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What does it take to inspire a PICU team to keep children on mechanical ventilation awake and playing? Who can bring the change? Hannah Child, a pediatric physiotherapist in the UK, shares with us her team’s evolution and successes.

Episode Transcription

Kali Dayton 0:00
Hello, and welcome back. Last episode, we were enlightened by Dr. Kudchadkar about new research and protocols in the pediatric world to avoid the damage of sedation and immobility in children.

So what does this look like at the bedside? How does this change come about? Who is actually keeping kids awake and playing on the ventilator? Hannah child from the UK shares with us her team’s evolution and successes. Hannah, thank you so much for joining us and sharing your insights. Can you tell us about yourself?

Hannah Child 1:02
Yeah, of course again. So my name is Hannah child. I am from the UK. So I’m a critical care physiotherapist. So I trained in Birmingham in the UK. And I actually now work at Birmingham Children’s Hospital, again, based in Birmingham, surprise, surprise.

And I’ve been there since 2010. But I’ve kind of specialized within critical care since 2012. So my specialty is intensive care, specifically Cardiacs. But we also do lots of other things within our unit. So we’re one of the largest single units in the UK. So we’ve got 31 beds. And we take things like major trauma. Cardiacs is one of our big caseload, would you liver surgery, and lots of surgical and other medical patients. So really mixed big unit.

So in the UK, physiotherapy works slightly differently. So in the US, you’ve got physical therapists, and then you’ve got your spiritual therapists. As in the UK, we kind of do both job jobs, really. So I, my specialty is respiratory physio. But I also do all the rehab components to that as well. So we kind of do both roles. So that’s a slightly different situation have in the UK. So that’s kind of how it’s slightly different. So we kind of do the sort of role of respiratory therapists not in its complete entirety, but all the chest video related to that will you do as well.

Kali Dayton 2:28
Which I think it’s really beneficial as well, because physical therapy helps the lungs? But I think from the nursing side, I think it took me a while to understand that myself. But that’s just ingrained in your practice. And so as a physiotherapist, what sparked your interest in early mobility? And what do you see the benefits of it? Or what benefits do you see from it?

Hannah Child 2:57
Yeah, so I mean, I kind of got my role, my specialty role in 2012. And I think, after kind of settling in, after about a year or so we kind of, I noticed that we were having lots of children that were staying for a long period of time and ICU. And actually we’re having significant deficits from being on it for that length of time. So some of it physically, but some of it cognitively, or emotionally, and not just the patients themselves, their parents also having kind of long lasting kind of negative, I suppose experiences of being on PICU.

So I kind of looked at what we were doing from a therapy point of view and what we could potentially due to change it, what we were doing is certain patients were getting a lot of input, but not all patients were. And we weren’t necessarily putting the input early enough. So we’re almost allowing the problems to happen, and then dealing with them rather than trying to prevent them happening in the first place.

So I kind of started looking around and sort of seeing was an adult practice. I know that they did lots of early rehab. And that’s kind of sort of mainstay within adult practice. But in pediatrics, it’s not really something that’s been explored that much or hadn’t been up to now. So I kind of started to look and see what other places doing around the world really. But which is when I kind of met Sapna, really.

And I was lucky enough to kind of explore the ideas of what she was doing and trying to sell it to our team. So luckily, we’ve got I’ve got a really good working relationship with our consultants and are you on our unit, and I kind of sort of started to sell the idea of early rehab and the benefits that would our patients would gain from it. So it was a big cultural change, Big Idea change. And it started with them kind of thinking, “We’re not against it, but we want to know more.”

So but mainly because the evidence to support it isn’t there like an added practice? So we haven’t got the randomized controlled trials to kind of say that it has these outcomes and if you do this, it works. And we haven’t got that evidence yet in pediatrics. So It’s a bit more of a hard sell. But I was kind of like keen to know more. And I was lucky enough to go to the John Hopkins critical care rehab Conference in Baltimore.

