What is pediatric sedation?
Pediatric sedation is a procedure to relax a child before painful or unpleasant medical procedures. The doctor administers medications that depress the level of consciousness in the child, relax their muscles and prevent pain.
Depending on the type and dosage of medication, sedation levels may be:
- Minimal sedation: The child is relaxed, awake and responsive.
- Procedural sedation: The child is semi-conscious and responds to stimulation.
- Deep sedation: The child is unconscious and may require assistance with breathing.
- General anesthesia: The child is completely unconscious and unresponsive to pain, and will require mechanical ventilation.
Emergency department procedures are typically performed under procedural sedation, which keeps the child semi-conscious, without affecting lung and heart functions.
Why is a child sedated?
The purpose of sedating a child is to relieve pain and fear, and control excessive movement during a procedure. Sedation takes away the child’s distress and makes the child cooperative, resulting in better outcomes from the procedure.
Historically, pain in children has been misunderstood and undertreated. Until comparatively recently, babies too young to verbalize were thought too young to experience fear or pain. Current research shows that even newborn babies experience pain, and sedation is essential before a painful procedure.
Some of the myths surrounding pain in children are:
- Children’s immature central nervous system (CNS) cannot experience pain.
- Children have no memory of pain.
- A given injury elicits an equivalent amount of pain in children as in adults.
- Children easily become addicted to opioids.
The facts are:
- Even newborns exhibit behavioral and hormonal changes in response to painful procedures.
- Children do not have to understand the meaning of pain to experience pain.
- Preemptive sedation and pain relief (analgesia) may decrease postprocedural opioid requirements.
- A child may require deep sedation in many situations where an adult would require minimal or no sedation.
What are the procedures that require sedation of a child?
Major pediatric surgeries may require general anesthesia, but procedures in the emergency department are generally performed using procedural sedation. Pediatric sedation may be administered during procedures that include the following
- Lumbar puncture
- Arthrocentesis (fluid drainage from a joint)
- Bone marrow biopsy
- Sexual assault examination
- Radiologic evaluation (CT, MRI)
Is it safe to sedate a child?
Procedural sedation is a safe and necessary step before performing any painful procedure on a child. Doctors generally use a minimum possible sedative dosage for the shortest duration required to keep the child relaxed and pain-free during the procedure.
The child’s vital signs are continuously monitored during and after the procedure until they are fully awake and stable. The emergency department is also always prepared with the necessary devices to assist breathing if required, and medications to reverse the anesthesia, if sedation gets deeper than intended.
- After Salmonella Cases Double in a Week, Cantaloupe Recall Expanded
- COVID Vaccines Curbed Pandemic-Linked Surge in Preemie Births
- Could a 'Brain Coach' Help Folks at Higher Risk for Alzheimer's?
- Early Promise for Stem Cell Therapy to Curb MS
- Internet Poses No Threat to Mental Health, Major Study Finds
- More Health News »
How do you sedate a child?
Before sedating a child an emergency department doctor:
- Obtains information on the child’s medical history which may include:
- Conducts a physical examination to evaluate the child’s
- Heart and lung functions
- Blood pressure and other vital parameters
- Airway structure and function
- Neurological and mental status
- Size and location of injury
In elective procedures, the child cannot have any food or drink for a few hours prior to sedation. This direction varies depending on the age of the child. The American Academy of Pediatrics (AAP), and the American Society of Anesthesiologists (ASA) recommend the following durations for nothing-by-mouth (nil per os [NPO]) status prior to sedation:
- Younger than six months: No solids or nonclear liquids for four to six hours and no clear liquids for two hours.
- Six to 36 months: No solids or nonclear liquids for six hours and no clear liquids for two hours.
- Older than 36 months: No solids or nonclear liquids for six to eight hours and no clear liquids for two hours.
The doctor may administer sedative to a child using one of the following routes:
- During the procedure, the physician continuously records and monitors the child’s vital signs including:
- Blood pressure and heart rate every 15 minutes for procedural sedation and every 5 minutes for deep sedation
- Oxygen saturation and airway function
- Level of consciousness and response to physical stimulation
- Some children may also be monitored with
The doctor continues to monitor the child’s vital signs until the child responds appropriately to gentle verbal or physical stimulation. The child may be discharged after:
- Their vital signs return close to normal
- They regain their age-appropriate mobility without assistance
- They are able to feed orally
What drugs are used for pediatric sedation?
Sedative and analgesic drugs and their doses are primarily based on the child’s weight, but are individualized according to the child’s need.
