Pediatric ICU Patients: What to Expect

What is the PICU?

In the Pediatric ICU (PICU), a team of nurses, doctors, therapists, and many others who have special training and experience very closely watch and treat children who require intensive care. These children may have breathing problems, heart problems, serious infections or injuries, or many other conditions which need complex tests and treatment. The specialized care in the PICU gives your child the best chance of getting better. Often all children need is very close observation. Sometimes children can have unstable conditions and require staff intervention and support from technical equipment to do well. With modern PICU care, children can have excellent outcomes, even when their illnesses are quite serious.

Equipment in the PICU

Monitors: Children in the PICU are watched very closely, often with the use of electronic monitors that display heart rate and rhythm, breathing rate and pattern, oxygen level in the blood, blood pressure, and additional measurements. These numbers or patterns change frequently. Usually small changes do not mean there is a problem, even if an alarm light or sound comes on. But the nurses and doctors do use the monitors to alert themselves to these changes because some of them might be important and a sign of a problem that needs attention.

Tubes and catheters: Tubes and catheters are also common in children in the PICU. Medication and fluids may be given to your child through small, peripheral IVs or through catheters that have been inserted into your child’s larger veins. Central venous catheters are used to give strong medication or IV feedings that cannot be given through a peripheral IV. They can also be used to draw blood for tests. Urinary catheters are tubes that go into the bladder to measure urine output. Endotracheal (breathing) tubes may be used to connect your child to a ventilator, a machine that helps someone breathe when normal breathing is very difficult or impossible.

Many different pieces of equipment are used in the PICU. Your child’s nurse and other staff will be glad to explain the reason for each piece of equipment they are using to care for your child.

A nurse critically caring for a child who needs it most. This child has an endotracheal tube connected to a ventilator that helps him breathe.

When do I meet the PICU team?

At the time of admission, members of the PICU team may be quite busy with the routine settling-in of your child if your child is relatively stable, or they may be taking care of more urgent medical issues while stabilizing your child. As this sometimes hectic phase slows down, the team will spend more time with you.

Your child’s nurse and doctor may have questions about your child’s condition. They will have important information about your child’s plan of care, including explanations of your child’s condition as well as its likely cause. They will also be able to discuss your child’s current or planned tests and treatments.

Will the PICU team tell me what will happen to my child?

The PICU team will do its best to tell you what to expect during your child’s stay in the PICU. Predicting the course or outcome for many of the children who are more seriously ill may be impossible. Team members will make every effort to keep you up to date with the information they have, but your child’s condition may change, and new or different tests or treatments may be needed.

What is my role as part of my child’s PICU team?

You are one of the most important members of the PICU team. You know your child better than anyone else and can be a major help in your child’s care. Please work with the team to help your child get better. Your child’s nurse will be the best person to tell you what you should and should not do to help your child and the team.

The PICU team includes people with many different jobs to do to keep your child as safe and comfortable as possible while working for the best and fastest recovery. A list of these team members is included at the end of this guide.

How safe is my child’s care?

In recent years, many new safety practices have been started in intensive care units, often called ICUs. More bar codes and stickers, arm bands, face masks, hand cleaners, gloves, and antiseptic procedures are being used. Members of the PICU team have many discussions among themselves to be sure they communicate all important information to one another. Please feel free to ask about the procedures or devices you see in use. If you are concerned about a safety issue, such as hand cleaning or use of certain medication, please bring it to the attention of your child’s PICU team.

Usual care for children in the PICU

Because every child is different, the PICU has almost no such thing as routine care. But some kinds of care are appropriate for almost all children in the PICU.

Nutrition and medication: Most children in the PICU receive IV fluids and medicines. Some may have oral medication and some may have oral feedings. Others may have just IV fluids or tube feedings, or IV nutrition called total parenteral nutrition (TPN).

Pain control: Your child’s PICU team will do its best to keep your child comfortable. Finding the best pain medication sometimes takes more than 1 try. Severe pain usually requires a narcotic drug, but other choices are available to ease mild or moderate pain. Good pain control is one of the team’s main goals.

Sedation: Children with or without pain may be very anxious or agitated by their condition and surroundings in the PICU. A sedative may be very important in speeding their care and recovery. Sedatives are calming medicines used to decrease the anxiety and fear that any child who is ill may have. Pain medicines and sedatives may have to be adjusted at times to get the best balance between good effects and side effects. Your child’s PICU team is specially trained to choose the best medication for your child’s comfort.

What can I do?

