Scope of Services

St. Louis Children’s Hospital is home to many highly trained pediatric-focused specialists who helps us provide high quality care to our patients.

Child-life specialists are pediatric health care professionals who work with children and families to help them cope with the challenges of hospitalization, illness, and disability. They provide children with age-appropriate preparation for medical procedures, pain management, and coping strategies. They also provide information, support, and guidance to parents, siblings, and other family members. Our child-life specialists are available during the busiest times of the day, every day of the week and help to provide a calming, relaxed, and gentle environment to patients and families in otherwise scary and stressful procedures and situations.

Our specially trained pediatric emergency department social workers are present 24 hours a day to help our patients and families. From supporting families through medical emergencies and trauma to helping the medical team navigate child protection emergencies, the social workers are an integral part of the medical team. In addition, they provide safety and health information to families, including counseling on safe sleep, safe gun storage, postpartum mood and anxiety disorders. They can provide necessary equipment such as pack and plays and gun locks to families who need them. Our social workers also provide information about valuable community resources related to nutrition, safe housing, and healthcare. In addition, we have a dedicated community coordinator who serves our families by helping them establish with a pediatrician and arrange emergency department follow up visits with primary care providers and subspecialty services to help children stay out of the emergency department and get the long-term care they need.

We have numerous specially trained nurses and nurse practitioners credentialed as sexual assault nurse examiners (SANE) who are on call 24 hours a day. These NPs and RNs are specially trained to perform forensic histories, clinical exam, and evidence collection. Working with our social workers, they assist families in making police reports and arranging follow up with our child abuse pediatricians.

Emergency physicians routinely provide sedation and analgesia, monitor the respiratory and cardiovascular status and manage critically ill patients of all ages. The provision of safe and effective sedation and analgesia is an integral part of emergency medicine practice. Failure to adequately treat a patient’s pain can have negative consequences, the event potentially affecting later physiologic responses and behaviors. Appropriately treating pain and anxiety decreases patient suffering, facilitates medical interventions, increases patient/family satisfaction, improves patient care and may improve patient outcome.

Our emergency department has been a pioneer in the “Ouchless ED” philosophy. Proactive steps are taken long before any procedures to minimize anxiety and create a calming environment, and family members are encouraged to hold their children for comfort throughout procedures. Oral narcotics can be given by our nurses in triage to expedite pain relief long before the patient is ever seen by a physician. Buffered injectable lidocaine and distraction is used with every IV start. Sucrose is used for neonates immediately before and during painful procedures.

Nitrous gas is encouraged for use during simple procedures, obviating the need for IV access, itself an additional cause of pain and anxiety as well as causing delay in treatment and disposition. During deep sedations with ketamine, a specially trained nurse or medic assists the sedation physician with set-up and vital sign charting, allowing the physician to focus all attention on the patient. Our emergency department has advanced the practices of using nitrous gas during hematoma block placements in fracture reduction, as well as the efficacy and safety of rapid-push Ketamine during sedation.

All procedures, including splinting and suturing, are performed by physicians or NP/PAs. Procedural competency is a hallmark of our fellowship training program and fellows’ shifts are structured to allow ample time and experience with all procedures performed in the ED.

St. Louis Children’s Hospital is the pediatric flagship of BJC Healthcare, one of the largest nonprofit health care organizations in the U.S. and receives pediatric trauma referrals from its 14 additional hospitals with over 500,000 yearly ER visits throughout greater St. Louis, southern Illinois and mid-Missouri regions. This unique location allows for trainees to experience traumatic injuries from both rural and urban settings. 

Furthermore, SLCH is the only designated Pediatric Level 1 Trauma center that is verified by the American College of Surgeons in both Missouri and Illinois, which means we provide the highest classification of trauma care. We see approximately 2,000 injury related cases per year ranging from minor to severe, including head injury, burns and orthopaedic injuries, and have access to all pediatric specialties.  Our penetrating trauma rates are one of the highest in the country.  We have highly specialized trauma programs including neurocritical care, neurorehabilitation, sexual assault nurse examiners (SANE), trauma clinics and pediatric acute wound services (PAWS).  We are members of the Injury Free Coalition for Kids and focus on research and advocacy to address injury prevention in our region.  Pediatric emergency medicine fellows are expected to learn how to adequately address trauma airways as well as lead the trauma activations.  All of our trauma stat activations are video recorded for quality improvement purposes and reviewed at a quarterly educational conference.

Popular among both patients and providers is our fast-track. Staffed predominantly by nurse practitioners, our fast-track allows patients who otherwise do not have access elsewhere get the high-quality care provided by the team at St Louis Children’s Hospital. Fast-track is open during the busiest times of the day, allowing our emergency medicine physicians and generalists to focus on the highest-acuity and most critically ill patients.