When Your Child's in the Pediatric Intensive Care Unit

What's the PICU?

The PICU is the section of the hospital that provides sick children with the highest level of medical care. It differs from other parts of the hospital, like the general medical floors, in that the PICU allows intensive nursing care and monitoring things like heart rate, breathing, and blood pressure.

The PICU also allows medical staff to provide therapies that might not be available in other parts of the hospital. Some of these more intensive therapies include ventilators (breathing machines) and certain medications that can be given only under close medical supervision.

Who's Sent to the PICU?

Any child who's seriously ill and needs intensive care and whose medical needs can't be met on the hospital's main medical floors goes to the PICU.

Kids in the PICU might include those with severe breathing problems from asthma, serious infections, certain heart defects, some complications of diabetes, or those involved in a serious automobile accident or near-drowning.

Some kids may have been stable enough to initially be cared for on the hospital's main medical floor, but may be transferred to the PICU if they become more acutely ill. Following major surgery, many children are cared for in the PICU for several days.

How long kids will be in the PICU depends on their condition — some might stay a single day; others might need to stay for weeks or even months. As always, ask the doctor or nurse caring for your child if you have questions.

Who Takes Care of Kids in the PICU?

The PICU has many highly skilled people to closely care for kids. But not knowing who everyone is and what they do can be confusing and a little overwhelming at first. Most people will introduce themselves and indicate how they're involved in your child's care, but if they don't, feel free to ask. At all times, you should feel comfortable asking the doctors and nurses questions about your child and the care being given.

The nurses who work in the PICU are experienced in caring for the sickest children in the hospital. They're the people most intimately involved with the minute-to-minute care of the kids. The PICU also tends to have a higher nurse-to-patient ratio than other parts of the hospital (in other words, each nurse cares for fewer patients, which gives them more time with your child).

Numerous physicians may care for your child, but the attendings are in charge. Your child may be cared for by a pediatric intensivist, who is a doctor who did a 3-year residency in pediatrics after medical school, followed by additional years of subspecialty fellowship training in intensive care.

Also on the PICU team are residents (doctors who've completed medical school and are training to be pediatricians) and PICU fellows (pediatricians training to be attending intensivists).

Many other subspecialists, such as cardiologists (heart doctors) or neurosurgeons (brain surgeons), may be involved, depending on your child's needs. Respiratory therapists are experienced with ventilators and other breathing equipment, and are often involved in the care of PICU patients. In addition, physical therapists, occupational therapists, nutritionists, and pharmacists may play a role in your child's care.

You may also meet social workers who help families cope with the emotional burdens of having a critically ill child. They can help to arrange housing for families (through organizations like Ronald McDonald House), assist with insurance issues, or coordinate discharge planning when your child is ready to go home.

You may also want to ask whether the hospital has child life specialists. Trained in fields like development, education, psychology, and counseling, they help kids understand and manage being in the hospital by, for example, listening if a child needs to talk, calming fears about what's happening, or providing distractions like books and games.

The medical team meets every day, usually in the morning, to discuss each patient's case in detail; these discussions are known as rounds. You may see a group of doctors, nurses, and others walking from patient to patient, planning the medical care for each.

By understanding everyone's role and how each contributes, you may find the group of people caring for your child less intimidating.

What Should Kids Expect While in the PICU?

Possibly the most alarming aspect of the PICU environment is the medical equipment that may be attached to your child. The machines have alarms and display panels, and the noise and lights can be overwhelming.

Your child's stay in the PICU might include:

• IVs. Almost all kids in the PICU have an intravenous catheter (or IV) for fluids and medications — usually in the hands or arms, but sometimes in the feet, legs, or even scalp. An IV is a thin, flexible tube inserted into the vein with a small needle. Once in the vein, the needle is removed, leaving just the soft plastic tubing.
  
  Some situations require larger IVs that can be used to deliver greater volumes of fluids and medications. These are known as central lines because they're inserted into the larger, more central veins of the chest, neck, or groin, as opposed to the hands and feet. Arterial lines are very similar to IVs, but they're placed in arteries, not veins, and are not generally used to administer medication but to monitor blood pressure and oxygen levels in the blood.
• Medications. Most medicines can be administered anywhere in the hospital, but certain ones that can have dangerous side effects are only administered to children who are closely monitored in the PICU. Instead of being given every few hours, some are given continuously, several IV drops at a time, and are known as drips. Doctors may use these medications — like epinephrine, dopamine, and morphine, for example — to help with heart function, blood pressure, or pain relief.
• Monitors. Kids in the PICU are attached to monitors. The monitors are secured to the body with chest leads, which are small painless stickers connected to wires. These leads can count the child's heart rate and breathing rate. Many kids are also connected to a pulse oximetry (pulse-ox) machine to check blood oxygen levels. Also painless, this machine is attached to the fingers or toes like a small bandage and emits a soft red light. Unless blood pressure is being directly monitored through an arterial catheter, the child usually will also have a blood pressure cuff in place.
• Tests. Doctors may order a variety of tests to obtain more information, including tests on the child's blood and urine, and sometimes on the cerebrospinal fluid, which surrounds the brain and spinal cord. Additionally, images or pictures of different parts of the body may be taken through X-rays, ultrasound, computed tomography (also called a CT or CAT scan), and magnetic resonance imaging (MRI).
• Ventilators. Kids in the PICU sometimes need extra help to breathe. This may mean getting some extra oxygen from a mask on the face or tubing in the nose. But sometimes, a child needs to be connected to the ventilator (or breathing machine). This is done via an endotracheal tube (a plastic tube placed into the windpipe through the mouth or nose) or a tracheostomy (a plastic tube inserted directly through the skin into the windpipe) connected to the ventilator on the other end. There are different kinds of ventilators — different situations call for different machines — but they all serve the same basic purpose: to help a child breathe.

If Your Child Is in the PICU

In the PICU, all of your child's physical needs will be met by the staff. You, as a parent, are there to provide emotional support, love, and a familiar voice or touch. However, you shouldn't feel as if you have to stay at your child's bedside every minute of the day. Getting away from the commotion of the PICU briefly or even leaving the hospital grounds can help you gather your thoughts.

Staying around the clock with a child who's in the PICU for more than a few days can be both physically and emotionally draining. Although some hospitals allow parents to spend the night with their child, many do not. Often, hospitals encourage parents to go home, get a good night's rest, and return to the PICU refreshed in the morning, which can help them be even more of a comfort to their child.

If the hospital does allow you to spend the night, the decision whether to stay in your child's room is a personal one. Either way, the PICU staff will support you and reassure you that your child will be well cared for. Whatever you do, make sure you get enough rest to be able to support your child throughout the PICU stay.

When Kids Leave the PICU

While some patients are sent home directly from the PICU, many are transferred to a regular floor of the hospital for further, less-intense monitoring and follow-up care. Still, discharge from the PICU is a significant milestone on the road to recovery. It means that a child no longer needs such an intensive level of monitoring, therapy, and nursing care.

But leaving the PICU might also cause some anxiety. It's not unusual for parents of kids who were in the PICU to think, "He was so sick and now he's better. But shouldn't he stay here until he's completely back to normal?" But the doctors and nurses in the PICU won't transfer kids before they think they're ready and stable, and the team on the hospital's regular floor will have the resources necessary to continue guiding your child's recovery.

Caring for a critically ill child is always stressful and difficult. But with a basic understanding of the people and things in the PICU, the stress on the family can be minimized — leaving you better able to support your child and plan for when the entire family is home together again.

Reviewed by: Larissa Hirsch, MD
Date reviewed: April 2009