Anxiety Checkpoints: MRI Think I Can

An MRI (Magnetic Resonance Imaging) is a special scan that takes pictures of the inside of the body. On the pediatric unit, we often have patients admitted for EEGs and MRIs after experiencing a seizure or multiple seizures. This is normally a quick, 24-hour stay as we can typically get them in for an MRI within a day.

For those experiencing seizures, this gives us real-time pictures of the inside of the brain without having to do surgery. MRIs can detect tumors, cysts or other abnormalities. These scans take an extensive amount of images and because of that, usually range from 20-60 minutes. It is imperative that the child hold extremely still, much like they would if they were having their picture taken by a parent, so typically children (especially young children) are sedated for this procedure.

Usually for young children being sedated (approximately ages two-six years old), this can create anxiety for many reasons and as the child life specialist, you have to be mindful of all of these moving parts.

The first anxiety checkpoint is that they’ll be having a procedure – one that they probably know little to nothing about – and this creates anxiety due to the unknown. The best thing you can do for this age group is build rapport and have as much one-on-one time with the patient prior to the procedure.

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I like to show the patient what the MRI looks like by bringing in a wooden replica of the MRI machine and using either a Barbie or Ken doll to give the child the opportunity to play and gain familiarity with it beforehand. We talk about what shape the machine is (I like to call it a big donut), what color it will be and remind them that their job is to lay on the bed outside of the machine.

The second anxiety checkpoint is explaining that they’ll be asleep for this procedure and helping the child process that being asleep is a temporary, safe and “fun” thing to do. This can be tricky.

I have recently found several coloring pages online from different children’s hospitals that I have began to utilize with this age group as it continues to reinforce what they just learned about the MRI and helps us start the conversation about how they’ll be going to sleep, either using an anesthesia mask or sedation medication through their IV. I’ll explain that in order for us to get good pictures, it helps if our body is really still and the best way to do that is to let our bodies go to sleep. We’ll talk about the special doctor (anesthesiologist) whose job it is to help them go to sleep and help them wake back up (either with their mask or IV). If I have time, we can have this conversation while coloring a picture of an anesthesiologist holding a mask.

Mask
Excerpt taken from Hopkins Children’s Guide to Surgery Coloring Book

If it’s with an anesthesia mask, I’ll provide one for us to look at, touch and engage in pretend play with their stuffed animal. I’ll even provide bubbles for us to dunk the mask in and blow bubbles through it! This age group usually really enjoys this and it, again, helps them gain familiarity with something that otherwise may be scary had they not played with it first.

IMG_3378The third anxiety checkpoint is when they realize that mommy and daddy won’t be coming with us into the MRI room and that only our new friends (the MRI techs and anesthesiologist) and the CCLS will be coming along for the adventure. This is where separation anxiety kicks in and it helps to have something to distract at this point to continue making the MRI/going to sleep seem like a fun thing to do. This can be difficult as the MRI machine does not allow for anything magnetic (or things with batteries) to be taken into the room due to the magnets on the machine. This means the iPad, bubble gun, books with buttons or noise, light spinners, or basically all wonderful distraction tools for this age can’t come in with us. I like to have a bubble parade down to MRI and sometimes even into the MRI room itself. It’s a real big hit with this age group!

Some key preparation points to include if the child will be AWAKE for the MRI:

  • Nothing will touch or hurt you; you will simply move in and out of the machine while lying on the bed/table
  • It is important to remain very still during the pictures. Ask them what pictures look like when you move around – to which most kids will respond “blurry” – and then talk about how the doctor won’t be able to see what he needs to see if the pictures are blurry so it’s very important to remain very still
  • The MRI machine makes noises – I use the app “Simply Sayin’” to show them pictures, descriptions and it even comes with audio of what the machine sounds like. There are approximately four different audio clips with different noises and I find it entertaining to have the child tell you what they think it sounds like (train, construction site, jack hammer, etc)
  • Depending on if your hospital provides this, it may be possible for the child to listen to music or watch a movie during the MRI, but if not, they’ll receive ear plugs to help make the noises more bearable
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Simply Sayin’ app

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