Tips on Immobilization of Pediatric Patients for Radiography

In general, pediatric radiography should always use as short exposure times 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. Good techniques and effective methods of immobilization are essential. Immobilization can improve image quality by minimizing patient motion. It can decrease the risk of repeat exposure and missed diagnosis from sub optimal exam. It can decrease the overall time of the procedure. And because of all these factors, it can lower the patient, parent, and staff radiation dose.

1. Soothe the savage beasts (and the parents too)

Fear and combative resistance are common reactions for a young child about to participate in a radiographic procedure. The technologist must take the time to communicate to the parent and the child, in language they can understand, exactly what needs to be done. The technologist should try to build an atmosphere of trust in the waiting room before the patient is taken into the radiographic room. This includes discussing the probable necessity of immobilization as a last resort if the child’s cooperation is unattainable. If the parents aren’t participating in the exam, it helps keep the child calm by allowing the parents to stay with the child for as long as possible. It may help to use comforting devices such as stuffed animals, pacifiers, or blankets. If possible, it may also help to use distractions such as a TV, movies or games on a phone or tablet, toys, etc. Decorating imaging rooms to be kid friendly can also help them to be distracted and feel more at ease. Parents can help by speaking calmly, holding hands, praising the child for being cooperative and helpful. Make sure parents have been given clear instructions and are engaged.

2. The Pigg-O-Stat (pictured at the top of this article)

It seems that these were used a lot more in decades past. The Pigg-O-Stat has been used successfully all over the world, by doctors, clinics and technicians for over 40 years. The Pigg-O-Stat was originally designed by a technician with many years of experience with the problems encountered in immobilizing and positioning infants and children. They are great in a pinch when nobody is around to help and if the baby is calm, but they are not effective for babies who are motivated to squirm out of it. The Pitt-O-Stat has fallen out of favor probably due mostly to the proliferation of velcro and radioluscent foam allowing it to be replaced by papoose style restrainers.

3. The Jerry Rig

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, can be effective in immobilization. The items should either be disposable, or vinyl coated so they can be cleaned with bleach after each procedure. Thick layers of bandages and adhesive tape might show on the radiograph and create artifacts. 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 mid calf. Do not wrap too tightly; this would cut off circulation. An old fashioned mummy wrap with a blanket or a Velcro papoose is sometimes sufficient with infants.

4. The Pedia-Poser

It’s rare to see these in use, probably because they look like midevil torture devices and parents would bit a shrick if they saw their kid put in one. Also, I’ve never seen one of these used, but from the looks of it any toddler would get out of this before you can say Houdini.

According to the ad copy, the Pedia-Poser chair provides fast, gentle, and secure immobilization of infants through 4-year olds for X-ray imaging. The patient is secured only once: the chair rotates, quickly positioning for different views. This simple, reliable product is the child-friendly solution for pediatric positioning. The bench seat is used with toddlers up to small 4 year olds. The seat can be placed in one of two seat slots depending on the height of the child. The chair back adjusts to the height of the child. The non-stretchy Velcro straps are used with the stronger toddlers to secure their arms in the desired pose. The chin strap is used to achieve the desired head tilt.

5. Papooses, Infantainers, Child Huggers, etc.

There are a variety of these swaddling devices on the market. They are made of Lightweight Plexiglas, contoured soft-foam, or radiolucent plastic with adjustable velcro closures. They safely and comfortably secure pediatric patients during CT scans, radiographic exams, and even minor surgical procedures. They are inexpensive and effective. The main benefit of these is that the patient can be adjusted in a large variety of positions and immobilized. For an uncooperative older child who is large and strong, the exam simply may not be possible. In such cases it’s important to consult with the ordering provider to determine an appropriate course of action.

6. The Parent Trap

A faster and easier method (and by far the most common) is to have the parent hold the child in position. This usually works best for extremity exams such as an elbow, but is much more difficult for torso and head exams. Whenever the parent or guardian is participating in this way, it’s best practice to have them wear lead aprons and gloves in case their anatomy slips into the exposure. Always take extreme care when attempting to immobilize the head. Infants in particular have soft skulls and compression from head clamps may cause injury. It’s always best to consult with a physician regarding immobilization if there is a concern for the patient’s safety.

It’s best to plan for immobilization whenever the patient is less than 3 years old, if the patient is unable to follow instructions, and if the exam is difficult or requires a long exposure time. Always choose immobilization devices that are easy to use, will be able to be removed quickly, do not obscure the area of interest, do not compromise airway or circulation, and which are comfortable and safe.