How Do We Care for Children with Autism Spektrum Disorder When Coming for a Procedure Requiring Anesthesia?

Background: Children with Autism Spectrum Disorder (ASD) have problems with communication and social interaction. They are also dependent on routines and sensitive to sensory stimuli. Due to the problem’s children with ASD have it can be a challenge for the Health Care Professionals (HCP) to establish a rapport with the child. This can lead to an uncooperative behavior during anesthesia induction which might result in the child being physically restrained for anesthesia induction. Such a traumatic event can exaggerate a child’s anxiety for the next anesthesia induction. Children with ASD pose a challenge for the HCPs tasked to provide the child with care. Preparing both the child and the environment to suit the child’s needs may decrease anxiety in children with ASD. In order to achieve this, the use of family-centered care and evidence-based guidelines would be beneficial.

Objectives: The aim of this study was to describe current ways to prepare and care for children with ASD for procedures and oral health care with sedation or general anesthesia.

Methods: A web-based questionnaire was distributed to the head of Swedish dental departments of pediatric dentistry and to anesthesia departments in Sweden. The questionnaire investigated the existence of guidelines for preparing and care of children with ASD for procedures and dental treatment under sedation or general anesthesia. Descriptive statistics and content analyses was used to analyze the answers from the questionnaires.

Results: Six pediatric dental departments out of 37 had guidelines on how to prepare children with ASD for sedation or general anesthesia and 7 out of 68 anesthesia departments caring for children with ASD had guidelines on how to prepare and care for these children. The guidelines in the pediatric dental departments consisted of comprehensive planning together with the parents for the entire health care visit to suit the individual child. Many departments left the preparation of the child to the anesthesia department when it came to anesthesia for dental care for these children. From the anesthesia departments three categories emerged, those were: “care with specific consideration for children with ASD”, “lacking the necessary conditions,” and “no extra consideration needed”. These three categories span a continuum in the care from a care that was based on family-centered care tailored for the specific child to actually have as a routine to physical restraining a child for an anesthesia induction.

Conclusions: Considering the lack of guidelines for preparation of children with ASD for procedures and dental treatment in sedation or general anesthesia, there is a necessity for evidence-based, guidelines that are specifically designed to meet the needs of children with ASD in order to give high quality care and avoid a traumatizing experience for the children.