Help, my child needs an Endoscopy

“Help, the doctor said my child needs an endoscopy.” I often get calls and emails from parents when their infant or child with Gastroesophageal Reflux Disease (GERD) needs a medical procedure such as an endoscopy. Parents often worry about sedation and the risks associated with the procedure while children worry about pain and being separated from their parents.

Parents often ask me questions about having an endoscopy so I have answered the most common questions:

What is an endoscopy?

An endoscopy is a common medical procedure used to diagnose Gastroesophageal Reflux Disease (GERD) and other diseases of the digestive tract. During the endoscopy, a child is sedated and a flexible tube is placed in the mouth and down to the stomach. The tube has a camera so the doctor can visualize the lining of the esophagus and stomach, take samples (called biopsies) and photos. After the test, your child may feel sleepy from the sedation and experience a sore throat. Most children feel fine after a nap and a drink and resume their normal activities the next day.

What are the risks?

As with any medical procedure, there is a slight risk of complications. The good news is an endoscopy is very safe and most infants and children tolerate the procedure without any problems. In rare cases, there may be a reaction to the anesthesia (medicine used for sedation) or an injury to the esophagus or stomach from the tubing. The procedure may be performed in a hospital or an outpatient surgery center.

How do I get ready for an endoscopy?

It is very important to ask the doctor or hospital staff for detailed information about the procedure, the sedation and their policies. I always ask what items I can bring such as special blankies and stuffed toys. Most of the time, my kids have been able to have their special comfort items with them the entire time. My kids appreciate the bedside DVD players so they can watch a movie before and after the procedure. Sometimes the kids need to wear a gown and other times they just wear loose comfortable clothing (especially for older children).

How do I prepare my child?

It is important to use age appropriate language to describe what will happen. For a preschool aged child, it is best to describe things from his/her point of view. The biggest concern is experiencing pain and being separated from his/her parents. You don’t need to describe what will happen during the procedure. Just tell him/her that the doctor needs you to go to sleep for a few minutes to do the test and you will wake up right away and see mommy.
Be sure to use the information you have gained about the “amenities” of the endoscopy center or hospital when you talk with your child. You might say, “I talked with the nurse and she said you could bring Teddy and two DVD’s.”

An older child may need to know why the test is done and want a more in depth description of the process such as the need for an IV. Keep in mind that an older child may have some memories of previous experiences with medical procedures. Having some discussion about the procedure and perhaps participating in the decision making with the doctor may be appropriate.

When should I tell my child about the procedure?

I spoke with a group of GI nurses recently and they complained that parents often hold off on telling their child about the procedure until they get to the door of the hospital on the day of the test. The child is not prepared and become anxious about doctors and hospitals. Preschoolers have a poor sense of time so a day or so in advance is enough. An older child may want to know a few days in advance.

Teens will often want to know far in advance so they can prepare for missed school work, sports practice and other activities. It may be a good idea to include a teen in determining the date.

What if my child is anxious about the procedure?

It is common for children of all ages to have some fear about a medical procedure. Make sure you ask questions and watch for signs of distress and concern. Many surgery centers and hospitals have nurses and Child Life Specialists to help children discuss their fears and use play and art to help them cope.

When my daughter was 5 years old, she was able to work with a Child Life Specialist before a procedure. She decorated a rag doll and gave the doll a hospital bracelet and an IV. I could see her rehearse the steps, process the information and cooperate fully when it was her turn.

Ask the doctor or nurse for a referral to a counselor if your child has extreme anxiety about going to the doctors or having a medical procedure.

Should I promise to take her to Disney World?

Parents often feel a great deal of guilt and anxiety about subjecting their child to a medical procedure. Sometimes it feels like a big reward is needed for such bravery. Other parents may feel a need to offer a big reward to ensure good behavior.

I think that a promise of a small reward is ok such as a balloon or stuffed animal in the gift shop. It should be phrased so that it is not perceived as a reward or a bribe; it is just part of the package.

When Rebecca was young, we had many appointments in a large clinic. The gift shop in the lobby had a row of candy bins at her level for easy access. She knew when we were done with our appointment; we would go to the gift shop and get a few pieces of individually wrapped candy. Oh the decision making and the negotiations might take forever but she was totally in the driver’s seat. It cost me under fifty cents and it was a huge treat for her. The candy wasn’t a reward for good behavior or a bribe to behave. It was just part of our “going to the clinic” routine and it was a sign that we were done and we could get in the car for the long ride home.