Photo courtesy: Dayton Children’s

Surgery can easily frighten any child or parent, but can be additionally traumatic for children with special needs.

A team at Dayton Children’s, led by pediatric anesthesiologist Sean Antosh, MD, believed there was a better way to humanize care and environments for patients, particularly for children with Autism Spectrum Disorder or other special needs like ADHD or high anxiety.

Antosh, also the organization’s Chief Medical Wellness and Engagement Officer, says parents have commented that other places aren’t providing sensory-friendly environments, and they’ve said the care they’ve received has been amazing because Dayton Children’s listens to parents and children.

“There was a turning point when parents would actually request, ‘I want a sensory room. I want to talk to Child Life. I want to talk to anesthesia ahead of time,’” he says. “So once we started hearing that, we knew that we were starting to make gains into what we’re doing, and that it was being effective for parents.”

Doing Things Differently

Antosh says that if a patient doesn’t like bright lights, providers ensure that all the lights are off. They also offer dimming lights and color-changing sensory tiles on the wall, so patients can pick their favorite colors or avoid colors they don’t like.

“If they don’t like medical equipment, we take all that out of the preoperative room and avoid taking their blood pressure,” he says. “If they don’t like the bed, we even take it out. We have crash pads that they can lay on and play on, color-changing tiles that they can walk on, and a lot of plush sensory toys that they can either play with or touch. We have stuff that they’re able to take home with them. They often like chewing, so we have chew toys they can chew on.”
The organization also provides sensory brushes that the family can use to gently brush on their child. If children don’t like sounds, Dayton Children’s has headphones that they can put on. “We have sunglasses; we pretty much have it all now,” Antosh says. “And again, it was little by little that we could add this to the program.”

The results? Since the start of the sensory program in 2017, the experience has helped reduce the percentage of patients who require pre-surgery calming medicine from 90% to 20%. With the 20% who still need medication, it can be given in an easier format for families, like fluid medication instead of intramuscular medications. Previously, many special-needs patients needed to be held down before a shot could be administered, and Antosh says that this new change has been remarkable for their families, who have never had different options before.

“We’ve also realized a whole untapped part of the community,” he says. “Many of these kids aren’t able to get their immunizations; they’re not able to get their laboratory draws. So, what we’ve done is, we’ve partnered with the general pediatricians in town and told them, ‘We have this service,’ so kids coming in through our procedural unit, just for some light sedation in the sensory rooms, are also able to get vaccinations done or a routine lab draw that they need for their medications.”

How Dayton Children’s Approaches Surgery

When a child is scheduled for surgery at Dayton Children’s, the preoperative clinic handles the first contact with a nurse —reaching out to call families. During that call, information is gathered about medical history and medical experiences. If the child is identified as having autism, sensory needs, ADHD, high anxiety, or medical PTSD, or is an oncology patient, clinicians immediately send that over to the organization’s Child Life specialists, Katelyn Shellabarger and Katie Fringer.

The Child Life specialists then call, about a week or two weeks ahead of time, to talk to the family and develop a coping plan. This incorporates the child’s likes, dislikes, past medical incidences, and anything that went well or didn’t go well with them, and triggers. That information is then entered into the organization’s EHR system, so everyone who takes care of that patient can read the document and know what will trigger that patient before they even set foot in the room.

“It’s proactive to ensure we know exactly what will benefit that patient,” Antosh says. “And then the day before the patient comes in, then our perioperative nurse liaison Robin Lawson changes the sensory rooms into what we think will benefit them. A lot of what we’ve learned is from listening to the families. The one thing that I always love to point out is, we used to have fluorescent lights above every bed in the pre-op rooms. If you’re sitting in bed, you’re just staring at this giant light—and for the neurodiverse population, they can perceive the 50-hertz frequency in that light. The light vibrates their eyes the entire time they’re there, which is torture.”

“One of the families, early on, told us that about their child. So since then, it has been a remarkable thing for all of us to realize. And now we no longer have those fluorescent lights. We have LED dimmable lights that we can either keep on or turn off, depending on the child, but we can take that away just by listening to the families. We’ve had patients who come in, for whom we didn’t know they had any sensory issues, and within five minutes, the room is completely changed so that we can decrease those stimuli in real-time, listening to their families.”

The sensory program has been so well received that Dayton Children’s has four sensory rooms at its main campus—one in a procedural unit, one in its laboratory medical imaging area, and two at its surgery center—and is adding two more this coming year. Having just built a new ambulatory center, they are now also incorporating elements of the sensory program into that.

“We’re trying to get the whole organization to get those sensory components going,” Antosh says.

Growing the Innovation

In 2021, Parents magazine named Dayton Children’s one of the top 15 children’s hospitals in innovation and technology for its sensory program, inspiring the Dayton community to do things differently, too.

Antosh says they were contacted recently by a doctor about a severely autistic adult patient who was on seizure medications. The doctor was asking if Dayton Children’s sensory room was an option to help the man get his blood drawn. While Dayton Children’s only serves children up to age 21, another hospital in town had heard about everything they’d done—and is now partnering with Dayton Children’s to build a program for adults.

Photos courtesy: Dayton Children’s

“One of the biggest issues we’ve heard is that kids eventually age out, and we can’t appropriately care for a patient over 40,” Antosh says. “But others have asked how to build a program like ours to ensure adults are cared for. We’ve done a lot of work with making sure that our nursing and ancillary staff are educated about autism, sensory needs, developmental disorders, and any special needs to begin with, because I think once you make that connection, there’s a way to connect with this child that may be different, that we have to figure out.”

Antosh admits that duplicating a sensory-friendly environment is about more than building pretty rooms.

“Without the people, we wouldn’t be where we are,” he says. “We are asked about replicating models, and that’s great, but you must have the culture of the people to make it functionally work. It’s somewhat about the equipment, but it’s also making people realize that there’s more to it than that.”