Communication and preparation help to ease anxiety
by Dr. Amber Hoffman
You’ve met with your child’s medical team and consulted with the surgeon. You’ve asked all the important questions and understand the risks. But mental, emotional and practical preparation is also important to reduce uncertainty and anxiety—for both parents and young patients. Children cope better if they have an idea of what’s going to happen. To do that, parents must have a good understanding themselves of what to expect. First, be familiar with common complications, such as blood loss and infection. There are also risks from being under anesthesia. If anyone in your family has had severe complications with anesthesia, like malignant hyperthermia, it would be very important for the anesthesiologist to know. This is a condition that is usually inherited. People with malignant hyperthermia can develop a severe fever and problems with their muscles and organs when exposed to some anesthetics. Anesthesiologists can choose different anesthetics if this is a concern. If your child develops an illness prior to surgery, especially one that involves their lungs, the surgery may need to be rescheduled. Anesthesia can pose more risks to a child with recent lung problems so it is better to wait until they recover fully. This can be frustrating for families in the winter cold and flu season, but it helps if you understand why the delay is necessary.
Many questions about surgery are difficult to answer precisely, but your medical team will be able to give you generalizations. Before surgery, find out the average time the surgery will take, and how long
to expect your child will be in recovery post-op. Kids often want to know about receiving injections, whether surgery will hurt even if they are asleep, what they will feel like when they wake up, what their surroundings will be when surgery is over, and how soon they can see Mom or Dad afterward. Depending on the age of your child, simple answers to these questions wil
l help eliminate the unknown and reduce pre-surgery anxiety. If your child will need to be admitted after surgery, find out how long the stay may be. This gives you time to prepare for being off of work, to arrange child care for your other children, and also take care of any important tasks that may happen while you are away, like paying bills. If you are staying overnight or for a few days, pack a bag for yourself and your child to make your stay more comfortable. Don’t forget to pack your own medications if you have them. Give your child a sense of how long they will be away from home. Help them choose important comfort items to pack, like a favorite stuffed animal or a picture of their whole family to keep close by. For school-age kids, they may want to gather necessary schoolwork in advance so they don’t fall behind or they may want to communicate with a special friend about visits if permitted.
In the days leading up to the surgery, make sure that you know when your child should last eat or drink and what medications are okay to give on the morning of surgery. For example, you may be told to give your child their seizure medications, but not their vitamin or calcium supplement. You want your child’s stomach to be as empty as possible so that they do not throw up when they have anesthesia. This could cause them to inhale the vomit into their lungs which can cause severe breathing problems. It can be hard to keep your child from eating and drinking as many of them do not understand why they cannot. This can become more challenging if your child’s surgery is delayed. Just try to remember that it is for their safety and it is short term. If you give in to letting them eat and drink, their surgery will likely be canceled and they will have to go through the process all over again.
When kids have surgery, their intestines tend to slow down. If they have constipation at baseline, it can get worse after surgery, especially if they need narcotic pain medications. You can help make this better by potentially having your child take extra medications prior to surgery to help clean out their bowels. That way they do not go to the hospital already backed-up. Constipation can make children feel miserable after surgery, especially if they are having surgery in their abdomen.
It can be nerve-wracking for everyone once you arrive at the hospital and are waiting for surgery to begin. Come prepared with things to occupy and distract both children and parents—toys, books, or a personal tablet with music, movies or games. While your child is in surgery, minutes can seem like hours and parents also need a distraction can help pass the time. Cut coupons, knit, read a book, listen to music. Bring snacks or food with you as well. If you need to leave the waiting room for any reason, let the staff know where you are going, how to contact you, and when you will be back. This helps if your cell phone coverage is spotty. During your child’s surgery and hospitalization, parents often forget to take care of themselves. Do not be shy, ask about resources for parents and families. Many hospitals have hospitality areas or Ronald McDonald rooms where caregivers can get food and drinks for free.
When your child comes out of surgery, they may be very sleepy and say or do unusual things. This is common and the staff in the recovery room can assess your child for any more concerning behaviors. Some children wake up from anesthesia and have the opposite response. They may cry, yell, or be very aggressive. This too will pass, but it can be challenging to watch. Kids tend to do better when they are in a dark, quiet room. Children may vomit after surgery and there are medications that can help with this. Depending on what type of surgery your child had, they may not be able to eat or drink right away. It is best to start off slowly once it is safe for them to drink and eat. They may think they want a cheeseburger, but it’s better
to steer them to something that is gentler on their stomach.
They may also come out of surgery on some supplemental oxygen. This generally happens because they are not breathing deep or coughing while they are under anesthesia. They can develop something called atelectasis which is when the air sacs in the lungs are not fully inflated. Deep breathing and coughing generally resolve this problem quickly.
Pain medications are sometimes ordered to be given on a set schedule; other times pain medications are ordered to be given as needed. For children who have surgeries that are likely going to cause severe pain, they may have a continuous IV pain medication infusion set up. If you are concerned that your child is having pain, please ask for medications for them. Many children have fevers after surgery, but they tend to go away in 24 to 48 hours. If a fever persists, or if the child looks ill, then your doctors may look for other causes of fever. While surgery is never fun, knowing what to expect before, during and after helps parents and kids prepare. In addition, good age-appropriate communication delivered at the right time goes a long way to easing everyone’s anxiety. Get more tips from these online resources:
Amber Hoffman, MD, specializes in caring for children with special health care needs. Dr.Hoffman is the Medical Director of the Beacon Program at Children’s Mercy Hospital, which provides a patient-centered primary care medical home for children with the most complex special needs and their siblings. Dr. Hoffman began her medical career in 2002 and she has been recognized as Best Doctor by the Kansas City Business Journal and Best Doctors in America by Best Doctors, Inc. Contact Beacon Program and Clinic: 816-960-8040, firstname.lastname@example.org