Having a child undergoing surgery can be anxiety provoking for both child and parent alike. Children of all age groups cope better with unusual situations if they have an idea of what is going to happen and why it is necessary. If a child is not prepared, the whole experience can be a traumatic one.
General information regarding medications and supplements to avoid before an operation, and fasting times, can be found by following this link.
We would recommend talking to your child truthfully about why they need to come into hospital, as this gives them time to ask questions and prepare. How you approach this, and in what timeframe, will depend on the age of your child:
The worst thing a parent can do before surgery is to not prepare their child at all. The change in routine, being surrounded by unfamiliar people, being given an anaesthetic and waking up without any understanding of why they might be in some discomfort, can be confronting and traumatic for a child. Children may then understandably act out, and be left with a fear of hospitals, doctors, nurses, and health care in general.
Children take cues from their parents. They look to their parents to know what to expect and how to respond. Many children will adopt their parent’s attitude about healthcare and surgery. If you are prepared and confident, you will be better able to prepare your child and help them to feel more confident and reassured as well.
Make sure you are comfortable with what is going to happen, and if unsure, feel free to ask questions of your surgeon, hospital, and anaesthetist.
It is also important that your body language matches your words. If a parent is saying, “It’s going to be OK,” but their body language says, “I’m terrified”, the child will usually adopt the attitude of fear.
Hospitals have evolved from the days of whisking a child away and not allowing parents to stay, to being a family friendly environment as much as possible. One parent can generally stay at all times except during the operation and in the recovery room. A bed will be provided for a parent staying overnight. On the ward, you will shown the play room and kitchenette.
On the day of surgery bring in:
Make sure you:
Pre-medicating children prior to surgery is rarely required. Occasionally, because of circumstances such as autism, or high anxiety, this may be appropriate. If you think your child might benefit from pre-medication based on past experience, make sure you talk to the anaesthetist prior to the day of surgery.
Younger children will usually have a “gas induction”. An anaesthetic gas agent such as Sevofluorane will be used via a mask gently held near your child’s face. As they breathe the anaesthetic, they drift off to sleep. They often go through a wriggly phase, which can look unusual, but is a normal phase of going to sleep, just more noticeable with an anaesthetic. It is unusual to use muscle relaxants and mechanical ventilation in children – they are kept in a plane of anaesthesia where they are unaware, but still breathing for themselves.
Older children will typically have anaesthetic cream applied to their hands and arms, to allow placement of a drip cannula with minimal discomfort. Anaesthesia can then be induced with intravenous medications, quickly and safely.
Anaesthesia for children is very safe, and life threatening complications very rare. You anaesthetist will discuss the appropriate method and potential complications associated with anaesthesia, in most cases on the day of surgery.
The recovery room is designed to support patients until they are safely over the effects of the anaesthetic, and to ensure pain relief is adequate prior to return to the ward. There is a high ratio of nursing staff to patients at all times. As soon as your child is awake, they are returned to the ward. In general, parents are not allowed in the recovery area, in view of other patient’s privacy and to minimise disruption to the high level care that is required. Occasionally exceptions will be made, if the child requires additional comfort during this period.
It is a good idea to bring a favourite toy, and this can be left on their bed in the operating room, so they have something familiar when they wake up.
Immediately after surgery, preschool children are often irritable and more difficult to deal with than normal. Often they have a further snooze, as anaesthetic effects wear off, and then wake up in a more alert state.
Some children go through a phase of “emergence delirium”, which can be quite confronting for parents. This occurs as the body is awake, but the brain hasn’t quite caught up yet. They can look quite distressed and inconsolable, but will often “snap out” of the delirium after a finite time. Having this once does not imply it will happen again at the next anaesthetic, and vice versa.
During longer term recovery, children go through an adjustment period. Each child is different, and how they respond to the experience of surgery and any discomfort afterwards will vary, just like in adults. Preschoolers will often be more difficult to deal with than is normal, and may become clingy. As difficult as it may be, it is important to exhibit patience with your child during this trying time. This will settle as your child’s life returns to normal. Additional support from friends or family during this stressful time, can be very helpful.
Sometimes, night terrors are seen for 1 to 2 weeks. This is more prevalent in children who have tonsils and adenoids out for airway obstruction, as their brain has “catch up” deep (REM) sleep, that they had previously been missing out on.
