A study from Lerner Children’s Pavilion at Hospital for Special Surgery (HSS) of nearly 2,000 children showed that pediatric MRIs were completed with a 0% sedation rate through the support of certified child life specialists (CCLS). The findings, which highlight how this innovative and noninvasive approach eliminated the need for sedation while improving care for young patients, were presented at the Pediatric Orthopaedic Society of North America (POSNA) Annual Meeting.
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Challenges of Pediatric MRIs
A typical MRI is not only loud and confining but also very sensitive to motion, requiring subjects to lie still during the 20- to 80-minute procedure, which is a major challenge for pediatric patients. Consequently, sedation is used in up to 28% of pediatric MRIs, and reports show this number is increasing.
While sedation can facilitate successful imaging—and is considered relatively safe—relying on this strategy for young MRI patients poses potential risks, including cardiopulmonary issues and allergic reactions. Additionally, the combination of MRIs and sedation can cause anxiety for children and their parents and prolong recovery.
Researchers found that avoiding anesthesia—and post-anesthetic recovery—through CCLS interventions improves the overall efficiency of the MRI process, benefiting both families and care teams.
“Without anesthesia, children can avoid the need for an IV, they don’t need to fast prior to the MRI, and they don’t need to extend their hospital-related experience to recover,” says lead study author Jessica H. Heyer, MD, pediatric orthopedic and spine surgeon at HSS. “And from a hospital perspective, it enables children to have an MRI even when an anesthesiologist is not available.”
The American Academy of Pediatrics stresses that these types of nonpharmacological interventions “must be considered as standard procedure in infants, children, and adolescents undergoing MRI,” supporting the approach taken in this study.
Benefits of Avoiding Sedation
For this retrospective cohort study, HSS researchers looked at 1,936 patients between the ages of 4 and 12 who, in total, received 2,319 MRI scans over an eight-year period. They found that no child who received CCLS intervention prior to and/or during the procedure required IV sedation during MRI.
Despite the study’s remarkable success rate, Dr. Heyer notes that there are always exceptions: “Sedation-free MRI may be more difficult for very young children, those who need longer scans, children with cerebral palsy, and for those who need a head, brain, or neck MRI."
While all children can greatly benefit from CCLS intervention, Dr. Heyer notes that children between ages 5 and 10 appear to show the strongest results. Study co-author Melissa Collins, MS, senior child life specialist at HSS, adds that this strategy is particularly valuable for children with sensory processing issues or those with a history of negative medical experiences. “For example, children who’ve been told a procedure wouldn’t hurt and then were held down or experienced pain are less likely to trust medical professionals and medical environments,” she says.
Effective Child Life Techniques
The researchers examined several CCLS techniques, including guided imagery, distraction strategies, and caregiver involvement, but the most helpful strategy is “appropriate preparation based on the patient's developmental age,” says Collins. “MRI anxiety typically stems from uncertainty, so it’s important to provide children with accurate expectations, so they’re able to prepare and cope more effectively.” Collins suggests showing children a video of an MRI that walks them through each step and what they’ll see, hear, and feel during the scan to help take away some of the fear of the unknown. “It also helps to reiterate that nothing is going to touch them or hurt them,” she says.
At the Lerner Children’s Pavilion, one or both parents are always encouraged to accompany their child into the MRI suite. Children are also invited to bring a favorite soft, metal-free toy into the MRI unit and are given mirrored glasses so they can see their caregiver or the technologist behind them throughout the MRI. To celebrate their bravery, each child receives a small reward at the end of the exam.
Looking Forward
“Our research demonstrates that with proper preparation and support, we can transform a potentially stressful medical procedure into a positive experience for children,” concludes Dr. Heyer. “By reducing the need for sedation, we’re not only reducing medical risks but also empowering children to actively participate in their healthcare journey, potentially making future medical encounters less intimidating.”
Reference:
Tracey OC, Zucker C, Wisch J, Adhiyaman A, Thakur A, Collins M, Parise J, Denneen J, Jaramillo D, Potter H, Ipp L, Heyer JH. Not Just Fun and Games: Certified Child Life Specialists Improve Success Rates of Young Children Undergoing MRI Studies without Anesthesia. Presented at: Pediatric Orthopaedic Society of North America (POSNA) Annual Meeting, 2025
Thestrup J, Hybschmann J, Madsen TW, et al. Nonpharmacological interventions to reduce sedation and general anesthesia in pediatric MRI: a meta-analysis. Hosp Pediatr. 2023;13(10):e301-e313. Accessed May 14, 2025, at https://doi.org/10.1542/hpeds.2023-007289
Uffman JC, Tumin D, Raman V, Thung A, Adler B, Tobias JD. MRI Utilization and the Associated Use of Sedation and Anesthesia in a Pediatric ACO. J Am Coll Radiol. 2017 July;14(7):924-930. Accessed May 14, 2025, at https://www.jacr.org/article/S1546-1440(17)30121-7/abstract
About HSS
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 15th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2024-2025), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2024-2025). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a fifth consecutive year (2025). Founded in 1863, the Hospital has the lowest readmission rates in the nation for orthopedics, and among the lowest infection and complication rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. In addition, more than 200 HSS clinical investigators are working to improve patient outcomes through better ways to prevent, diagnose, and treat orthopedic, rheumatic and musculoskeletal diseases. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 165 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.
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