Trying to Keep Visits as Painless as Possible

By Alice Reid
Friday, December 21, 2007

No kid likes to be stuck with a needle.

IVs? Forget about it.

In short, most things in hospitals are pretty scary for children, especially surgery.

Enter Children's Hospital's anesthesiologists, a six-member team of specially trained doctors who make sure that surgery is not frightening and that a youngster's visit to the hospital is as pain-free as possible.

They try to think of everything, even what they wear.

"A lot of children are afraid of lab coats," said Dr. Yewande Johnson, who with a colleague, Dr. Sophie Pestieau, led me around the surgery unit recently. "That's why we wear fleece!"

A trip to Children's Hospital for an operation is more Chuck E. Cheese than St. Elsewhere. Every patient gets a teddy bear or other soft toy before entering a pre-operation waiting room, where tropical fish swim along a colorful mural and Mom and Dad are right there. There's also a promise of popsicles. ("As many as you want when you finish your nap!") When it's time for that nap, patients blow into a bubble-gum-scented balloon that in turn delivers a sleep-inducing sedative. Children who can't shake their anxiety have the option of swallowing a SweeTarts-flavored syrup that leaves them woozy.

No conscious child ever gets an IV. That comes after the bubble gum balloon.

One recent afternoon, 4-year-old Mikael Mohamed bravely lay on a gurney as his mom and dad, Suad and Ibrahim, bent their faces near his and held his hands.

Backlit photos of tropical fish shone on the ceiling.

"Now, blow into the green balloon and count the fish," directed the anesthesiologist.

Mikael blew as hard as he could until his thick black lashes shuttered his eyes. Off he went to one of the hospital's 11 operating rooms for eye surgery.

Anesthesiology for children is tricky. How much of a drug to administer for how long isn't something that can be calculated simply according to body weight.

"Children are most definitely not little adults," Dr. Johnson said. "The way they process different drugs is totally different from adults. Even the anatomy of their airway is totally different from adults."

Children usually require a lower dose. "But sometimes a child may require more of a certain drug than an adult would," Dr. Pestieau said. "And a premature baby is entirely different from an 8-year-old."

Keeping pain at bay is a priority at the hospital, not just in the operating room but also for invasive tests and procedures such as heart catheterizations, for some treatments for serious diseases and for keeping a very sick child comfortable.

Hospital researchers constantly search for drugs to ease pain. Dr. Julie Finkel, who runs the hospital's pain management project, said some drugs given to adults can intensify pain in children instead of reducing it. Finding substitutes for such medications is key.

But Finkel's particular passion is developing a way to measure pain in patients who can't speak. Think toddlers and babies. Pain in children is to be avoided, especially in newborns. It can have lasting effects.

"In an infant with pain, it can change how he is hard-wired in the future," Finkel said, adding that research has shown that premature infants, who spend months being poked and prodded and needled, grow up to have a pain threshold lower than normal.

How to Help

At Children's Hospital, pain research and the delivery of anesthesia are right up there with curing disease.

We've been urging readers to help keep that kind of medicine available to every child in the Washington area who needs it.

Your gifts, large and small, have been very generous. So far, $87,065.52 has come in, and we're well on our way to our goal of $500,000 by Jan. 18.

To help, make out a check or money order payable to Children's Hospital and send it to Washington Post Campaign: P.O. Box 17390, Baltimore, Md. 21297-1390. To contribute by phone using Visa or MasterCard, call 202-334-5100 and follow the instructions. All gifts are tax deductible, as allowed by law.

To donate online using a credit card, go to

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