Introduction to A Parent's Guide to Preparing Children for MRI Scans

Magnetic resonance imaging (MRI) is a medical imaging technique that uses strong magnetic fields and radio waves to generate detailed images of the inside of the body. MRI is often used to examine organs, soft tissues, bone, and other internal structures.
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It's especially important to take special considerations when performing MRI scans on pediatric patients. Children have different needs and challenges compared to adults when undergoing an MRI exam. Their smaller anatomical structures, developing tissues, and psychological factors require customized approaches to ensure a safe, comfortable, and successful scan.
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Some key differences include a child's natural anxiety about the procedure, their inability to remain still for long periods, smaller body habitus, and potential need for sedation medications. MRI staff also need specialized training in caring for children. With the right precautions and protocols in place, MRI can be conducted safely on patients of all ages. This overview will explore the most important aspects of pediatric MRI to optimize the experience and outcome for young patients.
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Anxiety and Fear
Having an MRI scan can be stressful and scary for children. The confined space inside the MRI machine, the loud noises it makes, and being inserted into a tunnel can trigger anxiety and fear. Children may be apprehensive about the unknown or unfamiliar MRI environment.
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Some techniques to help reduce a child's anxiety and fear include:
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Allowing the child to see the MRI suite and machine beforehand so they know what to expect. Giving them an MRI tour and letting them watch the machine in action can demystify it. Â
Providing earplugs or headphones to muffle the loud noises. Newer MRI machines are also quieter. Use of an MRI noise dampening system can help. Â
Having a parent accompany the child into the MRI suite and stay with them if possible. Allowing a comforting item from home like a stuffed animal or blanket can also help. Â
Explaining and showing the child exactly what will happen step-by-step. Using child-friendly language and images reduces the fear of the unknown. Â
Offering video goggles so the child can watch a movie during the scan and be distracted. Providing blankets and towels can add to comfort. Â
Using anesthesia or conscious sedation when necessary for younger children or those unable to cooperate due to anxiety. This ensures the child remains still for the scan. Â
Working with child life specialists who can provide tailored preparation and support. They help ease worries before and during the MRI.
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Addressing a child's natural anxiety and fears about MRI through preparation and comfort measures leads to a smoother scan and better image quality.
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Motion Artifacts
Children, especially younger ones, often have difficulty holding still for extended periods of time during an MRI scan. This can lead to motion artifacts in the images, reducing image quality. Strategies to help minimize motion include:
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Sedation or anesthesia for younger children who cannot lie still. This carries risks so is usually reserved for children under age 6. Â
Practice scans beforehand in a mock scanner so children know what to expect. This reduces anxiety and helps them understand the importance of staying still. Â
Provide entertainment such as TV/movies during the scan to occupy the child's attention. Â
Use faster scanning sequences when possible to shorten scan time. Â
Use immobilization devices to help restrict movement in the region being imaged. These may include foam pads, straps, tape, or a device that holds the head still. Â
Schedule scans when child is likely to be sleepy. For young children, morning is often best. Â
Have a parent/guardian present in scan room to comfort and reassure child. This provides both emotional support and allows prompt intervention for movement. Â
Use real-time motion correction software that adjusts for movement during scan.
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Ensuring the child is as comfortable and relaxed as possible prior to the scan helps reduce fidgeting or shifting during the MRI. With the above strategies, motion can be minimized to obtain quality diagnostic images successfully.
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SedationÂ

