After Conscious Sedation

AFTER CONSCIOUS SEDATION: THE LONGER VERSION

This is the rest of the sheet we texted you. It answers the questions parents ask us most, and it covers the hours after you get home.

If you are looking for what to do right now, use the sheet we texted you. Everything urgent is on it. If anything on the red flag list is happening, do not read this page. Call us any time on (870) 741-4746. The line reaches Dr. Chad after hours.

FIRST, THE THING PARENTS TELL US THE NEXT DAY

You did not cause this.

The crying, the wobbly walking, the upset stomach, and the hard sleep are the medicine leaving your child’s body. They are not something you did wrong. If your child woke up screaming and looked straight through you like a stranger, that is the part parents find hardest, and it is the part that has the least to do with you.

WHAT YOUR CHILD ACTUALLY HAD

Your child swallowed medicine here in our office. That is the whole of it. Nothing was put into a vein, and there was no operation. Your child breathed on their own the entire time, and one of our team watched your child’s breathing and heart rate from the moment the medicine went in until you left.

This is called moderate sedation by mouth. Your child was sleepy and relaxed, not unconscious. Many children answer questions during the visit and remember none of it afterward.

The medicines we use

We use one or a combination of these. Which ones your child had depends on their age, their size, and how long the visit needed to be.

Midazolam, also called Versed. This one relaxes a child quickly and wears off fastest. It is also the one that causes amnesia, which is why your child may have no memory of the visit at all. That is expected and is one of the reasons we use it.

Hydroxyzine. An antihistamine. It adds to the drowsiness, and it helps settle the stomach. It is the reason for a dry mouth, and sometimes for a longer stretch of sleepiness.

Meperidine. A pain medicine that also relaxes. It is the one most likely to bring on nausea or an upset stomach.

Diazepam, also called Valium. It works like midazolam but stays in the body much longer. If your child had this one, expect the grogginess to last well into the evening and sometimes into the next morning.

Why the watching lasts a full day. Some of these medicines leave the body slowly, and the body turns some of them into other substances that are themselves relaxing. Your child can look completely awake at 4pm and be heavy and stumbling again at 7pm. That is not a setback and it is not a sign that something went wrong. It is the reason we ask for a full 24 hours of watching instead of an afternoon.

HOUR BY HOUR

The ride home and the first hour

The ride is the part of the day we think about most, because your child is strapped upright in a seat, facing away from you, and falling asleep. Use the car section on the sheet we texted you.

Expect your child to sleep in the car. That is normal. What is not normal is being unable to rouse them at all.

The first few hours at home

• Sleep, on and off. Being wakeable is the requirement, not being awake.
• Walking that looks unsteady, like a much younger child.
• Words that come out slurred or slow.
• Crying that starts for no reason you can find, and stops the same way.
• Little interest in food. That is fine. There is no amount your child has to eat today.

The evening

• A second wave of sleepiness is common, especially with the longer-lasting medicines.
• Your child may fall asleep early and sleep hard. Keep checking that you can rouse them.
• Restless sleep or a bad dream tonight is common.
• Have your child sleep where you can hear them. Many families keep the child in their room for the first night.
• Once you are home, no sleeping in a car seat, a swing, or a bouncy seat. Move your child to a flat bed or crib.

Tomorrow

• Most children are back to normal eating, walking, and playing by the next day.
• Being clingy, tearful, or not quite themselves can last into tomorrow, and sometimes a day or two longer.
• An upset stomach can show up a full day after the visit. It usually passes on its own.

HOW YOUR CHILD MAY ACT, IN MORE DETAIL

Waking up upset. Your child may cry hard, thrash, arch their back, push you away, or look right through you without knowing who you are. Their eyes may be open while nobody is home behind them.

• This is the medicine wearing off. It is not pain, it is not fear, and it is not a change in your child.
• You cannot reason with a child during this, and trying tends to make it last longer.
• Keep them safe so they do not fall or hurt themselves. Dim the lights. Keep the room quiet. Fewer people, less talking.
• Most children settle before they leave us or shortly after getting home. Call us if it is still going strong hours later, or if you cannot keep your child safe.

