This report originally appeared in the January 2010 issue of DOTmed Business News

In health care, size matters. Just as you wouldn't give a child the same dose of medicine that you would an adult, the medical equipment used on children should be created keeping the size of the target patient in mind. To this end, many companies have beefed up their efforts in developing child-specific equipment.

"Medical equipment comes in variable sizes and obviously matching it to the size of the patient is essential, or we would be left with a lot of kids who would suffer," says Alan Nager, Director of Emergency and Transport Medicine at Childrens Hospital Los Angeles. "It could be anything from IVs to blood pressure equipment to something as simple as an oxygen mask."

While many of these advancements in pediatric equipment are technical, others simply deal with the look of the equipment, which can ease the mind of a frightened child. That's why equipment shaped as toys or animals often makes it easier for a medical professional to deal with younger patients.

"Some of those instruments coming at them can be intimidating and scary, but if it's coming at them covered in a furry animal, or something that would make the child laugh, it keeps them calm," says Evy Schwartz, online marketing director for Aria Medical, which sells a wide variety of medical equipment from different manufacturers and does a great deal of business in the pediatric market. "You want it to be a pleasant experience so some of the supplies we offer, we help doctors make it less scary for the younger kids and more fun."

CT for the Child

Over the past decade, the use of CT to image pediatric patients has increased substantially, with more than 7 million pediatric CT procedures expected to be performed in 2009. What a lot of people don't realize is that more than half of all children who undergo medical procedures are under the age of 5. These procedures are usually needed to diagnose and treat health problems or potential health problems caused by congenital birth defects. As they grow, sick children may require 15 to 20 different imaging procedures because of this.

"If you think about your average two-year-old, how do you tell them to hold their breath or sit still? This requires some very unique demands for pediatric imaging," says Robb Young, Senior Manager CT Business Unit for Toshiba Medical Systems. "You can't just take equipment designed for adults and apply it to children because the needs are definitely different. Because of smaller vessels, lower bone density and less body fat, pediatric patients have different imaging needs than adults."


That's why in 2007, Toshiba came out with the Aquilion ONE, the world's only CT system that can image an entire organ, such as the heart or brain, in a single X-ray rotation and show dynamic function, like blood flow and movement.

"It collects all the data it needs in .35 seconds, where a conventional CT can take 3 to 4 seconds," Young says. "When you're talking about a crying baby, 3 to 4 seconds isn't fast enough."

The Aquilion ONE's rapid acquisition time also exposes patients to less radiation and reduces radiation exposure by up to 80 percent, providing safer pediatric exams.

"One of the challenges with children, is often you have to sedate them and that has a risk," Young says. "If you can avoid sedating a child, it's better. We have been able to really reduce the need of sedation because of this [faster scanning]."

The equipment can be outfitted with decals that are custom-made featuring an underwater or jungle theme that creates a friendly room atmosphere for the children,

"We also have a mini-CT model with a stuffed animal on it to show them what to do," Young says. "We even have a display of cartoons above the scanner of a monkey holding his breath, so it's really brought down to their level. For the parents who were already stressed, we are tying to make their child as comfortable as possible."

Help with MRIs

While some companies have designed quieter MRIs with children in mind, the main thing that pediatric hospitals do is coming up with creative ways to keep a child from moving while inside.

"When you have an MRI scan you have to lie in a very long tube and not move for 30 minutes to an hour. So with children, that presents a whole new challenge," says Shannon Bozeman, RT(R) in the pediatric diagnostic imaging program at Nashville, Tenn.-based Children's Hospital at Vanderbilt. "We offer CinemaVision. They wear goggles and kids can watch TV or a movie while they are laying there and it definitely helps with the anxiety level. It can make a real difference in keeping them still so you don't have to sedate them."

The system includes headgear, goggles and cords, contains no metal parts that could be drawn into the MRI magnet, and allows the staff to communicate with patients through the headphones and a microphone on the patient's headset.

X Marks the Spot

An X-ray machine can weigh as much as 1,300 pounds and is almost 6-feet tall, so it can be very frightening to a young child when it comes rolling towards them to take a picture. That's why Mobile X-Ray Solutions, Inc. decided to do something to alleviate some of that fear.

