One of the biggest disparities in sleep medicine care is the scarcity of pediatric-dedicated sleep centers. Just as a child needs a pediatrician, a child also needs a sleep technician who understands children. Pediatric sleep technicians are our night heroes that make it all possible.
John Samuel has been a pediatric sleep tech for 24 years and has seen the sleep center grow from performing 6 to 16 sleep studies a week. John shared with me some of his thoughts on what the key concepts are that make a pediatric-dedicated sleep center a special experience. “The families receive a call from the sleep lab to advise them to bring anything that will make their stay comfortable, like their favorite toys, pillows, blankets, etc.,” says John.
Samuel continues: “Just like in any sleep lab, the family brings their medication and any other medical equipment. We give them guidelines about dinner and sleep time. In the pediatric sleep labs, one parent needs to stay overnight with the patient. If the parents seem to be anxious, we tell them that our technicians have extensive experience dealing with children. When patients and parents arrive, we mostly focus on the children. The technicians establish a bond with the child. The technicians praise the children for every little thing they do. Patients usually pick the color of the wire used for the EEG. Most often, they plug in the wires on the headbox. We let the patient hold the EtCO2 sampling line and the thermistor at their nostrils, while the technicians secure them. Finally, we secure the wires on the head with the elastic bandage and a mesh net. The technicians often make bunny ears or headband bows with the elastic net. The technicians make the children believe that they are Superman or Superwoman. The setup is not rushed at all. The technicians take ample time for the setup when they are dealing with children who have sensory issues.”
Documentation about the child’s medical diagnosis and medications is extremely important in a pediatric lab because in this way the parents and not the patient need to communicate the “care plan” for a specific situation. Parents of children with asthma or seizures are often required to bring a plan of action delineated by their pediatrician.
As Chris Ruth, who has been a sleep technologist for 21 years and currently is tech supervisor at Seattle Children’s Hospital, says: “Preparation and information-gathering are crucial to achieving a successful and safe pediatric sleep study. Prior to each study, we will read through the sleep clinic visit history and physical to obtain pertinent information which will be helpful to make sure our tech and room assignments are appropriate for each patient’s needs. Looking at each patient’s particular symptoms in the past medical history allows us to avoid errors in care and to be on the lookout for issues that may arise—for example, certain cardiac conditions causing a patient to have lower than normal saturations at their baseline. Being aware of this heads off any potential error starting supplemental oxygen. Also, we take advantage of seizure care plans, behavioral care plans, and asthma care plans for patients that have these in their medical chart. These help us to be prepared for what we’re looking for and how to respond in the situations noted in those plans. These kinds of info prep should be done for every child, including those referred for snoring to those referred for complex studies such as tracheostomy studies, ventilator setting adjustments, children with [a] vagus nerve stimulator, hypoglossal titrations, etc. Despite our efforts to prepare, unforeseen things sometimes just happen. That’s why it’s important to have good coordination and support from an on-call physician that’s available for each night of sleep studies.”
Kimberly Trotter is the sleep lab manager at the University of California San Francisco Benioff Children’s Hospital Pediatric Sleep Center and has worked as a sleep technologist for over 30 years. “Scoring and interpretation of pediatric sleep studies using the AASM scoring rules and practice parameters is very important. As we know, pediatric patients are not little adults and have different waveform patterns and sleep needs than adults. Since their waveforms tend to be so much larger than adults, using the right filters to allow for accurate scoring is a must. The AASM scoring rules for infants and pediatric patients is the culmination of experience and research on pediatric norms.”
Trotter adds: “Interpreting these pediatric studies using the AASM practice parameters and the ICSD manual is necessary to give an accurate impression of these patients’ results, and aids in any treatment options for their disorder. It is also important for the pediatric sleep technologist and interpreting physician to keep up with the trends and updates on pediatric sleep medicine. Continuing education on pediatric sleep medicine can sometimes be challenging to find, but is necessary to keep up with emerging diagnoses and treatments.” As Trotter concludes, “Many of our patients not only have a sleep disorder, but also have syndromes that further add another layer to the diagnosis and treatment of the sleep disorder, and it is important for the sleep lab staff and physicians to be familiar [with] and prepared for these patients.”
Pediatric sleep teams work together and include technicians, technologists, schedulers, laboratory supervisors who make the child’s experience fun and comfortable. The pediatric sleep laboratory team, together with the sleep medicine clinicians, provides the best care for children with sleep disorders.
Lourdes DelRosso, MD is a Sleep Physician at Seattle Children’s Hospital and Associate Professor in the Department of Pediatrics at the University of Washington School of Medicine.