No memory of the visit. Many children remember none of it. Some say strange or confused things for a while, or tell you about things that did not happen. Both are normal, and neither is a warning sign.

Hiccups. Common and harmless. They pass.

Dry mouth. Common. Small sips of water once your child is fully awake help more than anything else.

Emotional swings. Laughing, then sobbing, then laughing. This settles as the medicine clears.

Normal today versus call us

WHY WE GO SLOWLY WITH FOOD AND DRINK

Your child’s swallowing and coughing reflexes may not be all the way back yet, even when they look awake. Food or liquid can go down the wrong pipe and into the lungs. That is what the slow progression on the sheet we texted you is protecting against.

It is also why we do not force fluids. A full stomach on top of sedation tends to come back up, and a child who is made to drink usually throws up and ends up further behind.

Nothing hot today. If your child also had numbing medicine, a numb mouth cannot feel a burn.

MORE ABOUT THE RIDE HOME

The instruction sheet has what you needed in the parking lot. This is the rest of it, for next time.

Two people.

• If your child still rides in a car safety seat and one adult is driving, we want two adults in the car. One drives. The other sits in the back, next to your child, and watches.
• If you have no second adult, tell us before the appointment day. We will keep your child here longer and watch them until they are more awake. Do not just show up alone and hope.
• Older children who no longer use a car safety seat still need an adult who is not the driver, if you can manage it.

Head and airway.

• The watching adult should be able to see your child’s face, not the top of their head.
• Keep the chin off the chest. A chin sunk down onto the chest is the position that closes the airway.
• If the head flops sideways, put a rolled towel or blanket along each side of the head to hold it upright.
• Never put anything behind the neck or under the chin. That pushes the chin down and makes it worse.
• Never add padding underneath or behind your child that did not come with the car seat.
• Use the most reclined setting your car seat allows for your child’s size. Check your car seat manual.
• Stop the car if breathing sounds noisy, if you cannot see the face, or if you need both hands to help. Pull over. Do not reach back while driving.
• If your child’s breathing changes or their color changes, stop and call 911.

Once you are home. Take your child out of the car seat. Do not let them finish their nap in it. Car seats are safe in a moving car. They are not a safe place to sleep anywhere else.

THE REST OF THE DAY

Bathing and water.

• Tonight, a sponge bath or a washcloth is the easiest choice.
• If your child bathes or showers, an adult stays in the bathroom with hands on a small child. Do not step out for a towel.
• No swimming for 24 hours. No pool, no lake, no bathtub alone, no hot tub. Balance and reflexes are not back yet.

Moving around.

• Hold your child’s hand on stairs, or carry them.
• Expect walking to look unsteady.
• No bikes, scooters, skateboards, trampolines, playground equipment, or sports for 24 hours.
• No climbing on furniture.

Screens.

• Screens are fine, and a quiet movie is a good way to pass a slow afternoon. There is no screen restriction today.
• One caution: if your child feels sick to their stomach, a screen can make it worse. Turn it off and dim the room.
• A screen is not a babysitter today. You still need eyes on your child.

For older kids and teens.

• No driving for at least 24 hours.
• No cooking on a stove, no power tools, no machinery, no lawn mower.
• No job, no practice, no games today.

CAN MY CHILD GO TO SCHOOL TOMORROW?

Usually yes, if all three of these are true in the morning:

1. Your child is walking steadily, not unsteady.
2. Your child is eating and drinking normally.
3. Your child is acting like themselves again.

If any one of those is still off, keep your child home and try the next day. Plenty of children are ready the next morning. Some need an extra day, and that is not a problem.

• No PE, no recess climbing, and no sports until a full 24 hours have passed since the medicine.
• The sheet for the dental work itself may have its own rule about food or activity. Follow that one too.
• If you need a note for school, daycare, or your own work, call the office and we will write one.