"No one really had anything and the hospitals wanted something that was friendly for the kids so we designed 'Freddie the Fire Engine' and 'Aquila the Aquarium' AMX-4 Plus portables," says Bill Bentley, President of the Augusta, Ga.-based company. "Children aren't usually afraid of a fire truck so it creates a very friendly environment and it's used in a lot of hospitals."

The company thoroughly rebuilds and upgrades the machines, from the base to the collimator and every component in between to ensure a top quality product built to meet or exceed OEM specifications.


"We wanted to make [themes] we could mass produce-we had a giraffe model that wasn't cost prohibitive for us- but these two were the most popular," he says. "Other hospitals have come to us with ideas, and we can do a trademark if we get permission, so we will work with them if they have a theme in mind."

Airwave Equipment

According to Nager, who is also Associate Professor of Pediatrics USC & Keck School of Medicine, all hospitals should have proper airwave equipment for children as it could be a matter of life or death.

"If you don't have the appropriate sized airwave equipment, the most seriously ill children would be in danger and it could be devastating," he says. "When you are talking life saving equipment and airwave support there is a variety of differences. Endotracheal tubes that we put down for kids who need help breathing come in all sorts of sizes. If you are talking about a child with that kind of airwave, it's vital you use the proper size tube or you are left with catastrophic results."

Crash Carts

Even crash carts have been specifically designed for caring for youngsters, with manufacturers adhering to a 9-drawer, color-coded system.

"Pediatric crash carts have a lot more drawers. A normal crash cart may have three drawers but a pediatric crash cart will have nine drawers because there are more things that are necessary for children," says Schwartz. "They are also multicolored so it's easier for the nurses to grab what they need."

At St Luke's Hospital in North Carolina, the emergency department recently added these carts, and while they all contain essential equipment such as IV tubing, needles and oxygen masks to accommodate specific weights and sizes of young patients, they are divided into age-specific drawers, delineated by a certain color.

"In any emergency, the ABC's must be addressed immediately," says Lori Oliver, RN, nurse manager of St. Luke's Hospital Emergency Department. "The sooner basic and advanced life support is initiated, the greater the child's chance for complete recovery. Knowledge and skills required at the time of a pediatric emergency are not those that the emergency care provider uses on a daily basis, so this new pediatric crash cart is crucial."
Tip of the Iceberg

There are a plethora of companies that have products designed for children, whether it's a stethoscope shaped like an elephant or a medical cabinet with pictures of dolphins on it.

With a motto of "taking the scare out of healthcare" Minn.-based PediaPals offers a number of serious medical equipment selections for a child-friendly world. They have stethoscope covers in the shapes of animals and the Jamaal Giraffe reflex hammer, designed to be non-threatening for kids, but not at the expense of functionality. There's also the Benjamin Bear blood pressure kit.

In addition to the medical instruments, the company, which merged with Zoo Pals a few years ago, now offers exam tables shaped as things such as hippos, dinosaurs and turtles, and provides decals and wall decorations to create an entire child-friendly atmosphere.

Ann Kochsiek came up with the idea for the animal tables in 1988, after her 4-year-old son Ry was diagnosed with cancer.

"One day while he was getting a blood transfusion, I decided the tables for the spinal tap room had to be something better than this cold sterile environment," she says. "We would often times pretend we were at a zoo and the table was an animal and that's how we would get him on to the table for the spinal taps."

Kochsiek designed a prototype, and since the company's founding, thousands of tables have been sold around the world.

"Kids walk into the room and see the smiling face and they're put at ease," she says. "It's all distraction. Doctors say they love it and it's working and the exam is easier."

Clinton Industries Inc. offers a series of photo-driven tables that feature such designs as "Wild West," "Safari" and "Cosmos." The company also offers cabinets, scales and other office equipment with child-friendly themes such as "Space," "The Ocean" and "The Rain Forest."

"From a fear and anxiety perspective, we assume kids need distracting sounds and pictures and devices," Nager says. "Kids are most stressed about pain and blood and one of the things that can be done is to have soothing colors, calming pictures and gurneys that are child friendly. Lots of them now look like little cars or riding animals. Those kinds of things are distracting and add to the comfort level of kids who are traditionally uncomfortable and scared when they come into a hospital."

The efforts made by these and other companies to address the littlest patients help to make a difficult and frightening time a little less so - for children and for parents.