Helping your child prepare for an operation

by Dr Judith Short. With a little forward planning, your child’s hospital treatment need not be a stressful experience. Here are some tips for making it as easy and relaxed as possible.

Child sleeping with parents hand comforting him

Introduction

As a children's anaesthetist and parent of two small children (both of whom have needed operations), I am very aware of how anxious parents can feel when their children are facing anaesthesia and surgery.

Many children may also become very anxious themselves and this can often make their hospital visit much more difficult to manage than if they are calm and accepting of the care they need. So what can we do to help make a child's experience in hospital as easy and relaxed as possible?

Children very easily pick up on their parents' feelings, so one of the most important things you can do to help your child is to remain calm and relaxed yourself. This may be easier said than done - especially if you are unsure about exactly what might happen at the hospital - but finding out as much as you can beforehand often helps.

Many hospitals send out information in advance to help you plan ahead, and many have websites which provide additional details. Information about the anaesthetic may include discussing your options and advice about pain relief after the operation. If your hospital does not send out this information routinely, see the links to the Royal College of Anaesthetists' patient information website to the right of this page.

Preparation

It may be tempting not to talk to your child very much about their visit to the hospital because you feel that this will spare them some worry. But children who have not been prepared for anaesthesia and surgery often find the experience much more difficult than those that have worked through their concerns in advance.

Parents and caregivers often tend to underestimate how much children can understand about their medical conditions and their treatment, and it is important not to let children get confused by providing little or no information. Sometimes it can be hard to find the right words to describe what might happen, especially if you have never had an operation yourself.

Many hospitals offer families the opportunity for a pre-admission visit to the hospital, with a tour of the ward and operating theatres. This can be a very useful way to become familiar with the people and places you will see on the day of the operation.

In general, children benefit from simple, honest and reassuring explanations about the things that will happen at the hospital and the people they will meet. It helps to encourage your child to talk about the operation and ask questions. They may wish to act out the hospital visit as a story using their favourite toys, and may enjoy helping to pack their hospital bag.

The best timing for these discussions varies with the age and stage of development of your child. Children aged 2-3 years old should be told about the hospital visit 2-3 days before, and then again on the day; whereas for children aged 4-7 years, up to a week in advance is appropriate.

Older children and young people have usually been more involved in making decisions about the operation or investigation and so you are likely to have been talking about it for weeks before the day of admission.

More information

Having an anaesthetic

For many parents and children the main concern is having an anaesthetic. Here are some things that you could say to help reassure your child about the whole process:

  • Anaesthesia is a very deep sleep (unconsciousness) caused by medicines, which means you cannot hear, see or feel anything while an operation or test is being done.
  • You can usually have 'magic cream' on your hands or arms which helps to stop injections from hurting.
  • There are two ways to go to sleep - with an injection in your hand or with a mask full of sleepy air. Sometimes the anaesthetist has to say which way is best, but it might be possible to choose.
  • The anaesthetist is a doctor who stays with you all the way through the operation to look after you. The anaesthetist uses lots of monitoring equipment to help keep you safe.
  • You get anaesthetic medicine all the way through the operation to make sure you stay asleep. It is turned off when the operation has finished and you wake up about five minutes later.
  • Usually a parent can be there as you go to sleep and will be with you again when you wake up.
  • You will get medicines to stop you from feeling sore or sick when you wake up, but the nurses can always give more medicine if you need it.

You and your child will usually be visited by the anaesthetist before the operation. They will assess your child and make a plan for the anaesthetic and will give you the opportunity to ask questions about your child's care. If your child is still very anxious, the anaesthetist may arrange for them to have some sedative medicine to help them feel more relaxed before the start of the anaesthetic.

Children with special needs

If your child has special needs, you are likely to have extra concern. It is common for children with special needs to need hospital care, even if it is just to have investigations or dental treatment under anaesthetic.

Many children with special needs find visiting the hospital a challenge and may find it difficult to tolerate or cooperate with medical procedures. This may be due to a number of factors - the discomfort associated with fasting before an anaesthetic, the loss of normal daily routine, being in an unfamiliar environment with unfamiliar people or a simple lack of understanding of what is happening and why.

You may be worried that your child could become distressed and be unsure how well the medical and nursing staff will be able to deal with your child's particular needs and preferences.

