How I explain endoscopy to a child
Endoscopy is a procedure that allows us to look right into the stomach and the large intestine. We use a small, very thin instrument that’s really soft and has a light at the end that can take pictures. We can look inside and actually see inside the large intestine. This allows us to see how everything looks. Upper endoscopy is a procedure that doesn’t take very long, and it’s not uncomfortable. It can pretty much be done without medication, but we give people medication so that they’re comfortable and relaxed during the whole procedure. An upper endoscopy can take about 10 to 15 minutes; it’s pretty quick, and you can get pretty good information about how to take care of the gut. The lower endoscopy is a little different; it sometimes takes a longer time, but it also gives us very useful information. We can look at their whole intestine, up until the small intestine, and if we can get into the small intestine that gives us a lot of information about what might be happening with them.
We give them medication for lower endoscopy because sometimes it’s uncomfortable when we look around, because it’s very twisty, and sometimes it feels like you might have to go to the bathroom and you might have some cramps. So we give people some medicines that make it more comfortable, and then they’re not so aware of what happens. I always tell the kids that they’ll be sleepy enough that they’ll know what’s going on and hear our voices, but they won’t care. Basically, it’s like being in bed in the morning and listening to your mom trying to wake you up for school. You hear her, but you’re really not really paying attention. We always know before the kids do when they need more medication, and we give them more if needed, so that they stay a comfortable level. Now everything that’s done in the operating room under anesthesia is really different; the experience is different, because people have no knowledge of what’s going on during the procedure and are completely asleep. In that case, what they’ll remember is the preop area, coming in for their procedure and going into the operating room. Sometimes the operating room is scary for kids, because it’s sterile looking, but some children and some families prefer to go there for their procedure because they just want to be knocked out.
Lisa Heard, Former Clinical Coordinator, Endoscopy Program
Preparing a child for endoscopy
We see a lot of patients with IBD who are diagnosed with IBD here at Children’s Hospital because of symptomatic changes in their lifestyle, such as bloody stools, pain, and extraintestinal symptoms, such as arthritic symptoms. They come to us after having completed the most difficult part of their procedure, which is the preparation for colonoscopy. About fifty percent of the Endoscopy procedures done at Children’s are done in the Endoscopy Unit under sedation. Colonoscopies may be done with sedation or general anesthesia. We do a lot of counseling prior to procedures on the preparation, giving them tips and ideas about how to prepare for the procedure and how to actually do the bowel preparation that you have to do to clean the colon so that we’re able to see the entire colon. It’s a very challenging preparation. We spend a lot of time talking about what the procedure’s going to be like, bringing music to listen to, IV insertion and topical anesthetics to make that a little better for them, and sedation. We also use pre-procedure anti-anxiety medicine to help take the edge off of our anxious patients. They’re not given as a rule, but anybody who is anxious may receive this medicine. The IV is generally inserted after the anti-anxiety medicine is given. A nurse stays with the child throughout their whole procedure, and the physicians are stay as well. We encourage patient parental presence up until the actual procedure; we don’t let parents stay for the procedure because it can be difficult for a parent to watch. It also allows the caregivers to pay complete attention to their child. But we really do encourage parents to stay with their child until we can separate them in the patient room, and there’s very little separation anxiety then because the medication has taken effect and the child will be to the point of sleep when we separate them. We like them to be a little bit responsive so they know that their parents are leaving, and it’s good for the parent to see that they’re not affected by it. We stay with the child during the procedure, monitoring them there’s a nurse there for every patient and their sole responsibility is to monitor the patient; with no other tasks in the room. We care for them until their procedure is done and they go to the recovery room. All of the patients are recovered in the main OR recovery room, where they usually wait about 30 to 45 minutes until they have something to drink and they’re stable, and then they get to go home. Their lifestyle will be normal the next day, but they’re encouraged to relax and rest the day of the procedure. Most children can resume their normal diet once they are at home. We encourage the child to drink extra fluids on the day of their procedure to make sure they are well hydrated.
Lisa Heard, Former Clinical Coordinator, Endoscopy Program