How to Recognize, Avoid, or Get Out of Trouble in Pediatric Interventional Radiology

The average clinical practice of most interventional radiologists focuses on the care of adults (for practical purposes, defined as most patients over age 15). However, an increasing number of pediatric patients are being referred to Interventional Radiologists for evaluation and possible treatment. In some cases, these patients may not require significant deviation from the normal procedures of the lab (e.g., a 160 pound 14-year-old), although they may be designated as a pediatric patient by the anesthesia support team. In others, modifications must be made to ensure the safe and effective treatment of these patients (e.g., a 0.5 kg neonate). Unlike the specialty of adult interventional radiology (IR), pediatric interventional radiology (PIR) is relatively nascent. Like adult IR 10-15 years ago, PIR still competes for name recognition and even at the largest of pediatric medical centers, is involved in the political skirmishes that might make the most seasoned adult interventionalist smile (or cringe) in reminiscence. The field of PIR is growing rapidly and demands on these specialized practitioners are increasing. Some hospitals/centers have fellowship-trained Pediatric Interventional Radiologists who can attend to these patients, but others defer to the adult IR practitioners. Herein, we offer some thoughts on how to help the pediatric patient for our PIR and adult IR colleagues. These thoughts focus on preprocedural planning, optimizing intraprocedural success, and minimizing procedural morbidity. Throughout the process of preparing for a pediatric patient, it pays to recall the oft-recited mantra from medical school: "Kids are not just small adults."