So I went in 2017, met Sapna, kind of learned about everything they were doing over there, and then kind of came back with this burning desire to like do it in our unit, and kind of brought all that enthusiasm back to the UK. And that’s when we started a big Working Group, which had project lead, but a whole MDT group.

So we have medics, consultants. So that’s an attending research team, with the lead nurse of the unit in the team, nurses, occupational therapists, our Family Liaison Team, which is a bit like your child life therapists, speech and language therapists. So basically, huge team of people, which we kind of met, and then our early rehab program was born from there. So as a school move forward.

And that’s kind of where we started from really. And what we kind of did with that, or I suppose what the aims of what we wanted to achieve is to try and include all patients and our unit. So making sure that all children were considered regardless of age and ability, and that it was considered as early as possible. So that was our kind of main aim to try and see if we could offset the physical and the emotional and cognitive problems that we found our children developing.

Kali Dayton 6:24
Wow. So you as a therapist, grabbed the reins and said, We’re turning this around. And everyone you could see jumped on board.

Hannah Child 6:39
So I mean, the unit’s amazing. So yeah, everyone was kind of like, we’re not saying no, we’re just saying we want to know more. So we went and found more. And luckily, one of our consultants, Barney Schofield, I think he might talk to you in due course, he’s also kind of started to become really interested in early rehab. And he’s now set up a research study in the UK, which is soon to, well, certain parts of it have already gone live. But the whole implementing implementation phases seem to start. So that is kind of hopefully going to get some of that evidence that we’re lacking within pediatrics. So he’s a key player, as part of our program too.

Kali Dayton 7:14
wow, and even without the published evidence, what changes have you seen and the outcomes of your patients?

Hannah Child 7:22
Yeah, so it’s been completely like mixed, I suppose mix lots of different things we’ve seen so often, the obvious things is the fact our patients are now out of bed more than they’ve ever been before. So that’s one thing that we’ve achieved. And even if it’s not always working, as well as it could do, we could always do more.

If you kind of walk onto our unit, on any given day, you will find children out of bed, children out for cuddles, children out and seating, children engaging in play, which is kind of the one of the biggest aims you want to achieve.

Kali Dayton 7:56
While on the ventilator?

Hannah Child 7:58
yeah, while on the ventilators, so they’re not just in that being sick, they’re actually being children whilst recovering from being sick. And so that’s a huge change. I think lots from a patient and family point of view. So I think we’re trying to like, encourage positive experiences from being in the ICU. So no parent wants to ever have to be on intensive care with their child. But ultimately, what we’re trying to do is, is make that experience as positive as it can be.

So things like creating positive memories is really important. And something we try and reinforce. So if it’s birthdays, or special events, or anything like that, we really go to town. So we’ve had ponies come onto our unit for children’s birthdays, and like big parties, things like that. So we’re engaging all the whole family into the experience to try and make some the best out of bad situations because we’re also kind of allowing children to be children.

So even if somebody is sick, we’re kind of giving them every opportunity to try and play or at least engage in play, whatever that level of ability is. So I think that’s another really important kind of aspect of the work we’ve done, which is great. I think, from a staff point of view, and kind of what it’s done from a staffing perspective on the unit is I think, all our kind of our nurses and our physios and adopted, everyone started to kind of see the positive impact of why it’s so important on our medics are converted, they’re literally kind of like asking on board round now.

Can this child get out of bed? I mean, sometimes they’re pushing us to do it. And we’re like, hang about, we’re the ones that invented the concept. So actually, it’s amazing how it’s turned around because they’re asking about it. So that cultural change has really started to started to kick in, which is amazing. But we’ve still got lots more work to do. It needs to happen across the board more.

And I think we we need to keep pushing the boundaries and doing it even earlier. But we’ve made kind of We’ve had some really good success stories that have kind of really boosted morale suppose around the unit that have made everyone kind of go, “wow, we’re really achieving something amazing here, which is great.”

