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What Happens When your Child Needs Surgery
From pre-op to post-op, here’s how to prepare for your child’s trip to the hospital
by: Sydney Loney
Children and Surgery
- Getting as much information as possible beforehand will help you feel less overwhelmed–you may even be able to take a virtual tour of the hospital's operating room.
- If your child is otherwise healthy and over three months, you may be able to accompany him into the OR until he is asleep.
- For years people thought infants didn't experience pain, but that is now known to be a myth–signs of pain in infants and small children include decreased movement, grimacing, irritability and crying.
- Although your child will have one-on-one nursing care in the recovery room, you can help make him feel better by distracting him with a favorite toy, book or game.
- Children under six kilograms may remain in the recovery room for at least four hours, while those over six kilograms could be discharged to the ward within an hour of waking up.
very parent hopes their child will be healthy, but the reality is children get sick and sometimes need surgery, requiring an anesthetic. "We probably anesthetize 18,000 infants and children a year," says Dr. Larry Roy, chief of the Department of Anesthesia at the Hospital for Sick Children in Toronto. Children can need elective surgery for everything from heart issues to hernias–here's what you should know about your child's trip to the OR.
Prepping for Your Child's Surgery
If your child needs elective surgery, it's important to educate yourself as much as possible about the procedure. The more you know, the calmer you will be and the better able to comfort and reassure your child.
1. Get informed: The first step is to take advantage of all the resources the hospital has to offer. Some children's hospitals provide detailed information packages, as well as an opportunity to attend a pre-operative clinic with a member of the department of anesthesiology. Pre-op clinics give you access to additional information, as well as an opportunity to ask questions either in person, by phone or video conference.
2. Take a tour: Many hospitals also provide information on their websites about what to expect during your child's visit and what resources are available to you during your stay. Some even include virtual tours of the operating room. Accessing this information will help you feel more prepared and less overwhelmed on the day of your child's surgery.
3. Know the risks: It's also important to understand the risks involved, says Dr. Roy. When it comes to anesthetizing a child, there is a risk of cardiac arrest, brain injury and death, but that risk is very small. In 1972, there was approximately one anesthesia-related death in every 10,000 anesthetics, whereas now that rate may be as low as one death in 150,000 anesthetics. "The good news is it's a lot safer now, largely due to new drugs, new technology and better education," he says.
At the Hospital and in the OR
Most children's hospitals believe parents should be involved in every aspect of care whenever possible, and that includes escorting their child into the operating room, says Dr. Roy. "For most elective surgeries in an otherwise healthy child over three months of age, parents may be allowed to accompany their child into the OR."
If you choose to be in the operating room, you'll likely have the opportunity to hold and comfort your child while he is hooked up to various monitors–you may even be able to help hold the mask as he goes to sleep. Once your child is asleep, you'll be escorted to a waiting room. "Having parents in the OR allows them to participate in the care," says Dr. Roy. "They get to take a look around, see the entire team of physicians involved, and it can be reassuring."
What Happens in the Recovery Room
As soon as your child is in the recovery room and stable, you'll be notified and brought in to be at his bedside as he wakes. Be ready to reassure and comfort him as he'll likely wake up confused and disoriented. Some children are simply groggy, others may cry or feel nauseous after the anesthetic. Your child may also feel some pain or discomfort.
Pain after surgery: "The problem is that when an adult undergoes surgery, they can vocalize their concerns once they're awake and tell someone that it hurts, whereas a three-month-old can't do that," says Dr. Roy. For years it was believed that infants didn't experience pain because their neurological systems weren't fully developed, but that is now known to be a myth, he says. Signs of pain in infants and small children include decreased movement, grimacing, irritability and crying.
Dealing with pain: "We assume a child will have pain and so we're very aggressive when it comes to treating it," says Dr. Roy. Patients who are exposed to substantial pain may have delayed healing, need to stay in hospital longer or may be more predisposed to infection. "There is lot of suggestion that by dealing with pain aggressively, the patient benefits. The goal is to have pain well managed for when the child wakes, so that they may feel no pain or discomfort at all." This is usually accomplished with a combination of pain management techniques, including medications such as rectal Tylenol and local anesthesia, such as freezing an incision.
Understanding your role: Although you'll likely have one-on-one nursing in the recovery room when your child first wakes up, parents also play an important role in the recovery process. "It helps to have the parents there all the time using diversion, toys, comfort–all of those things are key," says Dr. Roy. How long your child spends in the recovery room may depend on his size. Children under six kilograms may remain in the recovery room for at least four hours, while those over six kilograms could be discharged to the ward within an hour of waking up.
As your child recovers from surgery, your main role is to comfort them and be their advocate. "Parents should feel empowered to ask questions," says Dr. Roy. If you feel your questions aren't being answered or if you have any concerns, most children's hospitals have a patient representative you can talk to, while others even have a hotline you can access just by picking up the phone in your child's room. Asking questions and getting help will ensure your child is getting the best care possible.
Finally, if your child is staying in the hospital overnight, you can stay with them on a built-in, foldout bed. Having familiar things on hand, such as favorite toys, books or blankets can help make overnight stays easier for your child.
Meet our expert:
Dr. Lawrence Roy is a pediatric anesthesiologist at the Hospital for Sick Children in Toronto where he has spent the last eleven years as Chief of the Department of Anesthesia. Dr. Roy sponsored the development of the Divisional Centre of Pain Management and Pain Research and continues to champion the development of the Centre of Excellence for Pain Management and Research at SickKids. He served as Chair of Section on Pediatric Anesthesia, was a former president of the Canadian Pediatric Anesthesia Society and is a Clinical Teacher at the University of Toronto.
