WAGS: Wonderful Alternatives to General Anesthesia & Sedation

Available on weekday mornings. 

Who is eligible?

Infants under six months of age are eligible. 

Who is not eligible?

Infants over the age of six months or infants with feeding problems (e.g. severe gastroesophageal reflux) are not eligible.

Please note: While we do our best to keep appointments on time, delays can occasionally occur in a hospital setting. Emergency or urgent patients may need immediate access to the scanner, which can impact scheduled appointments, including feed and sleep studies. If this happens, our team will keep you informed and do everything possible to minimize wait times. Thank you for your patience and understanding. 

Instructions for parents before MRI scan: 

• Arrive one hour prior to MRI scan time 
• Withhold one feed from baby before coming to MRI department (arrive hungry) 
• Keep baby awake for three to four hours before the MRI (arrive tired) 

On arrival for MRI: 

• Fill out the MRI screening form 
• Tell the nurse or technologist how long it typically takes to feed your baby 
• Change your baby into non-metallic hospital clothing 
• Change diaper if needed 
• Your baby’s height and weight will be measured 
• Your baby may require an IV to be inserted for contrast enhanced images 

Getting ready for MRI scan: 

• Small cushions or cloths are placed between baby's legs and between their arms and body, so they don't touch 
• ​Baby is swaddled in a baby blanket and placed in an MRI-compatible immobilizer 

​To encourage sleeping during MRI scan: 

• Room lights are kept dim 
• Baby is given a large feed immediately before the scan 
• Ear plugs and earmuffs are used to reduce noise 
• Baby pacifier and/or sucrose may be used if baby wakes up 

The feed and sleep technique does not always work. If that happens, sometimes the patient is rebooked to try this technique again on another day, or instead the patient is booked for MRI using general anesthesia. 

How do I request feed and sleep for my baby when they need to have an MRI? 

There are a few ways to do this:

1. Your referring provider can note the request on the MRI form or contact the MRI scheduling team. 
2. Parents and caregivers can request the Feed and Sleep technique when the MRI team calls to book the appointment, or by calling the MRI scheduling team during business hours. 
3. The MRI scheduling team or radiologist may also suggest Feed and Sleep after reviewing your child’s request. 

What happens next? 

Our MRI nurse will review the request to see if your baby is eligible for the feed and sleep technique. This is based on your infant's age and development, the type and length of the MRI scan requested, and other information that might mean a general anesthetic is still needed. 

"My son was born with a very serious heart condition and at a young age required numerous medical interventions. One of these interventions required him to have more than one MRI throughout the course of his hospital stay. There were times when a feed and sleep method was used, and although it may have taken a longer time (as my son was at a young age), the desire not to give him sedation medication was a preferred option for me. Especially given the fact that my son was already on quite a few medications, I found that the feed and sleep method was less invasive and allowed my child's body to naturally adjust to the upcoming procedure. My experience with the feed and sleep method was a positive one and I was glad that the staff showed patience and care before, during and after the MRI scan.”

Available upon request on certain weekday mornings.  

Who is eligible?

Patients over the age of 3½ years are eligible. 

Who is not eligible?

Patients under the age of 3½ years are not eligible. Patients with the following conditions or circumstances are also not eligible: 

• Cerebral palsy 
• Immediate post-operative (especially if neurosurgery) 
• More than two body parts are being scanned, or the scan will last longer than 90 minutes 
• MRSA, VRE and/or CPE carrier or infection 

Upon arriving in the MRI department and after completing the standard registration and screening process, the patient and their parents/caregivers meet the therapy dog team – the dog and their handler – in the waiting room. 

The interaction with the therapy dog includes the patient sitting near the dog, petting it and engaging in low-level play under the supervision of the handler. The handler keeps the dog on a loose leash at all times, attends to the dog's needs and can answer any questions. They use the dog to reassure the child about the upcoming scan – such as placing a pair of "mutt muffs" (headphones used to protect a dog's hearing in small aircraft) on the dog as a way of explaining to the patient that they will also be wearing ear plugs and headphones. 

The therapy dog stays with your child in the MRI preparation area, including during IV placement if needed, and then goes with your child into the MRI scan room while they are getting settled on the MRI table. The dog gets onto the table first, and then your child follows. 

Once your child is positioned in the scanner, the therapy dog waits in the MRI control room during the scan. The dog may come back into the scan room between parts of the scan if the MRI technologist feels it will help your child stay calm. During all interactions, the handler encourages your child to hold the dog’s leash. 