And I’m trying to think of some good ones, we had one. So an ECMO patient, so on VV ECMO, so really, really sick 10 year old boy. And he was kind of got poorly had to go on to ECMO. And we were kind of really worried that he came, he walked into ICU, and we wanted him to walk out. So that so while he was on ECMO, we did loads of rehab to kind of maintain your strength, maintain his range movement as much as possible. So with him, because we did all of that, so he did cycling while he was on ECMO, he did sitting on the edge of the bed, did a stand.

And then when he managed to wean off ECMO and and even when he was still tubing on the ventilator, he carried on doing standing. And then when the tube came out, he discharged our PICU within two days, and then was walking to the ward, essentially, on the ward, he only stayed in for three days on the ward and then literally did a stairs assessment and went home. So, amazing.

So yeah, that just sort of shows that by maintaining his strength and maintaining his function, he didn’t actually have long in hospital whatsoever, which is incredible. Considering how poorly he was. I’ve got some feedback from a parent, which I think is, is kind of, to me, this is exactly what it’s about, really.

So this is a summer four month old, which isn’t really our target audience, I suppose. So the difference between adults and pediatrics is that our most of our population says 70% of children and ITU will be under one. So if you think about how many children are actually going to be up and walking, not many, because most of the age range, they don’t walk by them.

Kali Dayton 11:54
Right.

Hannah Child 11:54
And it doesn’t mean you should yeah, it doesn’t mean we shouldn’t think about that under one category. So they shouldn’t be missing their developmental milestones just because they’re in intensive care. So this is a mother of a four month old giving us some feedback on our “Me Forward” programs. This is how she felt about her child being part of “me forward”. And she essentially said, so move forward targets were so that we sort of set we have a like a frog cycle progressive program.

So you start off being a tadpole, when you’re really sick, and you become a frog by the end of it. So it’s like a four stage approach. So it’s we call them like targets, as they move forward targets were absolutely amazing. When my four month old was on ECLS and ECMO, it was lovely to see him transition through the through from a frog spawn to eventually being a frog. It gave me hope every day, when I could see he was achieving little steps, which essentially made that meant that he would move up a level, it gave me that small, achievable steps to focus on thank you for giving me the hope that I needed.

So see she essentially clinged on to the progress that she could see through moving up the stages, which meant that actually he was becoming less sick. It made it I suppose it gave her like a tangible, something to focus on.

Which we hadn’t really even considered that as being part of it. Because to us, it’s like, “yes, they’re sick, they’re not sick, they’re less sick, they’ve progressing.” But obviously to a parent, she’s seeing that the day he’s now become a frog is like an amazing day and got really excited every time we changed the pitch on his bed. Because it meant that he he was getting better. So it was just quite powerful to see that’s what it was was doing for a parent.

So that was really amazing to see really. And as I said, not someone that not a particular age category were completely targeting. So normally over six months is when we’d really start to push development as he was think he was four months old. So again, not someone that we’d normally jump on from a physio point of view. But yeah, so that’s kind of some of our big sort of successes. But yeah, just the I think the cultural changes is the most exciting part of it.

And the fact that we’re we’re trying to kind of change how children bed, look, they should be, they should be up, they should be awake. They shouldn’t be playing, they should be allowed to be children, essentially. So that’s what we’re kind of trying to achieve. And hopefully we’ll get the evidence to prove that it works.

Kali Dayton 14:20
Because you’re doing it! You can’t research what you don’t do. So you’re doing and therefore you can research it and change the ICU community.

Hannah Child 14:29
Absolutely. Yeah.

Kali Dayton 14:31
And this is why I can’t do pediatrics. I just I cry all the time. I’m sure he did. He talked about bringing a pony into the unit and parents being able to hold their children. It’s all too fresh for me.

I was just in the hospital with my daughter this weekend after surgery. But she was in the ICU this last October this last fall so a few months ago, and she was on the cusp of having to be on a ventilator. And, and her brain is one of the only the most functional part of her is her brain. And I did not want to damage that.

