Rarely, sedation can lead to problems such as breathing difficulties, abnormal heart rhythms, or allergic reactions to the medicines^[8].

Infants are more susceptible to respiratory complications due to their anatomy and physiology, which increases the risk of low oxygen levels^[3]. This is why careful monitoring throughout the procedure is so important^[3]. The healthcare team ensures that appropriate emergency equipment is available and performs a thorough medical evaluation before starting sedation to reduce the risk of problems^[3].

Research has investigated whether sedation or anesthesia might affect brain development in young children^[8]. Current evidence suggests that receiving sedation or anesthesia for a short time for one procedure does not put a child at risk^[8]. Scientists continue to study the safety of all medicines used in infants and children to make procedures even safer^[8].

You should call for emergency help immediately if your infant has trouble breathing, becomes limp and floppy, is very sleepy and hard to wake up, or loses consciousness after sedation^[6]. Contact your doctor if your infant has new or worse vomiting, develops a fever, or if you have any concerns about their recovery^[6].