Before the MRI, your child will spend about 20 to 60 minutes with the therapy dog. They may also have some time with the dog during and after the scan, depending on the situation. After the MRI is finished, your child will always get one more visit with the therapy dog outside the scan room, with time for photos and a final cuddle. 

How do I request a therapy dog for my child when they need to have an MRI?

There are a few ways to do this:  

1. Your referring provider can note the request on the MRI form or contact the MRI scheduling team. 
2. Parents and caregivers can request support from a therapy dog when the MRI team calls to book the appointment, or by calling the MRI scheduling team during business hours. 
3. The MRI scheduling team or radiologist may also suggest therapy dog support after reviewing your child’s request. 

What happens next?

Our MRI nurse or Child Life Specialist will review the request to see if your child is likely to benefit from a therapy dog. This is based on your child's age and development, the type and length of the MRI scan requested, and other information that might mean a general anesthetic is still needed.  

If it’s decided that a therapy dog may help your child during their MRI, the MRI scheduling team will work to book an appointment during regular business hours and coordinate with one of our therapy dog teams. The appointment time will depend on how soon the scan is needed, your availability, and the availability of the therapy dog team.

"Thank you for organizing the therapy dog for the MRE... It was incredible to see R's interaction and response to the dog. I firmly believe she is the reason R was able to complete the test. My older three boys have now decided they will do some fundraising for more therapy dogs.”

VR services are available on: 

Monday, Wednesday, Friday: 10:00am-11:00am   

Tuesday and Thursday: 2:00pm-3:00pm  

Who is eligible?

Patients over the age of 3½ years are eligible. Eligibility may vary based on individual circumstances. 

Who is not eligible?

Patients under the age of 3½. are not eligible. Patients with the following conditions or circumstances are also not eligible: 

• Infectious disease 
• History of seizures  
• Balance disorders 
• Nausea 
• Head lice 
• Immediate postop neurosurgery 

Our virtual reality (VR) headset uses interactive games to simulate the MRI process, teaching children what to expect and allowing them to practice lying still, an important skill for a successful scan. The VR headset can also provide distraction and comfort during procedures such as IV (intravenous) insertion. 

In addition to VR technology, we use toy models of MRI scanners to familiarize patients with the MRI environment, making the experience less intimidating and more engaging for children and their families. 

How do I request MRI Simulation/VR for my child when they need to have an MRI? 

There are a few ways to do this: 

1. Your referring provider can note the request on the MRI form or contact the MRI scheduling team. 
2. Parents and caregivers can request MRI simulation/VR when the MRI team calls to book the appointment, or by calling the MRI scheduling team during business hours. 
3. The MRI scheduling team or radiologist may also suggest MRI simulation/VR after reviewing your child’s request. 

What happens next?

Our MRI nurse or Child Life Specialist will review the request to see if your child is likely to benefit from MRI simulation/VR. This is based on your child's age and development, the type and length of the MRI scan requested, and other information that might mean a general anesthetic is still needed. 

If it's determined MRI simulation/VR may help with your child's MRI scan - the MRI scheduling team, MRI nurse or Child Life Specialist will book a session with you and your child before your planned MRI exam to complete the simulation. 

Please note, requesting MRI simulation/VR support will not impact the scheduling timelines of your child’s appointment. 

This service is available Monday to Friday, 8:30 a.m. to 4:30 p.m. 

All patients at SickKids can request support from a Child Life Specialist. 

With an innovative and fun approach, child life specialists aim to improve patient and family care, satisfaction, and overall hospital experience. This program is designed to familiarize patients with the sights and sounds of an MRI and to explain the step-by-step process of what they can expect to do during their appointment. By providing clear, honest, and developmentally appropriate explanations, Child Life Specialists empower patients to cope more effectively, leading to a more positive overall experience. 

Recognizing that every child responds differently to medical encounters, our specialists assess each patient’s unique needs and create individualized coping plans. Whether working independently or alongside other non-sedation strategies, Child Life Specialists offer supportive alternatives to general anesthesia for children undergoing MRI scans. 

Child life Specialists can provide: 

• Education and preparation: Through an interactive and visual approach, child life educates patients by using a tablet, virtual reality or a mock MRI table with a cloth doll to help patients gain a better understanding of their MRI. Developmentally appropriate explanations are used.   

• Distraction techniques: For some cases, a patient may need contrast (a liquid dye sometimes referred to as “picture water”) that helps to highlight a certain part of the body to get a clearer picture, which means an IV is needed. Child life offers coping techniques to make this process quicker and more positive such as guided imagery, breathing techniques, playing fun games like "I-spy" and listening to music.  Additionally, techniques to reduce pain can be offered such as numbing cream or freezing spray applied to the skin before an IV is inserted.   