Response to medication can vary even among children of the same weight, and some children might need a higher dose than others. The doctor typically starts with the lowest dose possible and adjusts based on the child’s response.
Sedatives and analgesics
Following are some of the commonly used drugs for pediatric sedation:
Opioid analgesics for pain relief, such as:
- Morphine sulfate
Benzodiazepine class of sedative agents that include:
Barbiturate class of drugs such as:
Other sedative agents include:
- Nitrous oxide
Medication doses can be minimized by including some of the following techniques to distract the child during the procedure:
- Providing some visual or auditory distraction
- Having a parent engage the child’s attention with a story
Reversal agents are used to reverse the effects of the anesthetic drugs after completion of the procedure, or if the child has adverse reactions to the sedative agent.
The two reversal agents used are:
- Naloxone: Reverses opioid analgesic agents
- Flumazenil: Reverses benzodiazepine class of drugs
What are the side effects of sedation?
A child may take up to 24 hours to completely recover from the effects of sedation. The side effects of sedation include:
Sedative and analgesic drugs and their doses are primarily based on the child’s weight, but are individualized according to the child’s need. Pediatric sedation is a procedure to relax a child before painful or unpleasant medical procedures.
Multimedia: Slideshows, Images & Quizzes
Childhood Diseases: Measles, Mumps, & More
Is your child at risk for these childhood diseases? Know when to call the doctor for conditions such as measles, mumps, ringworm,...
Top 10 Parenting Mistakes- Children, Infants, Toddlers
Parenting a child isn't easy. Explore the top 10 mistakes that new parents make. Discover newborn parenting tips for...
Your Child's First Year of Development
What developmental milestones can you expect to see during baby's first year? Find out when babies learn to smile, laugh, crawl,...
Abdominal Pain: Common Causes of Stomach Pain in Children
Abdominal pain in children can be more than just a tummy ache. What are the common causes of abdominal pain in children? Learn...
Common Childhood Skin Disorders
What are the most common skin rashes in children? Learn about childhood eczema, ring worm, chicken pox and more. Get the facts on...
10 Common Symptoms in Infants and Young Toddlers
Watch this slideshow to see common symptoms and home treatment for infant and childhood illnesses including fever, nausea,...
Brain Foods: Healthy Food for Kids' Brains
Use this brain foods list to make your child smarter and healthier with these brain-boosting meals! Developing brains needs the...
Home Remedies for Sick Children
Home remedies for sick babies, toddlers, and kids can help with things like colds, flu, cough, sore throat, stuffy nose, fever,...
Children's Health: 11 Pictures of Common Skin Rashes
What causes skin rashes in children? See which chemicals in your home could be causing your child's skin rash, irritated skin,...
Related Disease Conditions
Cold and Cough Medicine for Infants and Children
The safety of giving infants and children over-the-counter (OTC) cold and cough medicine is important for caregivers to understand. While there is no "gold standard" recommendation for giving infants and children OTC cold and cough medicine for fever, aches, cough, and runny nose, a few standards have been recommended.
Children's health is focused on the well-being of children from conception through adolescence. There are many aspects of children's health, including growth and development, illnesses, injuries, behavior, mental illness, family health, and community health.
Approximately 40 million children suffer abuse every year around the world, and more than 1,500 children die of abuse in the U.S. every year. Symptoms and signs of child abuse include poor school performance, physical injuries, regression, anxiety, and panic. Treatment involves ensuring the safety of the child and tending to any physical injuries.
Children's Cough Causes and Treatments
Children's cough causes include infection, acid reflux, asthma, allergies or sinus infection, whooping cough, and exposure to irritants. Treatment for a child's cough include cough medicine for children over the age of four.
Croup in Infants and Children: Patient Education
Croup is a viral infection caused by parainfluenza viruses, adenovirus, respiratory syncytial virus (RSV), or measles virus.
Treatment & Diagnosis
Medications & Supplements
- fentanyl injection (Sublimaze)
- midazolam injection, Versed (discontinued brand)
- midazolam - oral syrup, Versed
- Side Effects of midazolam
- Ketalar (ketamine)
- morphine high potency injection (Astramorph, Duramorph, Infumorph, AVINza)
- Side Effects of Sublimaze (fentanyl)
- Side Effects of Duragesic (fentanyl patch)
- Brevital Sodium (Methohexital Sodium for Injection)
- Subsys (fentanyl)
Health Solutions From Our Sponsors
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.