Intensive Care for Children

What is intensive care after surgery?

An intensive care unit (ICU) is for people who need close or specialized monitoring. A child will go to the pediatric intensive care unit (PICU) or neonatal intensive care unit (NICU). The unit they go to depends on their age.

Intensive care is needed for children who have had certain types of major surgery. These include heart surgery, organ transplants, or neurosurgery. In the ICU, your child will be closely watched 24 hours a day and cared for by specialized healthcare providers. Your child may remain on a breathing machine after surgery. They may have thin tubes that measure blood pressure in major veins or arteries.

Learning about the ICU equipment

ICUs are equipped with complex machines and monitoring devices. These are designed for the unique needs of children who had surgery or are critically ill. The equipment may include:

• Cardiorespiratory or heart monitor. This monitor displays your child's heart and breathing rate. Wires from the monitor are attached to sticky patches on the skin of your child's chest and belly.

• Blood pressure monitor. Blood pressure is measured using a cuff placed on your child's arm or leg. At times, a blood pressure monitor pumps up the cuff and measures the blood pressure. Some children need continuous blood pressure monitoring. This can be done using a thin tube (catheter) placed in one of your child's arteries.

• Pulse oximeter. This device measures the amount of oxygen in your child's blood through the skin. A tiny light is taped or connected to your child's finger, ear, or toe. A wire connects the light to the monitor. This displays the amount of oxygen in your child's red blood cells.

• Transcutaneous oxygen or carbon dioxide monitor. This machine measures the amount of oxygen and carbon dioxide in your child's skin. A small, circular pad is attached to your child's skin, most often on the chest or belly. The pad warms a small area of skin and measures oxygen, carbon dioxide, or both. A wire connects the pad to the monitor and displays the levels. Because the transcutaneous monitor heats the skin, it may leave a temporary reddened spot on the skin. The pad must be moved to different places on the skin every few hours.

• X-ray. Portable X-ray machines are brought to your child's bedside in the ICU as needed. X-rays are taken for many reasons. They may be used to check placement of catheters and tubes. They may be used to look for signs of lung problems or bowel problems.

• Endotracheal tube (ET tube). This tube is placed in your child's mouth or nose and into the windpipe (trachea). The ET tube is held in place with tape or a tube holder and is connected with flexible tubing to a breathing machine (mechanical ventilator). Because the ET tube is uncomfortable, your child will be sedated. Their wrists also might be restrained to prevent them from pulling the ET tube out. Your child will not be able to speak while the ET tube is in place. This is because the vocal cords can't vibrate and make sounds with the tube in place. This is temporary. Your child will regain their voice after the ET tube is removed. After removal, your child may be temporarily hoarse, or have a sore throat.

• Breathing machine (respirator or mechanical ventilator). This machine helps children who are unable to breathe on their own. This problem may be due to medicine that causes your child to be sedated. The machine may also be used for a child who needs help taking bigger or better breaths due to illness. Ventilators can also deliver extra oxygen, if needed. The breathing machine is used for the shortest time possible. The length of time depends on many factors. The ICU team can explain why your child needs ventilator support.

• Chest tube. This is a plastic hollow tube placed between the ribs into the chest cavity. It drains blood, fluid, and air from the space around the lungs.

• IV (intravenous) pumps. IV pumps deliver fluids, feedings, and medicines in very accurate amounts, through catheters into the veins.

• Foley catheter. This is a thin hollow tube placed in the bladder to drain urine. This tells the nurse how well your child's kidneys are working. The nurse will measure the amount of urine your child is making.

How often can I visit the ICU?

Ask someone on your child's healthcare team when you first arrive about visiting hours. If needed, ask about services provided to families (such as social workers or chaplains, child life specialist, and phone numbers to call from home) when you can't be there with your child. Many pediatric ICUs encourage a parent to be at the bedside as much as possible. Check with the staff about visiting your child.

What other healthcare providers will help my child in the ICU?

Your surgeon may ask other specialized healthcare providers to help manage your child's care while in the ICU. These specialists may include:

• Pulmonologists. They manage breathing or lung problems.

• Anesthesiologists. They help manage pain.

• Critical care medicine healthcare providers. They help coordinate your child's care when many healthcare providers are involved. And they watch for complications after surgery.

How can I help my child while they are in the ICU?

Even if your child is receiving medicine to control pain or help them sleep, your child needs to know you are there. The healthcare team that is caring for your child will be happy to suggest ways that you can comfort your child at every stage of recovery. They will also welcome suggestions from you about how to make your child feel more comfortable and secure. A child life specialist can be a great resource for showing you and your child relaxation and pain management skills. Ask the ICU staff if you can do any of the following for your child while they're in the ICU:

• Touch your child and talk to them in soft, soothing, reassuring tones.

• Bring your child's favorite music from home.

• Record your family reading your child's favorite story.

• Place pictures of your family, child's friends, or family pets where your child can see them.

• Bring 1 or 2 items from home that help your child feel secure. These could include a favorite stuffed animal, a soft blanket, a special cup to drink out of, or a pacifier.

• Ask if your child can use earplugs or noise-reducing headphones.

Coping with stress

Seeing your child in an ICU bed, surrounded by the sounds, smells, lights, and busy providers can be overwhelming. Parents report feelings of fear, anger, loneliness, confusion, exhaustion, and helplessness.

With all these emotions, and as difficult as it may be, parental self-care during this time is very important. Find a quiet space to rest, go for a walk outside, go to the gym, or spend time with friends or pets. It’s also OK to go outside and scream if you need to. You will be better able to care for your child’s needs, talk to providers, and make important decisions if you take care of yourself.

Remember that the hospital staff also want to help you. You can talk to a hospital social worker, chaplain, or other social care provider. They know that a parent with a child in the ICU needs support, and they are part of your team.