And when she’s sick, she’s not herself and I, I just I’m hurting, imagining having her completely sedated and not being able to look into her eyes. And it’s apparent when you’re so worried about them, and you just want to connect with them. And her eyes are one of the most communicative parts of her. So if I couldn’t see her eyes, for weeks on a ventilator, it would be extremely traumatic for me as a mother, and even as even though she she was just in high flow nasal cannula and needing lots of suctioning.

During that hospitalization in the ICU. I held her on my lap all the time, because that was gonna be the best thing for her lungs. And for both of us to just sit there and cuddle and the staff said, “oh my gosh, she is one of the most held kids that we’ve ever seen on this unit.”- And it actually broke me.

Like I tried to imagine not holding her or not being able to hold her for she was there for a week. So for a week. And I just because of all my research and all this podcast, I tried to imagine her on a ventilator and just the isolation that a kid should never have when as a kid not held for a week or weeks straight.

When are they not looking into their parents eyes. And the survivors this adult ICU survivors have talked about their feelings of isolation and loneliness under sedation. But how much more is that for kids? Who can’t tell us? And so I believe I’m so touched by the humanity that your team practices, what would you recommend for pediatric ICU teams that want to implement this kind of approach.

Hannah Child 16:59
So I think the biggest thing that we found what, what you have to do is to get, it can’t be a single team that drives it in terms of, I couldn’t as a as a lowly physiotherapist, push the whole thing. Just because of through my team, you need to get that whole unit approach. You need to get everyone on board, everyone kind of pro-it or at least converted to this as much as you can do, and get a bunch of people in a room and meet regularly to get it to work.

Which is kind of the how John Hopkins achieved there. So it’s their approach, really, it’s developing guidelines that are going to work for your unit. And so we’ve, our program is an adaptation of the PICU app, which is that this program and character will liberate. So it’s a bit of a combination, because we felt that there were certain things that for our unit, and maybe from the UK point of view, made more sense to do it in a different way.

So we slightly tweak things to make it work for our unit. And then suppose thinking about, you don’t need lots of money, you don’t need lots of resources to be able to do it. So I think lots of people think you need to be launching a big rehab road- meaning you need to know loads of fancy equipment. You don’t. You don’t need lots of fancy equipment. You need I suppose you need enthusiasm, and you need to drive.

You need some pieces of equipment, some basic seating, you might need a little bit, which we already had, in the fizzy department kicking around, we just changed who we used it for, we just put it up to intensive care instead. And you need things like bubbles, skittles, balls, iPads, stuff to play with, you need just basically really cheap play stuff, because children just want to play. So I think that’s what you need to allow them to do. So you don’t need all this fancy equipment.

I mean, we’ve now kind of invested in, we’ve got a bed bike, which we do use but only certain children use that because it’s it doesn’t give small enough for our tiny little ones. So you don’t need all the fancy stuff. But you do need people to drive it forward. And you do need that ambition.

Kali Dayton 19:09
I think that’s another concern too. They’re like, “Oh, we don’t have the staff for it.” Like, as if there has to be a whole additional team to do this.

Hannah Child 19:16
Yeah, so we launched our program with no additional staff whatsoever. So the premise analysis because it’s not, although it was led by a physio, it’s not driven by physio. So the idea is the bedside nurses to screen the patients and choose what category they’re going to be in. And then between the nurses or the physios, if they’re there or the medics or space and you decide you pick which category or which activities that child is going to do that day.

And the parents also feed into that. And that’s depending on what level of sickness they are. And then either the nurses might do that. So if it’s like sensory stuff or storytime or painting, then that they will do that there and then or if the physios come along and might do a sit on the edge of the bed at the same time, or we might the physios and nurses work together.

So it’s just kind of collaboration really and and timing it. So it works. But you don’t need loads of additional people. And we’re kind of two, three years in now, I think the only thing would be lovely to have would be maybe a physio assistant that can help you even more with the rehab, but we’ve done it without, and it’s achievable without, it’s the hardest thing is keeping it going, you’ve got to keep that drive and don’t take your finger off the gas ever.

