Caring together: Information on the Pediatric Intensive Care Unit (PICU) for parents

Dear Parent,

Your child has been admitted to the Pediatric Intensive Care Unit (PICU). Parents have told us how stressful this experience can be. This information has been prepared in the hope that it may be helpful to you during this difficult time. We will touch on some of the issues, experiences and ways of coping that other parents have shared with us. You will also find information about the environment and equipment as well as the people who work here. 

Parents know their children best and we rely on you to let us know some of the things that are important to your child. Members of the PICU team are available to offer support and assistance throughout your child's stay in the unit. It is very important that we speak openly so that together we can provide the best care possible for your child.

You’ll notice that we have used the masculine pronoun to refer to both girls and boys so that the text would be more readable. This webpage also contains links to resources and additional information you may find helpful.

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What is happening to my child?

"The time of waiting while your child is being admitted to the PICU is the time of a million thoughts running through your mind, so fast," said Annie's mother. "What is taking so long? Will she be okay? Why is this happening to us? Will they tell me the truth? I can't let them see me cry!"

Upon admission, your child will be examined, connected to a monitor as well as an intravenous (IV) line and given immediate treatment.  You will be able to see him as soon as possible.  Your child's doctor and nurse will share with you whatever information is available at the time, and try to answer your questions clearly.  Before your entry into the unit, someone will explain the precautions to take before you enter, such as hand washing, for instance, and will describe what you can expect to see. 

Our team believes in being honest and open. Regular updates will be provided. We encourage you to ask questions and to let us know if something seems unclear.

In stressful situations, parents have told us that they often forget what they wanted to ask when they met members of the team. It may be a good idea to jot down some of your questions as they arise.

Parents may need to ask the same questions several times. This is not unusual in these circumstances and we urge you to ask your questions as often as necessary.

We have never been in a PICU before

"One of the things that helped us a lot, said Julie's parents, "was getting clear explanations -- about the equipment, the people around, the rules and the activities."

An intensive care environment can be quite intimidating, with its many unfamiliar sights and sounds.  It may even be difficult to focus on your child with all the equipment and activity around you. While this new environment might seem overwhelming at first, the PICU team can help you better understand what is happening around you and your child.

The staff member bringing you into the PICU will let you know about some of the things you can expect to see and hear. Your child's nurse can familiarize you with some of the equipment and explain the activities going on around him. Feel free to ask questions and raise any concerns you may have with the team as they arise.

Who are all these people?

One of the things that helped us a lot, said Julie's parents, "was getting clear explanations -- about the equipment, the people around, the rules and the activities. Martin's dad sometimes had the impression that he was in Grand Central Station. In time, he was able to sort out who was able to sort out who was who and how the related to Martin's care. For the most part, people introduced themselves, and if they did not, he would ask.

The PICU has a large multidisciplinary team made up of various health professionals with different specialties and skills. Your child will be assigned a nurse, and at least one doctor or Advanced Practice Nurse (APN) will be responsible for his medical care. These health professionals will be most closely involved with you and your child and are a good source of information. Although it is not always possible, we do try to have the same nurses caring for your child throughout your hospital stay.

Your child’s progress and care plan will be discussed during the morning and evening team rounds. Rounds are daily meetings that bring together health professionals from a variety of other health disciplines to plan and evaluate a patient’s care. You can attend and participate if you choose. A member of the PICU team will follow up with you after daily morning rounds to give you more information and explanations, if needed.

Other members of the PICU team may be involved in caring for your child or helping your family. Please do not hesitate to ask them about their roles.

You will also meet parents of some of the other patients in the PICU. Even though each child's situation is unique, some parents have found comfort in talking with others going through a similar experience. We encourage you to do so if you feel it would be helpful.

Can I stay with my child?

One of the things Matthew's mother was surprised to hear that she or his dad could spend as much time as they wanted with their son in the PICU. They were afraid that they would be in the way. Tina's parents were torn between their desire to be with her and their other responsibilities. After discussing it with her nurse, they arranged for her favourite aunt to spend the afternoon with her since they could only be there in the evenings.  

Having regular contact with a parent or family member is an important part of your child's care in the PICU. Although your child may not respond to you due to medication or his condition, he may get comfort from a familiar and loving voice or touch. Parents are welcome in the PICU anytime, for as long as they wish. If you both choose to stay overnight, only one parent can sleep in the child's room and the other parent can stay in the family lounge, if space is available. You may be asked to step out of your child's room temporarily for reasons that will be discussed with you.

Finding a balance between your need to be with your child and your own needs as well as those of your family’s is a big challenge. You may feel pulled in many directions and it may be helpful for you to talk about this with your child's nurse, doctor or another member of the team. Some parents have found their own special way to be present with their child even during periods when they could not be there: by making a recording of a bedtime story, for instance, or leaving behind a favorite toy, writing messages for the nurse to read or arranging for another member of the family to be present.