MEDICINE: THE FULL LIST TO AVOID TODAY

The sedation medicine is still in your child’s body even after they look awake. Anything else that makes a child drowsy stacks on top of it and can slow their breathing.

Give nothing except what we told you to give. If it is not written on your instruction sheet, ask us first.

• Any more of the sedation medicine. Never. Sedation medicine is only ever given here, with our staff watching your child. Children have died when a sedating medicine was given at home.
• Codeine. We do not use codeine for pain after a procedure in children. Some children turn codeine into a much stronger drug than expected, which can slow breathing dangerously. The same goes for tramadol.
• Allergy medicine that causes sleep, such as diphenhydramine (Benadryl).
• Cough and cold medicine of any kind.
• Motion sickness medicine.
• Melatonin or any other sleep aid.
• Herbal or supplement products, especially kava and valerian. Both add to the sedation. Kava can also be hard on the liver when it is taken with acetaminophen.
• Leftover prescription medicine from another child, another illness, or another time.

Never give aspirin to a child unless a doctor told you to.

For pain, use the pain medicine card we sent you. If you do not have it, reply to this message and we will send it again. Do not guess at a dose. The card is the only place we print amounts, on purpose, so there is one set of numbers instead of several. Two things are different today: wait until your child is fully awake before the first dose, and give only what we wrote down for you.

If you were given an antibiotic: finish the whole thing, even after your child feels fine.

If your child gets any medicine you did not mean to give, or gets too much: call Poison Control at 1-800-222-1222 right away. They answer 24 hours a day, it is free, and you are not in trouble. If your child is having trouble breathing or you cannot wake them, call 911 first.

WHEN TO CALL US, THE FULL LIST

The red flags on the sheet we texted you are the ones that cannot wait. This is the fuller list. Call us any time you are worried, even if nothing here matches. You will not be bothering us. It is easier for us to answer a question at 9pm than to fix a problem at 2am.

Go to the ER or call 911 for any of these:

• Trouble breathing or trouble swallowing
• Your child stops breathing, even briefly
• You cannot wake your child at all
• Lips, gums, or face look blue, gray, or dusky
• Your child is limp and will not hold their head up while awake
• Swelling spreading below the jawline into the neck
• The floor of the mouth, under the tongue, looks puffy or feels firm
• A muffled voice
• Drooling and not able to swallow
• Stiff neck
• Confusion, or being hard to wake

Call us right away if:

• Your child gets harder to wake each time, instead of easier.
• Four hours after you get home, your child still cannot stay awake for 20 minutes when you sit them up in a quiet room.
• New snoring, or noisy rattly breathing that was not there before today.
• Your child has a fever of 100.4°F (38°C) or higher.
• Throwing up is still going 2 hours after you get home.
• Vomit has blood in it, or looks green.
• Your child cannot keep any liquid down for 4 hours.
• No pee, or no wet diaper, in 8 hours.
• Crying and thrashing cannot be settled, your child cannot be kept safe, or it is still severe hours after getting home.

Call us today or tomorrow if:

• Numbness is still there 12 hours after the appointment.
• Anything about your child still worries you in the morning.

If we sent you home with more than one sheet today, use the throwing up and drinking rules on the conscious sedation sheet. They are the stricter ones, and today is a sedation day. The conscious sedation sheet covers waking, breathing, throwing up, and drinking. The other sheet covers the mouth.

WHAT WE CHECKED BEFORE WE LET YOU LEAVE

We do not send a child home until all of these are true. It is the same list you are watching at home.

1. Breathing and heart rate are steady, and the airway is open.
2. Your child is easy to wake, and can protect their own airway.
3. Your child can talk, if they are old enough to talk.
4. Your child can sit up without help, if they are old enough to sit up.
5. For a very young child, or a child who does not do these things at baseline, your child is back to how they normally are.
6. Your child has had enough fluid.

Reviewed August 2026