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What is PICU Up!™?

PICU Up!™ is an early mobility program that aims to improve the health and well-being of children in intensive care.

Intensive care units (ICUs) provide life-saving care for critically ill children. Yet, lying still in an ICU bed for too long can cause muscle weakness and other negative outcomes. By making mobility part of ICU care, the PICU Up!™ Program can reduce those adverse effects.

Safe mobility for pediatric critical care

Everyone involved in your child’s care will take part in determining what is safe and beneficial for your child. In addition to a nurse and a physical or occupational therapist, your child’s PICU Up!™ team may include physicians, child life therapists, speech-language pathologists, and any other specialists involved in their care.

Benefits of the PICU Up!™ Program

  • Decrease length of stay
  • Prevent pressure injuries (bed sores)
  • Decrease delirium (from sedation or sleep interruption)
  • May help shorten time under sedation
  • Empower family caregivers to take part in their child’s care

How we make mobility part of ICU patient care

We work to set individual mobility goals for each child based on their medical stability and stage of development. A goal for a patient under sedation may be gentle range-of-motion exercises with the aid of a therapist, while another patient may be able to sit up, play a game, or get out of bed. 

Each day, a team of specially trained nurses and respiratory, occupational, and physical therapists will reassess your child’s mobility goals based on their medical status and how they responded to their goal the day before. You and each of the specialists involved in your child’s care (for instance, heart doctor, lung doctor, anesthesiologist) are part of the team that agrees upon mobility goals for your child. In many cases, you’ll also help your child achieve their goals.

Frequently asked questions

PICU Up!™ is part of patient care in every ICU at Boston Children’s Hospital, and we consider every child in the ICU for the program. To ensure patient safety, we take into account any medical restrictions that would make mobilization unsafe. For that reason, patients need to meet the following criteria to be eligible:

  • Medically stable enough to be moved
  • Infants not born before 34 weeks of gestational age

For reasons of effectiveness, we offer this program for patients expected to be in the ICU for three days or longer.

We’ll involve you in your child’s mobility activities whenever possible. This may include holding your child or reading to them. As your child’s health improves, you may be able to play games with them or take them for walks around the unit. We’ve found both patients and families benefit from being able to engage with each other in this way.

A team of specially trained nurses, and respiratory, physical, and occupational therapists along with the specialists involved in your child’s care will discuss what level of mobility is appropriate based on your child’s medical status, age, and stage of development. Only when you and every member of your child’s team agrees that an activity is safe will we move forward with engaging your child in that activity.

Your child may not be meet their mobility goals every day — sometimes even ones they met the day before. This is not unusual in the ICU. Every day, members of our team will review your child’s mobility and modify their goals in line with their current capability.

We carefully assess the risks of any proposed activity for every patient. If the risks are too great, for instance, if a patient is at risk of pulling out lines or tubes, is easily agitated, or is on certain medications, we may recommend delaying mobility activities. In such cases, we may recommend talking softly to your child and gentle touch.

PICU Up!™ resources for families