Preparing For Pediatric Surgery

What part about surgery is most stressful for an infant? Recognizing what is stressful to infants can guide you in planning for your baby's surgery. Infants may become upset about:

• Separation from parents
• Having many different caregivers
• Seeing strange sights, sounds, and smells
• New and different routines
• Interrupted sleep
• Day and night confusion

How do I prepare my infant for surgery?

• It is important to keep your baby's routine the same before the day of surgery.
• Make sure you, your baby, and your family are well rested.
• Bring your baby's favorite security item and soothing music to the hospital to create a more familiar environment for your baby. Make a tape of your voice reading or singing for the nursing staff to play when you are not there.
• Let the nursing staff know what your baby's usual schedule is, including sleep patterns and feeding habits.
• Make plans for at least one parent to be with your baby as much as possible so that he or she will have a familiar touch, voice, and smile.
• Most important, try to remain calm. Your baby will sense if you are frightened or stressed.
• Be well informed about what to expect on the day of surgery and ask questions to alleviate any fears you might have. Relaxed, nonverbal communication such as voice, facial expressions, gestures, and body language can give positive assurance to your baby.
• Be patient with your baby. It is normal for him or her to cry and be fussy during this stressful time. Your baby may be very clingy or hard to comfort.
• The brief period before surgery when the baby cannot eat or drink can be difficult. Plan to distract, rock, walk, and comfort him or her during this time.
• Take care of yourself. Simplify your life; do not be afraid to ask for help from family and friends. Remaining positive and calm can help reduce your baby's anxiety.

At the Family Surgery Program at Atlantic Health System Children's Health, physician services are provided by Atlantic Medical Group and are on staff at Goryeb Children's Hospital.

What part about surgery is most stressful for a preschool child?

Understanding what might be stressful to your preschool child while he or she is in the hospital can help you prepare for the surgical experience. Children are often worried about:

• Being away from family and home, or of being left alone.
• Having a part of the body damaged
• Needles and shots
• Waking up during surgery
• Pain
• Being in the dark

How do I prepare my preschool child for surgery?

Preschool-aged children can certainly benefit from preoperative planning, education, and explanations provided several days before the procedure:

• Preschoolers fear the unknown. Your child should be told about surgery several days in advance and visit the hospital for a tour. Learning about the hospital provides time to talk about concerns and ask questions. Contact the hospital's child life department for this service.
• Tell the truth in simple terms and answer all of your child's questions. For example, "Yes, it will hurt, but it will not last long."
• Make sure your child understands the reason for surgery. Often, preschool children think they have done something wrong or that needles are given to kids who are "bad."
• Dramatic play is a big part of a preschooler's life. Use pictures, stuffed animals, or toys to help your child understand is better than simply telling him/her what will happen. Ask a child life specialist to help explain what will happen, and why, in terms your child can understand. Also try therapeutic play activities such as playing "hospital" with your child at home before he/she is admitted for the procedure.
• Give very simple explanations and use words carefully. For example, say, "The doctor is going to fix your arm." Do not say, "The doctor is going to make a cut on your arm." If you describe anesthesia as "being put to sleep," your preschooler may think of a family pet that died and wonder if he or she will die, too. A better way to phrase it: "A doctor will help you sleep (a different kind of sleep than how you sleep at night) during the operation, and wake you up after it is over."
• Your child may enjoy reading books about the hospital with the family.
• Allow your child to help pack his or her own suitcase. Be sure to pack a favorite toy and pictures of family and pets.
• Explain the benefits of the surgery in terms your child can understand. For example, "After the doctor fixes your arm, you can play ___ ."
• Learn as much as you can about your child's surgery. Children know when their parents are worried. The more you know, the better you will feel and the more you can help explain things to your child.
• Be with your child as often as possible to provide comfort and security.
• Be patient with your child. It is normal for him or her to require more attention, have tantrums or be uncooperative. It is not unusual for your child to return to bedwetting or thumb sucking. Regressive behavior should improve after the stress of the procedure has passed.
• Take care of yourself. Simplify your life; ask for help if you need it. Being positive can help reduce your child's anxiety.

At the Family Surgery Program at Atlantic Health System Children's Health, physician services are provided by Atlantic Medical Group and are on staff at Goryeb Children's Hospital.

When your child goes to the hospital, siblings may feel afraid, worried, or confused simply because they do not know what to expect, and may imagine the worst. They will also have to deal with being away from one or both parents, missing their brother or sister, or having to stay with other family or friends. Here are some of the feelings they might have:

• Loneliness: They miss having their brother or sister to play with, and their parents around to care for and comfort them.
• Abandonment: If they are not told about what is happening, brothers and sisters may feel like they are not important. They may worry about who will take care of them and may assume their needs will not be met.
• Jealousy: Brothers and sisters often wish that they were the ones getting all the attention or presents from family and friends, and may be resentful or jealous of their sibling.
• Guilt: Siblings may feel bad for having mean thoughts about their brother or sister, or feel like it is their fault their brother or sister is in the hospital. They might feel guilty for being healthy, when their brother or sister is ill.
• Fear: They might think they can "catch" something from the sick brother or sister. They may be afraid the sick child will not get well or will not ever come home.

How do I prepare my other children for their sibling’s surgery?

