Children do not all reach a sense of
understanding at the same predictable age.
This ability varies from child to child, and the
pediatric technologist must not assume that
children will comprehend what is occurring.
Generally, however, by the age of 2 or 3
years, most children can be talked through a
diagnostic radiographic study without
immobilization or parental aid.
Most important is a sense of trust,
which begins at the first meeting
between the patient and the
technologist; the first impression that
the child has of the technologist is
everlasting and forges the bond of a
successful relationship.
The technologist's attitude
and approach to a child.
The technical preparation in
the room.
❖ Introduce yourself as the technologist who
will be working with this child.
❖ Find out what information the attending
physician has given to the parent and
patient.
❖ Explain what you are going to do and what
your needs will be.
Tears, fear, and combative resistance are
common reactions for a young child. The
technologist must take the time to communicate
to the parent and the child, in language they can
understand, exactly what he or she is going to
do. The technologist must try to build an
atmosphere of trust in the waiting room before
the patient is taken into the radiographic room.
This includes discussing the necessity of
immobilization as a last resort if the child's
cooperation is unattainable.
Parent is in room as an observer,
lending support and comfort by his or
her presence.
Parent serves as a participator,
assisting with immobilization.
Parent is asked to remain in the waiting
area and not accompany the child into
the radiography room.
Most medical facilities have a procedure in
place to report suspected child abuse. In the
past, the term used for this was battered child
syndrome (BCS). The current acceptable term
is nonaccidental trauma (NAT).
Generally, it is not the responsibility of the
technologist to make a judgment as to
whether child abuse has occurred, but rather
to report the facts as they are seen or
suspected.
If NAT is suspected, the technologist should
discuss this with the radiologist or other
supervisor as determined by departmental
protocol. Laws vary on technologists'
responsibilities, and it is most important that
all technologists know what their
responsibilities are concerning this in the
state or province in which they are working.
Pediatric patients in general can include infants
through children up to ages 12 to 14. However,
older children can be treated more like adults,
except for special care in gonadal shielding and
reduced exposure factors because of their
smaller size. In general, pediatric radiography
should always use as short exposure times and
as high mA as possible to minimize image
blurring that may result from patient motion.
However, even with short exposure times,
preventing motion during exposures is a
constant challenge in pediatric radiography, and
effective methods of immobilization are
essential.
❖ Tam-em board
❖ Pigg-O-Stat
Pigg-O-Stat (set for PA chest).
A. Bicycle-type seat
B. Side body clamps
C. Film holder mount
D. Swivel base
E. Adjustable lead shield with markers
F. Mounting stand on wheels
G. Extra set of smaller body clamps
The simplest and least expensive form of
immobilization involves the use of equipment and
supplies that are commonly found in most
departments. Tape, sheets or towels, sandbags,
covered radiolucent sponge blocks, compression
bands, stockinettes, and ace bandages, if used
correctly, are effective in immobilization.
Strong canvas-type material and children's coarse
sterilized playing sand should be used. Coarse sand
is recommended because if the bag should break
open, the sand is more easily cleaned up, and the
chance of causing artifacts on radiographs is
minimized
Various types of “gentle” tape are used for
surgical procedures and sensitive skin.
Adhesive tape may show on the radiograph
and create an artifact that could obscure the
anatomic part of interest. Also, some patients
have an allergic reaction to adhesive tape.
The fragile skin of infants can be injured by
adhesive tape, unless the tape is twisted so
that the adhesive surface is not against the
skin. Gauze pads placed between skin and
adhesive tape also can be used effectively
A 4-inch ace bandage is best for small infants
and young children, whereas a 6-inch
bandage works well for older children. These
are best used for immobilizing the legs.
When starting the wrapping process, begin
at the patient's hips and wrap down to the
patient's midcalf. Do not wrap too tightly; this
would cut off circulation
Compression or retention bands are valuable
aids for immobilization. Compression bands,
however, are more effective with pediatric
patients when used in combination with
sandbags.
These are heavy steel angle blocks with thick,
radiolucent sponge pads attached. They are
relatively inexpensive to have made
compared with the cost of commercially
available head clamps. They are very
effective and versatile in immobilization,
especially when used in combination with
sandbags and/or tape, or if the patient is
mummified,
❖ The bones of infants and small children go through
various growth changes from birth through
adolescence. The pelvis is an example of ossification
changes that are apparent in children. As shown in,
the divisions of the hip bone between the ilium, the
ischium, and the pubis are evident. They appear as
individual bones separated by a joint space, which is
the cartilaginous growth region in the area of the
acetabulum.
❖ The heads of the femora also appear to be separated
by a joint space that should not be confused with
fracture sites or other abnormalities. These are
normal cartilaginous growth regions.
Reduction of repeat exposures is critical, especially
in young children, whose developing cells are
particularly sensitive to the effects of radiation.
Proper immobilization and high mA, short exposure
time techniques will reduce the incidence of motion
unsharpness. Accurate manual technique charts
with patient body weights should be used.
Radiographic grids should be used only when the
body part examined is greater than 10 centimeters in
thickness. Each radiology department should keep a
list of specific routines for pediatric imaging exams,
including specialized views and limited examination
series, to ensure that appropriate projections are
obtained and no unnecessary exposures are made.
Gonads of the child should always be
shielded with contact-type shields, unless
such shields obscure the essential anatomy
of the lower abdomen or pelvic area.
The following should be completed before the
patient is brought into the room:
The necessary immobilization and shielding
paraphernalia should be in place (sandbags,
tape, Tam-em board if used, sheets or towels,
stockinette, ace bandages, and shielding
devices for patient and for parents if assisting).
Image receptors and markers should be in
place and techniques set (if a solo technologist
is performing the exam).
Specific projections should have been
determined, which may require
consultation with the radiologist.
If two technologists are working together, they
should clarify the role that each will play during
the procedure. A suggested division of
responsibilities is to have the assisting
technologist set techniques, make exposures,
change the IRs, and process the images while the
primary technologist positions the patient,
instructs the parents (if assisting), and positions
the tube, collimation, and required shielding.
After the child is brought into the room and
the procedure is explained to the child's and
parent's satisfaction, the parent or
technologist must remove any clothing,
bandages, and/or diapers from the body
parts to be radiographed. This is necessary
to prevent these items from casting shadows
and creating artifacts on the radiographic
image because of low exposure factors used
for the patient's small size.