And I think that’s the main thing. It’s it’s hard work, but it’s definitely worth doing it. And when you see the culture change, I think for me, it was when when the medics decided that this is something that they liked. And I think it’s also helped in the in the world of Pediatrics Recently, there has been a shift, because the big intensive care conferences and peds are starting to talk more and more.

And people like Sapna have made that happen, because it’s now a commonplace discussion within medics on intensive care to talk about rehab, which is completely new. It’s in peds we hadn’t had that adult practice, we’re kind of way ahead of the game, and in that respect, but But yeah, that’s the kind of main things that I would kind of go for you don’t need lots of people. But you just need people that are keen and people that are willing to work.

Kali Dayton 21:26
Oh, that and I think that applies across the board. I think even in the adult world, it’s hard for us to imagine kids on a ventilator sitting up painting.

Hannah Child 21:40
They do and I think one of the kind of original barriers that everyone had when we started to talk about children being awake, is the fact “Oh, all of them will suddenly pull that tube out?” Well, yes, at times you have little babies that can thrash and irritates aren’t secured enough, then might they might accidentally pull the tube out. But that’s something that doesn’t happen very often.

And that’s something that whether they’re just in bed, or they’re getting them out of bed, it’s it’s not going to change whether it happens or it doesn’t happen. And I think a three year old sitting in bed with a tubing isn’t going to just suddenly reach out and pull their tooth for no reason. So they were allowed to be awake and allowed to play. And if you say, “Don’t pull your tube out”, they’re not going to pull the tube out.

So especially if they’re awake enough or not sedated to actually understand what’s going on. Because I think that’s some of the issue we’ve seen with our peds patient is if they’re sedated, and they’re then delirious because of it, that’s when you get the thrashing the misbehavior, because they’re not really them as actually if they’re awake and able to process normally. Then they can engage with play, they’re not frustrated, they don’t want to pull the tubes out because they’re happy. And they’ve had you’re giving them a story. So they’re happy to listen to that. And they’re not…

Kali Dayton 22:56
terrified and traumatized?

Hannah Child 23:00
Absolutely not. So I mean, again, there’s there’s, from a sedation point of view, and I think in pediatrics, there’s still there’s more we need to achieve when we had the sandwich trial, which is a big research trial that happened in the UK, which has really helped with that. So that was across lots of centers throughout the UK.

And that was basically looking at trying to activate children as early as possible, looking at the use of sedation and trying to reduce it to try and activate. So that’s really kind of helped lead the sedation reduction, I suppose in the UK. And that’s kind of helped our early rehab programs, they kind of go together, you need a child to be awake to be able to rehab them, or at least awake to a certain extent. But yeah, I think that’s something that is will continue to improve and continue to progress as we get more and more confident that it is okay for these children to be awake.

Kali Dayton 23:49
Amazing. And are you seeing the same outcomes as the adult side as far as decreased time on the ventilator, decreased time the ICU, decreased infections?

Hannah Child 23:59
Yeah, so I suppose we haven’t got the data to be able to categorically say it’s happening. I haven’t I can’t unfortunately, I haven’t got the enough data to prove it. But I suppose anecdotally, yes. I think at my patient I was talking about the 10 year old boy, he was kind of part and parcel with the fact that his time in hospital considering he was on ECMO was really reduced considering if you think of if he hadn’t moved and all the sedation that he would have had.

But he would have normally have had like a two month or three months day. And actually he had three and a half weeks today. So huge difference in terms of length of stay, and I think we’re starting to see more and more that actually, our children are doing more so it means when they get to the ward, they’re ready to go home.

I think that’s the difference. And as a person that does respiratory physio as well as rehab we’re kind of not not doing or respiratory stuff, because obviously, you still need to do that. But we’re using rehab as part of chest treatment as well. So we’re finding that we’re not having to do as much chest physio, because we’re doing movement and getting getting moving, which also massively, as you alluded to, before, helps the lungs. So it’s kind of it’s changing our practice a little bit for the better, but it’s just meaning their kids reading quicker. And get off the vents, which is, can only be a win.

