Your child needs elective surgery, and a date has been scheduled. Unlike emergency surgery, an elective procedure is optional and isn't being done as a matter of life and death. Having an elective procedure gives you the time to prepare your child psychologically for the hospital and the surgery.
Adequate preparation can help your child feel less anxious about the anesthesia induction and surgery and get through the recovery period faster. But, like parents everywhere, you're probably uncertain about the best ways to prepare your child.
The job isn't as daunting as you may think. The key is in providing information at your child's level of understanding, correcting misconceptions, and dispelling fears and feelings of guilt. You need to help your child understand the physical problem that requires the surgery and become familiar with the hospital and some of the procedures he or she will undergo.
Children of all ages cope much better if they have some concrete idea of what's going to happen and why it's necessary. But, to do that, you need to prepare yourself first, and correct any misconceptions of your own.
Preparing Yourself
The horror stories you heard from grandparents and parents about traumatic parent/child separations and very limited hospital visiting hours belong to days gone by. Hospitals have changed enormously. For example, most surgeries performed on children are now "same-day" procedures requiring no overnight or prolonged stays; most kids are back home, in their own beds, the same night.
Furthermore, most U.S. hospitals permit at least one parent to stay beside the child at all times except while the surgeon is operating. After the surgery, you may return to your child in the recovery room. As your child awakens, he or she will assume you never left.
Ask the doctors, nurses, or staff for the information you need about what's to take place so that you can prepare your child and deal with your own fears or concerns. To parents, one of the most fearful aspects of surgery is anesthesia. In today's hospitals, anesthesiologists - who use modern, safe anesthetics and are assisted by extremely capable monitoring technology - administer anesthesia very safely.
In the few cases in which hospitalization is required overnight or longer, most hospitals avoid separation anxiety by permitting at least one parent to stay with the child day and night. Other close family members may be able to visit at the family's convenience (not just during limited visiting hours).
As soon as your child is able, he or she may be playing with other children, toys, and games in a children's recreation room - even if that involves taking along an IV bag on a rolling support.
Explain the Problem
Now that you're more at ease, start preparing your child. Begin by explaining the reason for the surgery in simple, nonthreatening words. Tell your child - at his or her level of understanding - about the medical problem and why surgery is necessary. Don't use alarming language, such as "the doctor will cut you," "open you up," or "sew you with a needle." Say that the doctor will fix the problem. You can also relieve your child's anxiety by telling him or her that many children have this problem and must get it fixed at the hospital.
Although children seldom express it, they may fear that their parents aren't telling them everything - that their health problem is worse than they've been led to believe. To build trust now and for the future, don't mislead your child - tell as much of the truth as your child can understand.
Dispel Fears
Your child will probably fear that the operation will be painful. It may help for parents to explain to their kids that a special doctor, called an anesthesiologist, will give them special medicine to make them sleep very deeply so they won't feel anything during the operation. Once the operation is finished, they'll wake up. (Older children, in particular, need special assurances that they will wake up.)
Again, avoid frightening language. In other words, don't say, "You'll be given gas" or "You'll be put to sleep." A child may confuse "gas" with the fuel that can poison or kill, and confuse "put to sleep" with what happened to the family pet.
Give assurance that you'll be there when your child wakes up - and a favorite toy can come along, too. Explain to your child that if anything hurts right after the operation, a doctor or nurse can give him or her medication that stops the pain.
Although the two greatest surgery-related fears of preschool children are the possibility of separation from (or abandonment by) parents and the possibility of pain, school-age children also fear needles, knives, and mutilation. Give a child in this age group clear, rational information as well as assurances that the surgery will only fix an existing problem, not create a new one. This is especially necessary if the surgery involves the genital area.
The fears of adolescents go well beyond those of younger children. In addition to pain, mutilation, and disfigurement, your teen is probably afraid of losing control, being embarrassed or humiliated in public, and sounding childish by expressing fear, anxiety, and pain. He or she may also be afraid of waking up during the operation - or not waking up afterward.
Be sure to anticipate these fears. Emphasize that expressing fear, anxiety, and response to pain is quite normal (and OK) at any age, even adulthood. Correct any misconceptions about disfigurement or injury. And assure an adolescent that anesthesia is very safe today and that he or she will not wake up during the operation but will certainly wake up afterward. Encourage your child to read about the present safety of anesthesia and to share the information with the family. Reading and sharing information is an excellent coping mechanism.
One further fear that affects children of all ages is being seen naked and having their "private parts" touched or probed. If the operation involves your child's genital or anal area, your child will cope better if you explain in advance that although it might be embarrassing and uncomfortable, several doctors and nurses will need to examine these private areas, especially to check if they're healing after the operation. Explain that doctors, nurses, and parents are the only exceptions to the rules about privacy.
Encourage your child's questions about the health problem and hospital experience, so that other fears and anxieties can be expressed. Take all questions seriously, and answer them to the best of your ability. Let your child know that the doctors and nurses will be very willing to answer questions, too.
Relieve Guilt
Children often believe that their medical problem and operation are really punishments for "being bad." They may not say so, but they may feel guilty and believe that they've brought these things on themselves.
Let your child know that the medical problem is not the result of anything he or she may have done or may have failed to do, and that the operation is not a punishment, but simply the way to "fix" the problem.
On the other hand, if the medical problem was caused by an accident that could have been avoided if your child had obeyed safety rules, then you can certainly acknowledge the cause-and-effect relationship without making it seem like a punishment. Make sure that your child understands the reason for the rules and will be careful about them in the future.
Explain What Will Happen
Read books, appropriate to your child's level of understanding, about what to expect at the hospital. Reading together and discussing the surgery will make the hospital seem less threatening. Discuss each idea, and encourage your child's questions.
In addition to books, a young child will benefit from practicing on a doll or stuffed teddy bear with toy doctor-kit "instruments." Your child can take the doll or bear's "temperature" and "pulse" and listen to its "heartbeat" and "breathing."
Remember, as you discuss the hospital and surgery, that not only your words, but nonverbal things communicate your assurance: your tone of voice, facial expressions, gestures, and body language convey powerful messages. If you appear fearful, your child is likely to feel fearful regardless of the words you use to explain things.
Go on a Pre-Operative Orientation and Tour
Today, most hospitals offer special pre-operative children's programs, family orientations, and hospital tours, conducted by specially trained nurses or licensed child-life specialists (a professional who's trained to talk to kids and teens about medical procedures, comfort them if they're upset about something or need some extra support, and organize "play time" for hospitalized kids and teens to get together and hang out).
Call the hospital for an appointment to a pre-operative tour, program, or orientation as far in advance as possible, preferably from the doctor's office when the appointment for the surgery is made. Attendance is suggested a few days before the surgery - it's not permitted on the day of surgery itself.
The purpose of the orientation program is to remove the mystery of the hospital for the child and family - to make the hospital familiar and friendly and the experience predictable. Be sure to attend whatever programs are offered to spare your child from fear of the unknown.
On the Day of Surgery
When you arrive at the family waiting room of the surgical unit, a child-life specialist may help your child rehearse coping skills. Then your child can play with toys and books (including a favorite toy brought from home) or sit on your lap and be cuddled during the waiting time.
After surgery, you'll be escorted to the recovery room to be with your child as he or she awakens. Upon your hospital departure, you'll receive instructions for further recuperation at home and for a follow-up visit to the surgeon.
During recovery, there may be times of discomfort for your child and it will be important to have been able to help him or her prepare for that possibility. For you to be prepared don't be shy about discussing possible outcomes with your child's surgeon prior to surgery.
Reviewed by: Barbara P. Homeier, MD
Date reviewed: January 2005
