The truth about sedatives for children

Author: Fang Xiao, The First Affiliated Hospital of Zhengzhou University

Reviewer: Wang Huaili, Chief Physician, The First Affiliated Hospital of Zhengzhou University

Young children often have difficulty cooperating before an examination or treatment due to fear, pain or anxiety. Sedatives are often needed to help them complete the examination. How to use sedatives? What should be paid attention to before and after use? Today, we will reveal the truth about sedatives for children.

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1. What drugs can be used to sedate children before examination?

Commonly used sedative drugs before examination include phenobarbital, chloral hydrate, dexmedetomidine, etc. The usage, dosage, duration of action and adverse reactions of these drugs are shown in Table 1.

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If these sedatives are administered intravenously, they should be injected slowly, because injecting too quickly will greatly increase the risk of respiratory and circulatory depression. Drugs such as propofol take effect quickly and have a good sedative effect, but they also have a higher risk of cardiovascular depression and should be used with caution under the guidance of a doctor and ECG monitoring.

2. What precautions should be taken before using sedatives?

Before taking the medicine, tell the doctor about the child's allergy history, previous use of sedatives, the child's health status, etc., especially whether there are airway abnormalities or major cardiopulmonary diseases. Before taking sedatives, the child should be on an empty stomach to avoid gastroesophageal reflux or choking after sedation, which may lead to aspiration and suffocation.

3. What precautions should be taken after using sedatives?

When using sedatives and after taking them, pay attention to keeping the child's airway open to avoid accidentally blocking the child's mouth and nose or excessive bending of the neck to block the airway. At the same time, pay attention to the child's lips and facial color, breathing, heart rate, blood pressure, etc. If there is purple or pale lips, apnea, irregular breathing, too fast or too slow heart rate, take appropriate measures immediately. It is not recommended to eat while taking medication to avoid accidental inhalation; for older children, pay attention to preventing falls.

4. Why can’t my child fall asleep/wake up after taking sedatives?

Different individuals may have different abilities to metabolize drugs, so some children may not achieve the desired effect after using sedatives, and may even become irritable or excited. If this happens, other sedatives may be used as appropriate. Some children sleep too long after taking the medicine, or experience discomfort such as weak legs, dizziness, and memory loss during the sedation recovery period, which makes parents very worried. In most cases, this is normal, and the child will return to normal as the drug is gradually metabolized. However, if the child also has purple or pale lips, irregular breathing, a fast or slow heart rate, etc., you need to pay great attention and seek medical help immediately.

5. Is it safe to take two sedative drugs at once?

Some children have difficulty achieving sedation with one sedative. In this case, the doctor may recommend adding another sedative, or directly use two sedatives at the same time based on previous sedation experience. Commonly used combinations include chloral hydrate + dexmedetomidine, chloral hydrate + phenobarbital, phenobarbital + chloral hydrate, etc. This approach is feasible after fully evaluating the necessity of the examination and the child's health status.

6. In addition to the use of sedative drugs, what other methods can help complete the examination?

For non-invasive, short-duration examinations, such as CT scans, some children can complete them in a deep sleep state; some young children can complete the examination without sedation with adequate communication, comfort, and family members accompanying them. If sedatives are really necessary, it is recommended to let the child be in a relatively sleepy state before taking the medicine, such as waking up early in the morning, shortening the daytime nap time, etc., so that the effect after taking the medicine is better and the success rate of the examination is higher; on the contrary, if the child is in a very excited state, it is likely that it will be difficult to achieve the ideal sedative effect even if sedatives are used.

7. Will sedatives affect children’s brain development?

For sedation before the examination, doctors will choose drugs with less adverse reactions. The safety of these drugs has been repeatedly verified in clinical practice, and the dose used for sedation is much smaller than the anesthesia dose during surgery. Therefore, the reasonable use of sedatives will not affect the child's brain development.

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In short, proper sedation is necessary for successfully completing examinations, diagnosing and treating diseases as early as possible, and reducing children's pain and anxiety. However, sedatives may cause adverse reactions. We must view sedation correctly and not be anxious or nervous.