• Include siblings in conversations about the surgery - in words they can understand.
• Make sure your children know why their sibling is going to the hospital.
• Make sure brothers and sisters know that some other responsible adult will be caring for them during the time you have to be at the hospital, and that you will come back as soon as you can.
• Try to set aside private time for you and your children at home so that they can get some special attention.
• Read books about going to the hospital with the entire family.
• Give many compliments and hugs. Take extra time to notice good schoolwork or jobs done at home.
• Give the siblings the choice of visiting. If they choose to visit, help prepare them for what to expect. Always consult with the child life specialist.

What are signs of stress in children whose siblings are having surgery?

Children may react to stress by:

• Changing eating habits (eating less than usual, eating more than usual, or being picky about what he or she will eat)
• Not wanting to talk or be with family members
• Behaving “too good”
• Needing lots of hugs and attention
• Doing things to get in trouble and get attention
• Saying they feel sick too

How can I help the siblings at home?

• Let the child at home know that it is acceptable to be afraid and to cry.
• Tell the truth when you answer your children's questions, but be sure to use simple explanations your child can understand.
• Keep routines at home as normal as you can.
• Have your children at home draw pictures or make cards to send to the hospital.
• Set up times for your children to talk to each other on the phone or to visit at the hospital.
• Do not be afraid to ask family and friends to help. Simplify your life as much as possible. Remaining positive and calm can help the entire family.

As part of the Family Surgery Program at Atlantic Health System Children's Health, physician services are provided by Atlantic Medical Group and are on staff at Goryeb Children's Hospital.

What part about surgery is most stressful for a teenager?

Adolescents like to participate in decisions that affect their lives, including the kind of health care they receive. Parents need to partner with teens to make health care decisions. Recognizing the fears that teenagers have about surgery will help you in your preparations. Common fears include:

• Loss of control
• Being away from school and friends
• Having a part of his or her body damaged or changed in appearance
• Fear of surgery and its risks
• Pain
• Dying during surgery
• Fear of the unknown
• Fear of what others will think about them being sick or in the hospital

How do I prepare my teenager for surgery?

• Allow your teen to be part of the decision-making process. Encourage him or her to make a list of questions to ask the physicians and nurses.
• Your teen should start learning and preparing as soon as the decision to have surgery is made. Reading books and using the internet are good places to start.
• Child life specialists can provide age-appropriate explanations and assist teens in finding a variety of resources.
• Teenagers are often reluctant to admit that they do not understand explanations. Parents and health care professionals may need to explain treatment in several different ways, without making the teen feel uncomfortable.
• Ask friends from school to send cards or call during recovery.
• Your teen may find it helpful to write down his or her thoughts and feelings in a special notebook or journal.
• Encourage your teen to pick out and bring a few comfort items from home, such as books, hand-held video games, or a music player.
• During hospitalization, your teen may go through frequent mood swings. It is important to be patient and understanding. Your teen can become withdrawn and not want to talk or answer questions. There are times when he or she may need to be alone.
• Let your teen know that it is acceptable to be afraid and to cry. He or she might need to know you have the same worries they do. Reassure them of your support.
• Learn as much as you can about your teen's condition. Teens can tell when their parents are worried. The more you know, the better you will feel and will be able to help explain things.
• Be truthful when answering questions. Teenagers may become angry if they think people are keeping secrets from them. They need to understand what is wrong with their body. How the information is given is often as important as what information is given.
• Respect your teen’s need for privacy. Teens are often as private about their thoughts and feelings as they are about their bodies.

As part of the Family Surgery Program at Atlantic Health System Children's Health, physician services are provided by Atlantic Medical Group and are on staff at Goryeb Children's Hospital.

• You should follow all of the instructions that are given to you by your child's surgeon during the preoperative visit.
• Make arrangements for your other children to be cared for at home. 
• Before coming to the hospital, have your child remove any jewelry and nail polish – surgeons will monitor the color of the nail beds during and after surgery.

• Be sure to arrive on time or your child’s scheduled surgery may be delayed or even postponed.
• When you arrive at the hospital, your child will change into a hospital gown and receive a hospital identification bracelet with his/her name, birth date, and hospital number on it. A nurse will take your child’s vital signs including heart rate, respiratory rate, and blood pressure.
• Many of the same questions you have answered before will be asked again. This is a safety measure to insure that all the information in your child's record is correct. You will be asked about allergies, medications, and if your child has been exposed to any contagious diseases.
• Then an anesthesiologist will see your child to answer any questions and examine your child. A child life specialist will see your child to help prepare him/her for what to expect and to answer any questions your child may have. In most cases, your child's surgeon will see you to make sure your child is ready for the surgery.
• If your child has an allergy to medications or latex, make sure the staff places an allergy bracelet on him or her, and note the allergy on the hospital chart.
• When it is time for surgery, an operating room staff member will come to escort your child to the operating room. You may walk along side your child up to the operating room hallway. This is where you will give hugs, kisses, tell your child that you will be close by throughout the surgery, and that you will see him or her soon. Staff will verify child's identity once more and check the patient chart to make sure all information is correct. You will be directed where to wait while your child is in surgery. When the surgery is over, the surgeon will speak with you and let you know how the operation went.

After surgery, most children stay in the recovery room until the anesthesia wears off. Depending on the type of surgery, your child may be discharged or may go to:

• The hospital unit to recover for 24 hours or less.
• The pediatric hospital unit to recover for a few days.
• The pediatric intensive care unit to recover for a few hours or days, then to the pediatric hospital unit until time for discharge.