Hospital help for autistic children

Autistic children have difficulty socialising

A hospital has developed a programme to manage autistic children during medical procedures.

Between two and five of every 10,000 children are diagnosed with autism. Boys are affected more commonly than girls.

These children have an impaired ability to communicate and relate to adults and other children.

Our programme has turned hospital attendance from being a major ordeal into a manageable experience

Dr Johan van der Walt

Characteristically they have fixed routines in their every day life.

Any change in their routine can be very distressing and coming to hospital may cause panic attacks or temper tantrums, which are extremely difficult to manage.

The Women's and Children's Hospital, Adelaide, South Australia, has developed a management programme to help autistic children, their parents and staff cope with this distressful behaviour when they need an anaesthetic for an operation.

Dr Johan van der Walt, head of anaesthesia, said: "Our programme has been developed over the past four years and has turned hospital attendance from being a major ordeal into a manageable experience."

Anaesthesia

The hospital has developed systems to identify in advance that an autistic child is scheduled to have a procedure under anaesthetic.

Staff immediately contact the parents to plan an individualised admission and discharge procedure fur the child.

Features of the programme include:

• Admission to a special quiet room just before theatre is scheduled.
• Giving a sedative orally in the child's favourite drink. This generally avoids having to restrain the child in any way. Parents are often asked to drink an identical but non-medicated drink.
• Avoidance of stress on waking by routinely giving intravenous fluids to the sleeping child rather than waiting to see if these are necessary after waking.
• Avoidance of the stress of possible post operative vomiting by routinely giving anti-vomiting medication to the sleeping child.
• Allowing the child to waken in the parent's presence and plan for early return to their familiar home environment on the same day.
• When children are kept in hospital overnight they are accommodated away from other patients in a side room.

The programme has been successfully extended to the management of children with other behavioural problems.

Extremely stressful

Autism facts

Some people with autism have an altered sensitivity to pain.

They may be oblivious to injury, or alternatively, experience the texture of certain fabrics as painful.

A spokesman for the UK National Autistic Society told BBC News Online: "Hospitals can be extremely stressful environments for someone with autism.

"They may be completely unable to tolerate such an experience or else become so anxious that the consultation and treatment programme is adversely affected.

"The NAS warmly welcomes the establishment of guidelines for surgical interventions with children with autism and hopes that they will be taken up more widely."

The National Autistic Society's Helpline number is 0870 600 8585.

Details of the programme are published in the journal Paediatric Anaesthesia.