We ask that not more than 2 people (including a parent) be at a patient’s bedside at any given time. Visiting hours for people other than parents are limited for safety reasons. We encourage visitors to use the cafeteria or the Larry and Cookie Rossy Promenade as a waiting area in an effort to respect all parents need for personal space. For safety reasons, any visitors in the hallway or outside the sixth floor elevators will be directed to the Promenade.

"When Dimitri was in the hospital, all of our friends and family wanted to come and support my daughter and her husband", said his grandmother. "We asked my brother to talk to everybody, give them news and arrange a schedule when they could come upstairs. That way there were never too many at one time and also, the parents had some time to spend together, just the two of them."

What can I do to help?

Rémi's mother found her own feelings of helplessness almost overwhelming at times. In talking about Rémi's life at home and at school, she began to think of things to do that could help him cope with his heart surgery. "Even though he was asleep much of the time and even if he couldn't respond", she said, "I felt that the doctors and nurses knew him better through the pictures I brought and the stories I told. I also think that he must have heard some of those things, and they made him want to get better..."

As a parent, you know your child best. Sharing some personal information about him is important for his care. How do you usually reassure him when he is frightened or sick at home? What kind of things does he like? Who are the important people in his life? Any additional information you can provide can help us make sure he is as comfortable as possible.

Bringing pictures of your child and some important family members and friends will make the environment a bit friendlier and will help the team get to know your child better. Some of these can be added to the All About Me poster available in the PICU.  If you think it can be helpful, you can bring his favorite toy or blanket, as well as drawings and greeting cards made by his friends or classmates.

During the times you cannot be with your child, we can organize to have your voice or his favorite music recorded. Ask your child’s nurse about our reading program , music therapy program and our Dr. Clown program. It is also important to think about taking time to take care of yourself during the time that your child is in the PICU. 

"We wanted to call Michael's schoolteacher but we were too upset to remember even the name of his school! So we took time, the same night, to write down all the important phone numbers and carried them with us all the time. Sounds silly, but it helped us to do something useful. "

How long can our family life stay on 'hold'?

I was so afraid of bringing Shauna, my 4-year-old, to see Mark after his accident. He was unconscious and on a respirator. We explained things before, she had a million questions. When we told her that he might be able to hear her but he couldn't talk, she just said 'Hi Mark, I love you'.

Family life can be disrupted by a child’s serious illness. Everyone in the family has to quickly shift into "emergency survival mode". This can work well for a short time, but problems can arise if it goes on for too long. Getting some things back to normal, or as normal as possible, is important but not so easy; especially if a crisis is prolonged. Talking your ideas over with a member of the team (your child's nurse, the social workerspiritual care professional, or the psychologist) can help during your stay.  Speak with your child’s bedside nurse to request a meeting with a member of the PICU Psychosocial Team.

Your other children need to feel they are part of the family, even during a crisis, and can benefit from being included in ways that are appropriate to their age.  We can help you prepare them for what they will see and hear before they visit their sibling. The visit may be fairly short because of the constraints of the PICU. Other family members or a favorite babysitter can be on hand to take care of the children after the visit if you’d like to stay at your child’s bedside a little longer. We encourage you to talk to the staff about your other children. There are many ways that your children can be involved, for instance, by making and sending cards and drawings to their brother or sister in the PICU. Receiving regular updates with an opportunity to ask questions is also a way of being involved. Children are affected by whatever happens in their family.  Sharing thoughts, ideas and feelings is important and may help them feel less isolated and more supported.

It is often difficult to estimate the length of the hospital stay when a child is in the PICU. Taking care of yourself (for example, by eating regular nutritious meals and taking periods of rest) is important to maintain your health for the long haul.

"I figured that I could take care of myself once Katy was out of danger and my husband could manage at home. That was okay for a couple of days but then it got out of hand. We all got tired and mad all the time... Jody was really upset when he couldn't go to Cubs. It helped to have permission to take care of ourselves a little. We talked it over and tried to get back some of the normal routine."

Family Resources

Family Lounge

The family lounge is available to you. The room is equipped with a microwave oven and a refrigerator. Some parents prefer to bring a simple lunch from home, which can be left in this room. It is not possible for you to eat at your child's bedside, therefore we encourage you to use this room during meals and to get some rest. Please note that while you are in the family lounge, someone will come and get you if your child is asking for you or if his condition changes. They can also let you know when a health professional is available to speak with you. There is a telephone in the room on which you may receive outside calls. The telephone number is 514-934-1934, extension 22966 or 22812. To make local calls dial 9 followed by the area code and number. A computer and WiFi connection is also available, and we invite you to bring your own laptop or tablet for easier access.

The room is a resting area for all the parents who have a child in the PICU. For everyone’s comfort, we request that you limit the number of outside visitors (family and friends) entering the room to two people. A large number of visitors can be accommodated in the Larry and Cookie Rossy Promenadeor the cafeteria (in Block C level S-1). Visitors are not permitted after 8:00 p.m. If you are from out of town, the social worker can help you organize accommodations.

Chapel

A non-denominational Chapel is located in Block A on level 2. It is open 24 hours a day for prayer and meditation.  