Kali Dayton 25:25
Oh, absolutely. And you’re reminding me I’m going to do an episode later on secretions, secretion, mobilization, clearance, all the things with mobility. So that’s an interesting point that you make that you don’t do as much chest physio, is that you call it? Yeah, yeah, because you’re doing it naturally themselves.

Hannah Child 25:45
Yeah. Because if you put someone that’s if you’re lying someone flat in bed and expecting them to cough and share the secretions, I mean, if you try coughing, lying down, it’s really hard work, actually abuses someone up and allow them to be able to take a nice deep breath to have a good cough, then it’s amazing how much better that will be. So you’re actually just giving them a better position to cough in, which means they’re going to get stronger, which in this at the same time, the core muscles are going to get stronger. So their breathing is going to get stronger, which means they’re going to wean quicker. So it’s a win win situation. It makes sense. Sit patients up. It helps.

Kali Dayton 26:18
Yeah, amazing. And I’ve been told in the pediatric world that there’s a lot of withdrawal. Like we have sedation, especially the benzodiazepines, opioids on so high, and the kid develops as tolerance, that it’s really common for them to withdraw from those drugs. And so how has this approach impacted their withdrawal levels?

Hannah Child 26:41
Yeah, so I would still say that is still a problem, I wouldn’t say that we’ve completely combated it yet. So one of the next things we’re bringing in, and we’re kind of in the process of bringing into our unit is delirium screening. So in pediatrics, it’s not routinely screened for or not, not everywhere, definitely not many places that are thought.

So we you, you don’t find it if you don’t look for it. And I think sometimes it’s labeled as other things, as actually, you need to find ways of managing it. So we’re trying to kind of go down the Pharmaceutical Management, or non Pharmaceutical Management App.

So trying to think about bedtime routines, the use of what sedation we’re using to try and reduce the use of benzos, as much as we can do, or at least when they’re no longer needed, try and wean them as fast as we can do. But making but keeping in watching for that signs of withdrawal. So it’s a balance, because sometimes rehabs delayed because of withdrawal, which, obviously, is frustrating, because you want to try and get that rehab in as early as possible.

But I think it’s it’s looking at the holistic management with these kids. And if we, if we can pick up signs of delirium and things like that earlier, then we can put things in place to try and reduce it combat it, which means that they’re kind of road to recovery doesn’t have to be delayed. So it’s a work in progress, it’s definitely not perfect. We still need to address sedation practice. And that’s kind of something as a whole unit we’re working on.

But it definitely is a problem within pediatrics. Because when they’re really poorly, they need a lot of sedation. And I think it’s just recognizing when to reduce that, or starting less. And just start with, which is another another challenge within practice. But it’s it’s starting to happen. It’s getting that and watch the space, I suppose.

Kali Dayton 28:31
In the studies, are our long term outcomes been studied as far as cognitive deficits without developmentally, because it sounds like the few studies that we do have, that kids are not up to level or developmental level or baseline by six months a year. So is that been studied in upcoming studies as well?

Hannah Child 28:50
Yeah, so Karen Chung has done quite a lot of work into outcomes. I think someone from Johns Hopkins, I want to say as Dr. Harrop, I think, has done some outcome type stuff, which I think I randomly did a presentation a while ago, to some people, it’s got some stats, but essentially, it’s showing that even on discharge from HC.

So 82% of PICU survivors have a new functional disability coming out of it. So that’s not something they went in with that, because of the it stay 82% of the functional disability. So that’s the functional side, but at six months post discharge 56% and still have cognitive and psychological impairments from this day, which is huge.

They’ve also got an increased risk of fatigue and sleep disorders following being on this first day on PICU. And it’s found they’ve had a reduced academic performance. So it still has a long lasting impact. And they can even after so they may not have it initially post discharge but kind of three months following discharge from the ICU, they start to develop things like PTSD and the delusional memories and things like that from there it is day. So it’s clearly showing that actually, although at the time, we they may not be able to show how traumatic This experience has been for them. Children do show it just in different ways later. So it’s really important that we combat it. Now, really,

Kali Dayton 30:22
And that’s so much in line with the adult side. We call it post ICU dementia – which is a new diagnosis. So we’re giving kids dementia, that PTSD is almost at least once a day for showed probably over 80% of post ICU. PTSD is from the delusional memories. So that sounds like it’s in line with kids.