The 'general information' resources available for children may not be suitable for those with special needs, but it is still possible to help children with challenges prepare for a hospital visit. It is clear that every child has individual abilities and needs, and there will never be a single method of communication or preparation to suit everyone.

Some children with Autistic Spectrum Disorder may benefit from a 'social story' to help them to understand what is expected of them at the hospital. Other children with a learning disability may have the ability to understand the concept of 'now' and 'next' - even if they cannot grasp a complex series of procedures all at once.

Breaking down the visit to hospital into a series of steps and presenting them in the form of a time-line (which is something often used in schools), can help children to manage one procedure at a time. You can illustrate such time-lines with symbols or pictures, and use them both for preparation and to help focus the activities at the hospital on the day.

Steps in a time-line for day surgery might include:

  • Not having breakfast, but having any usual medicines and a drink of water
  • Checking in at the hospital
  • Meeting a nurse and then being weighed
  • Having a name band put on the wrist
  • Meeting a doctor
  • Having 'magic cream' put on the hands
  • Waiting and playing
  • Putting on a hospital gown or pyjamas
  • Taking some medicine and then going to sleep
  • Waking up and then having something to eat and drink
  • Going home

Talk to the hospital

Some children, particularly those with Autistic Spectrum Disorders, can become very agitated and distressed if they lose their normal routine and are exposed to unfamiliar places and people. The staff members looking after your child at the hospital will wish to cause as little upset to your child as possible, but will need to know about your child's needs and preferences in order to tailor their care appropriately.

When you know that your child will need to be admitted to hospital, it is a good idea to telephone the ward and talk to the staff. Many hospitals will have a check-list of details to discuss with you, so that they can be ready to look after you and your child when you arrive.

Although it is not always possible, surgeons and anaesthetists will usually try to put children with special needs first on operating lists, to reduce the amount of time they have to go without food and to keep waiting times to a minimum.

It may also be possible to provide quiet waiting areas for children who find busy open spaces difficult, and to provide side-rooms for children who need to stay in hospital. The staff will need to know if your child needs constant supervision so that they can be prepared to provide the appropriate care if you need to leave them to take a comfort break.

Providing the best care is usually a team effort between the healthcare providers and yourselves, as you know your child best – e.g. you will be able to help make decisions about the need for sedative medicine before an anaesthetic or a medical test.

For many families, their child's hospital treatment can be one of the most stressful episodes in their lives. With a little forward planning and preparation, the potential anxiety and distress for all concerned can be greatly reduced.

How CBeebies can help

My Story Online could be used as a tool to help you and your child prepare for an operation or stay in hospital. Templates and stickers could help you explain what is going to happen in hospital and talk about any fears and worries that your child may have. Pick the templates that best suit your situation, here are some suggestions that may help:

Ask your child to fill in a My Day page about what they think a day in hospital will be like. This is a good way to begin a conversation about what’s going to happen and to find out about any fears and anxieties your child has.

Create a timeline using a My Day page to break the hospital visit into a series of steps. I.e. not having breakfast in the morning, meeting the nurse, and being given medicine. A timeline is particularly helpful for children who find it difficult to cope with changes in routine, but can also be a useful discussion tool for all children.

The I wish and I feel pages can be used to discuss fears and anxieties and also the positive aspects of the hospital visit, i.e. being in hospital will make me feel better.

All of these, and other, templates can be printed out for your child to fill in during their hospital stay.

Use food and play pages to record the meals they ate and toys they played with in hospital. Use My Favourite Things and Things I Don’t Like pages to record the positives and negatives of their hospital experience.
Use My Day when you return home to talk about what happened- how did their experience compare with what your child thought it would be like.
Use My Day to talk about any changes in daily routine and what to expect throughout a period of recovery.

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Expert opinion

It may be tempting not to talk to your child very much about their visit to the hospital because you feel that this will spare them some worry. But children who have not been prepared for anaesthesia and surgery often find the experience much more difficult than those that have worked through their concerns in advance.

In general, children benefit from simple, honest and reassuring explanations about the things that will happen at the hospital and the people they will meet. It helps to encourage your child to talk about the operation and ask questions. They may wish to act out the hospital visit as a story using their favourite toys, and may enjoy helping to pack their hospital bag. 

Dr Judith Short, Consultant Paediatric Anaesthetist, Sheffield Children's Hospital

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