Sedation may be necessary for younger children under 6-7 years old who have difficulty remaining still for long periods of time inside the MRI scanner. Even with preparation, mock scans and play therapy, some children feel too anxious or fearful to stay calm and relaxed throughout an MRI exam without sedation. Sedating children helps reduce motion artifacts and ensures the scan can be completed successfully to obtain diagnostic images.
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The main risk with sedation is respiratory depression and airway obstruction. Younger children are at higher risk compared to older children and adults. Guidelines recommend monitoring oxygen saturation, capnography, and having personnel skilled in airway management and resuscitation present during sedation. The child must be nil per os for several hours prior to sedation to reduce aspiration risk. Reversal agents may be needed after the scan for rapid emergence. Specific sedative agents used for pediatric MRI varies, with considerations given to the pharmacodynamics, scan duration, and child's health status. Parental consent is required and recovery time afterward expected.
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Overall, sedation enables MRI scanning for children unable to cooperate fully. But the additional risks require careful pre-sedation assessment, monitoring during the procedure, and post-sedation observation until discharge criteria achieved. With proper protocols and personnel experienced in pediatric sedation, significant adverse events are rare.
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Implants and Foreign Bodies
Metal implants and other foreign bodies can pose unique safety hazards for pediatric MRI exams. Certain implants are contraindicated for MRI due to risks of device malfunction, overheating, or dislodgement caused by the powerful magnetic field. Common concerning implants include:
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Pacemakers and implantable cardioverter defibrillators (ICDs) - The MRI magnetic field can impact device function and potentially cause irregular heart rhythms or failure during scanning. Newer "MRI-conditional" models may be safe under certain conditions. Â
Aneurysm clips - Ferromagnetic clips have risks of movement or torque. MRI-compatible titanium clips are now widely used. Â
Cochlear implants - These require specific safety testing at lower field strengths due to internal magnets. Some models can be safely scanned. Â
Insulin pumps and infusion devices - There are variable risks depending on the pump model. Some newer devices are MRI-compatible. Â
Shunts - Programmable shunt valves can malfunction from magnetic field exposure. Â
Orthodontic braces and retainers - Removable dental appliances should not be worn during MRI. Fixed appliances may cause artifacts but are not hazardous. Â
Prosthetic devices - Internal devices could potentially be dislodged by magnetic forces. Common prosthetics like joint replacements are usually MRI-safe.Â
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Careful screening is needed to identify any implants or foreign bodies prior to MRI in children. Radiographs can help detect unknown metal fragments. Implant cards or medical records should be reviewed when available. Extra safety precautions may be warranted, such as utilizing lower field strength scanners or avoiding contrast agents. With appropriate screening and precautions, MRI can be safely performed in children with implants.
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Hearing ProtectionÂ

Loud noises during MRI scans can damage hearing, especially for children whose ears are still developing. The loud banging sounds produced by the MRI machine as it takes images can exceed 100 decibels, which is as loud as a chainsaw or jackhammer. This level of noise exposure, even for a short time, can lead to hearing loss or problems later in life.
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Hearing protection is crucial for pediatric patients undergoing MRI. There are several effective options for reducing noise during the scan:
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Earplugs made of foam, silicone, or other materials can block noise up to 30-40 decibels. These are inserted in the ear canal and may come in different sizes for proper fit. Parents should check that their child keeps earplugs in place during the entire scan. Â
Earmuffs with sound-dampening padding on the ear cups block more noise than earplugs. They fit over the entire outer ear for better noise isolation. Earmuffs are adjustable and one size can usually fit children of different ages. Â
Newer MRI machines have built-in noise reduction features and play music through headphones to mask scanner noise. However, the headphones and music may not provide enough protection on their own. Earplugs or earmuffs should still be used. Â
Sedation is sometimes used for MRI scans, which can help children stay still and also spare them from the loud noise. But sedation has its own risks, so other hearing protection is preferable.
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Protecting young patients' hearing should be a top priority during MRI scans. With proper ear protection methods, children can undergo imaging safely with minimal noise exposure or discomfort. Healthcare staff should explain the options and ensure children properly wear earplugs or earmuffs throughout the entire scan.
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Contrast Agents
 Contrast agents are sometimes used in pediatric MRI exams to enhance the visibility of certain tissues, blood vessels, or organs. Contrast agents work by altering the magnetic properties of nearby water molecules, causing specific areas to appear brighter on MRI images.
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There are a few special considerations regarding contrast with children:
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Contrast is more likely to be used for scans of blood vessels, tumors, infections, etc. It may not be needed for more routine brain or musculoskeletal exams. The radiologist will determine if contrast is recommended.Â
Children can have allergic reactions or intolerances to contrast. Be sure to inform the technologist of any previous reactions, asthma, allergies, or sensitivities. They have procedures in place to reduce risks.Â
An IV line will be started before the scan to inject the contrast during imaging. Extra time and patience may be needed for IV placement with wiggly or frightened children. Numbing cream, distractions, and child life specialists can help.Â
The technologist will monitor for any allergic reactions during and for up to 30 minutes after the contrast injection. Reactions are rare but may include hives, itching, or shortness of breath.Â
Contrast agents have been studied and deemed very safe for children by the FDA. However, some families may still have concerns, so discussing risks vs. benefits with the radiologist ahead of time is recommended.
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The technologists and radiologists are specially trained to determine if contrast is needed, obtain informed consent from parents, use proper pediatric dosing, and minimize any risks or fears during the process. Being aware of contrast procedures and precautions can help families of pediatric patients feel informed and reassured.
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Radiation Concerns

