VCUG for 4 Year Old

Hello,
Some background first:  my 10 month old baby boy has bilateral hydronephrosis (grade 3 on right side, grade 2 on left side) and dodged/delayed surgery by showing some improvement at his last renal scan.  Urologist says he needs to continue to show improvement in next month's ultrasound or he'll again recommend surgery.  By the time he was 2 weeks old he tested negative for reflux and posterior urethral valves.  We're accustomed to worrying about and getting testing for our baby.

Last weekend our 4 year old son was diagnosed with a UTI (urinary tract infection).  He had severe pain during urination, frequent urination, and many accidents.  No fever.  He hasn't had pain for 3 days now, but is still having accidents.  Yesterday our pediatrician recommended an ultrasound and VCUG for our 4 year old.  

Question 1:  is a VCUG necessary for our 4 year old?  When our baby was diagnosed, we asked if our older son should be tested and the answer was always no.  The urgent care doctor who saw him for the UTI didn't think there was any family link between the baby's hydronephrosis and the 4 year old's UTI.  Again, the baby tested negative for reflux - and I surely hope once he tests negative he should always be negative.

Question 2:  Assuming a VCUG is necessary, what type of sedation can we use?  I've read about versed and a strong version of laughing gas.  Our 4 year old has high anxiety when it comes to doctors.  For example, at last week's dentist appointment (at a pediatric dentist office), they wouldn't clean his teeth because he screamed so loudly and was so agitated.  We were moved to another room because he was upsetting the other children.  We had to hold him down for the dental exam and fluoride treatment and that was traumatic for him and us.  This was his 3rd time to the dentist and the first two times were not that bad; for some reason, he seems to be getting worse.

The ultrasound will be stressful enough for him but he'll just have to handle it.  At least that's not painful.

I'm worried about the VCUG.  What can we do make the VCUG bearable for him?  As much as I worry about sedation for a child, I feel it is essential for him given his personality.  Can they give him versed (to ease the stress from the IV and catheter) and then sedate him during the test?  Any suggestions?  


Help!
Thank you.

[angron97]

I don't know if this is too late but my 4 year old has grade 3 urinary reflux.  She was diagnosed when she was 2 years old and she has had 2 VCUG's.  I would DEFINITELY recommend Versed before the procedure.  He will not have to have an IV and the procedure is pretty quick but it is very traumatic.  She still cried a little during the first procedure but didn't put up a fight like she would have did she not have the Versed.  

She had a very hgh fever one night so we took her to the ER and they put a catheter in her to check for a UTI.  She screamed and kicked and it was awful.  It took me and 2 nurses to hold her down and it took them two tries before they could get it in all the way because she kept pushing it out.  I cried through it all and swore I would never do that again.  

So when they ordered the VCUG and explained the procedure I immediately asked about sedation.  At first they refused and I told them she either got it or she was not having it done.  After several calls and talking with my pediatrician, they reluctantly agreed with the help of my ped.  

I think parents know their children and would not give them a drug unless they really thought it was necessary.  They tried to tell me she would not be able to "void on demand" with the Versed but she did fine BOTH times.  They tried the second time to deny me sedation again but I insisted and they agreed.  They don't like it but they have to give it to them if you insist so I would stand my ground if they fight you on it.  

I have 2 other children and I think they would do fine without it but my youngest is different.  She is just not comfortable with doctors, dentists or anyone invading her space and never has been.  All kids are different and like I said, mothers know their kids and know what is best.  They can't treat all kids the same because they aren't.  I hope this helps and if you have any questions, please feel free to e-mail me at ***@****.  

Good luck!    

[monto2boys]

Thank you so much for your reply.  Is Versed itself the sedative and how is it given (e.g., do they drink it).

I completely agree with you, and my son is like your daughter in regards to doctors.

We finally received the approval to see our pediatric urologist.  They wanted to send us to a regular urologist so we fought and fought and finally they approved it.  Now we have to wait until we see our new pediatrician after Nov 1 so they can order the VCUG.  Feels like "hurry up and wait."

I hope your daughter is doing well - what has the doctor recommended?