Hannah Child 30:43
Yeah, absolutely.

Kali Dayton 30:45
I asked Sapna. I mean, “how do you know?” My daughter couldn’t tell me. You know, what kind of hallucinations she has had, you know what they experienced? But I guess kids old enough, can tell you and that will have you think about their nightmares and how they come running to bed how scary that is. But if they experience something even more vivid, and maybe more morbid for weeks, on an absolutely. How do they heal from that?

Hannah Child 31:10
I know, well, I remember I went in to see when he was eight, a little boy. And he kept telling me he’s like, “Can you tell the man on the corner to go away?” There wasn’t a man in the corner. And I was kind of like, “There’s no one in the corner. You’re fine. You, you’re okay.” And he was like, “no, he’s been there and he won’t go away.”

So obviously, he was just imagining there was someone there, which is terrifying. And then then he kept saying of spiders crawling all over the ceiling, which is, you know, horrible thing for him to like, think it’s happening, because obviously, it wasn’t happening at all. But that’s just shows the kind of had amazed, delusional type, delirious, things that these children go through, and PICU. So it’s kind of, yeah, making sure we try and put things in place to try and stop that happening, or at least if it does happen, trying to reduce the effects of it as much as possible.

Kali Dayton 31:58
And if we have pediatric team members listening right now, maybe for the first time on the podcast, I would invite you to go back and listen to episode four adults are talking about what they experienced under delirium, or under sedation. So I reached out to these adults, and I was ICU survivors. And I just asked, “What did you experience under sedation?”

I didn’t give him any prompts. I didn’t say “hallucinations, terrors…”- nothing. And yet, that’s all that they talked about. So episode four, and then episode 52. They talk about what they experienced. And then what they’ve carried with them throughout the following months and years after the ICU. Because it sounds like that applies to children. So if you work in pediatrics, listen to the adults and then try to see it within your own kids that you’re caring for.

Maybe the adults there, there’s so much in line, the adults can be the voices for kids that can’t speak for themselves, as far as what they’re experiencing, and the damage that it causes. How much potential how much growth are we hindering by our habits that we have in these ICUs. And you’re giving us proof that it can change, and it was a physiotherapist that brought the change. And I think that is so powerful, because I think sometimes, you know, with a hierarchy of ICUs, we feel like it has to come from the top. And it didn’t. And so often it doesn’t.

Hannah Child 33:27
Absolutely, I mean, it was I suppose it was it was me with the idea and the ambition, but I, I must, must reinforce it was definitely much a team approach that drove it through. So yes, I was kind of flying the flag, but I had many people along with me that massively were like completely essential to make it work too. So yeah, I think it’s that team approach is what’s needed. So yeah, just everybody communicate, talk to each other. Ultimately, you can achieve the same goal.

Kali Dayton 33:58
Well, after being in the hospital four times in the last five months, with my own daughter, sorry, emotional pediatrics is so special. And people go into pediatrics, because they’re some of the best humans on the earth. And I just know that as they listen to you, and understand what’s possible, and what the reality is for kids. They’re gonna make that change.

And I am so inspired by your efforts and your humanity. Thank you for fighting for these kids opportunity to survive, but also thrive. As a mother of a special needs child that may be on a ventilator someday, with any kind of kid cold. I am so grateful for all the good work you and your team are doing and I am excited to advocate for my own daughter and future children. So thank you so much.

Hannah Child 34:51
It’s a pleasure. Well, thank you for letting me letting me talk. I’ll happily talk to the cows come home on this topic. It’s so important

Kali Dayton 35:00
Well I may send listeners your way if they have more questions. Thanks, Hannah.

Hannah Child 35:04
Absolutely always happy to discuss it. Thank

Kali Dayton 35:07

 

Transcribed by https://otter.ai

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