Many parents have concerns about exposing their child to radiation during an MRI scan. However, MRIs use strong magnetic fields and radio waves to generate images, not ionizing radiation like X-rays or CT scans. MRI does not use radiation at all, so there is no risk of radiation exposure or damage during an MRI scan.
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Some of the public misconceptions about MRI and radiation stem from the term "nuclear" magnetic resonance imaging. This refers only to the use of the magnetic properties of atomic nuclei, and not nuclear radiation. The word "radiation" is also sometimes used to describe the radio waves used in MRI, but this type of non-ionizing radiation is harmless and different from ionizing radiation.
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Rest assured, MRI is an extremely safe imaging technique for children, with no radiation exposure whatsoever. It provides very detailed images to help doctors diagnose conditions in children without any radiation risks. MRI does not require exposure to ionizing radiation, unlike CT or PET scans. Parents can feel at ease knowing their child is not being exposed to any damaging radiation during an MRI scan. While MRI itself is safe, additional sedation or anesthesia may carry minor risks - but the MRI poses no radiation threat.
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Younger vs. Older Children
MRI exams for infants and toddlers require different approaches compared to older children.

Infants
For infants under 6 months of age, feeding and swaddling techniques may allow an MRI without sedation. Feeding the infant right before the exam can help promote sleep. Swaddling the infant snugly in a blanket mimics the confined space of the womb and provides comfort and security. The radiology team may also bring the crib into the scanning room to make the infant as comfortable as possible. Ear protection, sandbags to limit movement, and specialized coils may further enable a successful scan.
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Toddlers
Toddlers from around 1-3 years old are often the most challenging pediatric age group for MRI. They are mobile and active but do not understand instructions to stay still. Shorter scan times or shallow sedation may allow toddlers to remain still long enough to obtain diagnostic images. Child life specialists can educate toddlers about the MRI machine with pictures, videos, and child-friendly models. This preparation helps reduce anxiety and fear before the scan.Â
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Young Children
Older children around 4-8 years old can sometimes follow breathing instructions and lie still for MRI sequences. Their greater language comprehension and attention span facilitates the scanning process. Child life preparation is still important to explain the loud noises and confinement. Parents may stay with anxious children during the scan for reassurance. Younger children often need sedation for the 30-60 minutes required for a comprehensive MRI exam.
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Conclusion

Getting an MRI scan can be a challenging experience for children due to their young age, energy levels, and limited ability to remain still for long periods of time. However, with some special considerations and preparations, the process can be made more comfortable for pediatric patients.
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As discussed, the main considerations when getting an MRI scan for children include managing anxiety and fear about the procedure, limiting motion artifacts, determining if sedation is needed, screening for implants and foreign bodies, providing hearing protection, using contrast agents cautiously, addressing radiation concerns, and adjusting the protocol based on age.
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While standard MRI methods work for most routine scans, it's important to keep these pediatric-specific factors in mind. With adequate support and accommodations, children can successfully undergo MRI examinations and get the clinical benefits of this valuable diagnostic imaging tool.Â
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By understanding the unique needs of young patients, radiologists and MRI technologists can make the process less intimidating and deliver quality results. Ensuring children have a smooth MRI experience facilitates medical care and follow-up treatment when required. With continued advancements in technology and greater attention to patient-centered pediatric care, MRI scans will become safer and more patient-friendly for children.
Thanks you for taking the time to read A Parent's Guide to Preparing Children for MRI Scans and if you have any questions feel free to reach out to our MRI
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