You know your child better than anyone else and can give the PICU team helpful information about your child. Here is what you can do:

  • Participate in the care of your child. When appropriate, wash, feed, or hold your child (first always ask your child’s nurse if this is okay).
  • Be aware of daily and long-term goals to help your child get better. Understand what the goals are as well as the “big picture” that will help your child leave the PICU. Getting better is a process that may be unpredictable and is based on your child’s progress. Every child gets better differently, even from similar illnesses.
  • Ask questions to stay informed. Feel free to ask questions as many times as you need. Your child’s care team understands that you are under a great deal of stress and may not remember everything the first time you hear it. Write down the names of your child’s PICU team members and what their roles are. If you think of questions when the doctors are not around, ask your child’s nurse, or write them down to ask later.
  • Bring in pictures of your child or family. This helps your child’s PICU team see your child the way you do and personalizes your child’s care.
  • Bring in favorite toys, blankets, books, movies, and music. Familiar objects are comforting for children. Getting your child to focus on familiar toys and objects can help your child stay calm and recover more quickly.
  • Learn more about your child’s illness. Your child’s doctor or nurse can provide you with written material and websites, and they can sit down and explain to you what is going on.
  • Ask family and friends to send mail. Your child may enjoy receiving mail from family and friends. Your child’s nurse can give you the address of the PICU.

How can I take care of myself?

Caring for a child can be tiring and emotional. All members of the PICU team need to take breaks from the challenging work of caring for chidren who are ill. You will need to take breaks, too. Here are some suggestions:

  • Eat healthy.
  • Get enough sleep.
  • Exercise or stretch your limbs periodically.
  • Accept the help and support of family and friends.
  • Keep a positive attitude.
  • Use faith and spiritual support and activities, such as meditation or prayer.
  • Keep a journal of thoughts and feelings about your child’s progress.
  • Read inspirational material.
  • Ask a family member or close friend to take messages or to be a spokesperson for you.
  • Make sure someone looks after your house and pets, and checks your mail and phone messages.

How will this affect my other children?

The illness of a child can affect other people in your family. Here are some things to look for:

  • Children may feel responsible for a sibling’s illness because they wished him or her ill in the past.
  • Children may feel ignored or that you are favoring a sibling who is ill by spending so much time in the PICU.
  • Children may act out or may regress, such as losing bladder control.
  • Children may do poorly in school due to prolonged disruption in family life.
  • Extended family members or close friends may need some updated and accurate information.

Addressing these issues yourself or with the help of a specially trained psychologist or child-life specialist is often helpful. Family therapy may be helpful in dealing with the stresses of serious illnesses. Take some time to be with the rest of your family and to restore balance to your own life.

When a child is extremely ill

If your child is extremely ill or injured, it is possible that your child will not get better. Your child’s PICU team will work hard to provide every chance of recovery, even when those chances may be very small. Frequently discussing the cause and the seriousness of your child’s illness with the team is very important so everyone has a realistic understanding of your child’s condition and how it will affect your child.

While the course of your child’s illness cannot always be predicted with certainty, members of your child’s PICU team will share with you their best understanding of the possible and most likely outcomes of your child’s illness.

Need more information?

If you or your family needs to know more about the PICU and its team’s care for your child, feel free to ask members of your child’s PICU team questions. They want you and your child to feel safe and comfortable in the PICU. They want you to have any information that will help in your understanding of your child’s illness and time in the PICU.

PICU team members

A healthcare team will be taking care of your child many times throughout the day and the night. This team includes any or all of the following members:

  • Parents/Guardians: The most important member of the team is you.
  • Physicians (doctors): Several teams of doctors may be caring for your child. An attending physician heads each team, and each team may include
  • Pediatric intensivists: These doctors are highly skilled in treating very ill and injured children.
  • Surgeons: These doctors can perform an operation on your child.
  • Heart specialists, lung specialists, infectious disease specialists, and other specialists: These specialists work closely with the physicians and pediatric intensivists.
  • Medical students, residents, and fellows: These doctors are doctors in training. They work closely with the attending physician to care for your child.
  • Nurses: These healthcare workers are specially trained to closely monitor and care for your child.
  • Pharmacists: These specialists monitor your child’s medicines and dosages during the course of your child’s illness.
  • Dietitians: These specialists help manage your child’s nutrition, including IV feedings.
  • Respiratory (breathing) therapists: These specialists help your child breathe better. They can measure how well your child’s lungs are working and give your child oxygen and ventilator care.
  • Physical therapists: These specialists help tone and strengthen weak muscles and loosen stiff joints that your child may develop during a stay in the PICU.
  • Occupational therapists: These specialists can help your child relearn everyday skills, such as eating and dressing themselves.
  • Child-life specialists: These specialists help your child cope with being in the PICU. They are experts in child development and can also help get siblings ready for a visit to the PICU.
  • Social workers: These specialists support you and your family and guide you to resources as needed during your child’s stay in the PICU.
  • Psychologists: These specialists can counsel you and your child during your child’s illness.
  • Chaplains: Clergy can offer spiritual support to you and your child. They are usually nondenominational, but you can ask for denominational.
  • Unit clerks: These desk clerks order tests, coordinate transfers, and keep the administrative aspects of the PICU running smoothly.
  • Discharge planners: This staff helps coordinate the transfer of your child from the PICU to other hospitals or places of care. They can arrange for you to have equipment at your home that you may need to help care for your child.
  • Palliative care specialists: These specialists are concerned with maximizing your child’s comfort and quality of life during an extended illness.

Publication Date: 2012
Page Created By: Robert E. Lynch, MD, PhD, FCCM; Jonathan D. Feldman, MD; Jennifer S. Needle, MD