• Coping skills discussion and practice: Child life can provide a coping plan and coach your child through their MRI scan to help keep them calm and still. This might entail practicing staying still beforehand, practicing positive-self talk, guided imagery and deep breathing.   

• Emotional and family support: Child life will spend the time to build rapport, understand the patient and parents' needs and advocate their concerns to the rest of the healthcare team to ensure that the child or adolescent is comfortable throughout their appointment. 

How do I request a Child Life Specialist for my infant/child when they need to have an MRI?

There are a few ways to do this: 

1. Your referring provider can note the request on the MRI form or contact the MRI scheduling team. 
2. Parents and caregivers can ask for Child Life support when the MRI team calls to book the appointment, or by calling the MRI scheduling team during business hours. 
3. The MRI scheduling team or radiologist may also suggest Child Life support after reviewing your child’s request. 

What happens next?

An MRI nurse or a Child Life Specialist will review the request to see if your child is likely to benefit from Child Life support. This is based on your child’s age, development, the type and length of the MRI scan, and other factors that may mean general anesthesia is still needed. 

If Child Life support is a good option for your child, the MRI scheduling team will book the scan during regular business hours and coordinate the appointment with a Child Life Specialist. The timing will depend on how soon the scan is needed, your availability, and the availability of the Child Life team. 

Please note, requesting CLS support will not impact the scheduling timelines of your child’s appointment.  

"To be able to see and talk to a Child Life Specialist every visit, every blood test, finger poke and especially for each and every MRI is truly support like no other. From personal experience, one of the hardest things to go through was an MRI. Having to stay still and try to block out the noise and focus on a distraction, sometimes I was lucky to have child life there as my distraction. That is the magic of Child Life, you can be having a conversation and a 45-minute scan is over in an instant. ...not only do they bring support when patients need it, they put a smile on the face of kids and the families that have to bear witness to the difficulties patients face on a daily basis. I wish I could thank all Child Life Specialists individually.”

Available upon request. 

Some strategies require a Child Life Specialist, who is available Monday to Friday, 8:30 a.m. to 4:30 p.m. 

These strategies can help lessen anxiety and help with pain management. They can also promote a sense of control by offering the child choices. These strategies include:  

• Distraction e.g. tablet, fidgets, bubble wand, virtual reality, etc. (CLS required) 
• Sensory toys (CLS required) 
• Guided imagery (CLS required) 
• Comfort holds 
• Numbing Cream 
• Buzzy (needle and pain relief toy)  
• Deep breathing

How do I request IV coping strategies for my child when they need to have an MRI? 

Certain strategies require support from a Child Life Specialist, which will need to be requested in advanced.  

Parents and caregivers may request IV support and specific strategies, when our MRI scheduling team contacts you to book the scan, or by calling the MRI scheduling team during business hours.  

Available anytime upon request. 

This approach is most often used for children over the age of 3½. It can be used along with support from a Child Life Specialist, MRI practice sessions, or medication if needed. Audiovisual equipment (like movies or music) is available in all MRI areas and does not need to be arranged ahead of time. 

How do I request the movie and tv system for my child when they need to have an MRI? 

Simply ask your MRI technologist to set up the movie and TV show system before your exam begins. 

For children aged between 18 months and 5 years, although not always successful, it is sometimes possible to do the MRI scan by scheduling it in the afternoon to coincide with nap time, or evening to coincide with bedtime. 

For a natural sleep MRI, the child is kept awake longer than usual before the appointment and may have their nap schedule adjusted so they are very tired. When they arrive, the room is kept quiet, dim, and calm. Parents can feed, rock, or comfort their child until they fall asleep, just like at home. 

Once the child is in a deep sleep, they are carefully moved onto the MRI bed and the scan begins. Because MRI is noisy, soft ear protection is used, but the child continues sleeping. Staff closely monitor the child the entire time. 

There are a few ways to do this: 

1. Your referring doctor can contact our MRI scheduling team or write this on the MRI request. 
2. Parents/caregivers can ask our MRI scheduling team when they contact you about the date and time of the scan or you can contact them at any time during business hours. 
3. Our MRI scheduling team and radiologists may decide it might be a good option for your child when they review the request. 

What happens next? 

Our MRI booking team or Child Life Specialist will review the request to see if your child is eligible for natural sleep during MRI. This is based on your child's age and development, the type and length of the MRI scan requested, and other information that might mean a general anesthetic is still needed. 

If it's determined natural sleep may help with your child's MRI scan - the MRI scheduling team will find a time to book your child's scan, coordinating this with one of our Child Life Specialists. 

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