Cafeteria

The cafeteria is located in Block C on level S1, and is open Monday to Friday from 7:00 a.m. to 7:00 p.m. On weekends and holidays it is open from 9:00 a.m. to 2:00 p.m. and from 4:00 p.m. to 7:00 p.m.  When the cafeteria is closed, the seating area remains open. This may be a good place for additional visitors to wait for their turn to visit you in the Family lounge.

Family Resource Centre

The family resource centre is located in on the ground level (RC) of Block A, room 1107. It includes a business centre with Wi-Fi access, computer stations and printers, a library and a closed family conference room for support group meetings and workshops. It is a place where families can find health information about children’s medical conditions, parenting and pain management. A librarian is available to assist you in finding pertinent information.  

Play Material and Playrooms

Play material is available and can be brought to your child’s room from Child Life Service’s main playroom located in Block B - S1 level. Child Life Services also offers a variety of educational play interventions including music therapy, pet therapy,visits from Dr. Clown and school services. 

Parking

Parents and visitors can access the Block G parking lot via Décarie Boulevard. At the entrance, take a ticket and keep it with you in order to pay on your way out. Hospital elevators will take you to the parking level where your car is located. Reduced parking passes are available to PICU families. Please ask to speak with the Social Worker or bedside nurse for more information.

What are all these machines about?

Equipment in use in the PICU

It may be helpful for you to become acquainted with the equipment we use to assist us in monitoring your child's condition. The descriptions are brief; your child's nurse can provide more information on the equipment being used in your child's care.

Each piece of equipment has its own alarm. These alarms are often worrisome for parents even though we expect to hear many false alarms -- set off by a change in position or other movement, or because it is time to check the machine itself. Alarms will alert us to variations in your child's vital signs, even slight ones which may not be very significant. Each time an alarm rings, we will check to see what is causing it.

  • CARDIORESPIRATORY MONITOR: a monitor is placed near the head of your child's bed. It is used to keep a constant check on the rate and rhythm of his heart beat (and is connected to electrodes attached to your child's chest with special adhesive tape), to check the oxygen saturation, blood pressure and other pressures inside the heart after open heart surgery.
  • RESPIRATOR or ventilator: Should your child need help in breathing, a respirator is used. It is hooked up to a breathing tube (called an endotracheal tube or ET tube) which is carefully inserted through the nose or mouth into the windpipe (trachea) and secured with tape. Oxygen can be given as needed and the respirator can be set to breathe for your child for some or all of his breaths.
  • ARTERIAL LINE: A thin tube (catheter) is placed in an artery and hooked up to a special monitor and a flushing system. This monitor reads and displays the child's arterial blood pressure. Another use of this line is to let us to take blood samples without  having to continuously “poke” your child.
  • URINARY ( FOLEY) CATHETER: Your child's condition may require close monitoring of his urine. A urinary catheter is a soft rubber tube, inserted through the opening of the bladder, through which urine is collected. There are also some medications which affect the bladder's ability to empty itself, which is why a catheter may be necessary.
  • CHEST TUBE:A small tube is placed between the ribs and the chest wall and is connected to a suction device to treat a collapsed lung (pneumothorax) or after some surgeries to drain fluid that may collect around the lungs or heart.
  • CENTRAL VENOUS LINE: This is sometimes called a central venous catheter or Broviac catheter and is inserted into a larger vein closer to the heart, usually in the chest. It is used for long-term, stable access to provide IV fluids and nutrition.

The PICU team offers other specialized treatments such as ECMO and CRRT.

After the PICU

"I didn't want to leave the PICU. It was crazy, I was glad that Erik was better, but I had trouble believing that he didn't need all those monitors any more. It was as if I had no confidence in him or myself."

Another period of transition

Parents often express mixed feelings once it comes time to leave the PICU. It may take some time to deal with these feelings and to adjust to a new environment with new people. Saying goodbye can also be difficult.

The same skills that you and your family used and developed to adapt to life in the PICU will be useful in this transition. It may be helpful to spend some time writing down some of your concerns and feelings as well as some of the things you learned about parenting in unusual circumstances. 

In conclusion

This webpage is not meant to replace person to person discussion between parents and the team.  One of our goals is to highlight the importance of parents in the care of their child in the PICU and of open communication between staff and family. We encourage you to share your concerns and to ask questions as often as you need to. The PICU staff is committed to caring for your child in the best way possible and supporting you and your family through this difficult time.

Important telephone numbers
  • The Montreal Children's Hospital (Main number): 514-412-4400
  • Pediatric Intensive Care Unit (PICU) : 514-412-4400, local 22855
  • Family Lounge: 514-412-4400, local 22812
  • Spiritual Care Professional: 514-412-4400 local 22400
  • Social Services: 514-412-4455
  • Ombudsman: 514-412-4400 local 22223
Refer a patient 

Room: B 06.3718, Glen site

Phone : 514-412-4400 ext. 22855

Hôpital de Montréal pour enfants