Preparing a child for surgery – Instructional Guide

The Paediatric Patient

What is the operating room like?

The operating room can be a scary place, with unfamiliar equipment and people dressed in strange outfits. If your child visits the hospital before surgery, a child life specialist can show him or her some of the equipment. A child life specialist is trained in the growth and developmental needs of children.

One thing your child will need to know is that people in the operating room will be wearing surgical clothes. This is done to help prevent germs from infecting the surgical incision.

Surgical clothing may include:

• A protective cap covering their hair
• Masks covering their mouths and noses
• Shades or glasses over their eyes
• Gloves on their hands
• Long gowns
• Protective covers on their shoes

The surgeon may also wear special glasses that help him or her see more clearly.

Children need to be aware that the people in the operating room will be wearing this clothing. They can become frightened if not aware that the staff will be wearing strange clothes. If your child is able to visit the hospital before surgery, ask if he or she can play with the gloves, mask, and cap so they are not so scary.

Things to Avoid Saying Before Surgery

Children are very sensitive to the words used to explain what surgery is, what will happen and how surgery is performed. These are some key phrases to avoid using, as children are prone to misinterpreting what is being said.

1. They will give you “gas” – To children, gas is something that we put in cars or a rude substance that comes from one’s bottom.
2. “Anesthetize” – This word sounds like euthanize and can cause problems if your child knows the word euthanize, searches the internet or hears the word euthanize used in another setting. Anesthesia is a foreign word to children and needs to be explained. 
3. They will give you medicine to “knock you out” – To most people, being knocked out means being hit hard enough to be rendered unconscious.
4. “The doctor is going to make you take a nap” or “It’s just like bedtime” – Try to avoid confusing surgery with a normal daily ritual at home. If your child is afraid of surgery, they could become afraid of naps at home. It could also lead to fears of waking prior to the end of surgery.
5. “You will be put to sleep” – Many children are aware that when we put animals to sleep they die and may assume they too will die.
6. “You won’t wake up” – It is important to stress that they will sleep through the surgery without feeling pain, but that they will wake after surgery is completed. Children fear both never waking and waking during the procedure.
7. “Be a big boy and don’t cry” – Children need to be encouraged to talk about their fears prior to surgery and their pain after surgery. Surgery is scary and children need to be encouraged to discuss their fears so they can be discussed and alleviated.
8. “It is just like on TV” – Surgery isn’t like the surgeries on TV, where actors jump on top of patients and perform CPR and patients die after the less than successful heroics of the fictional staff.

Learning about the operating room equipment

The following is a brief list of equipment your child may see in the operating room. However, each operating room varies depending on the type of surgery being done. Also, many children are given medicine to help them sleep before going to surgery, and may not be awake enough to notice the equipment.

• The operating table in the center of the room can be raised, lowered, and tilted in any direction.
• The operating room lights are over the table to provide bright light, without shadows, during surgery.
• The anesthesia machine is at the head of the operating table. This machine has tubes that connect to the patient to help him or her breathe. Built-in monitors help control the mixture of gases in the breathing circuit. They also measure the child’s heart rate and blood pressure.
• The anesthesia cart is next to the anesthesia machine. It contains the medicines, equipment, and other supplies that the anesthesiologist may need.
• Sterile instruments to be used during surgery are arranged on a stainless steel table.
• Adhesive patches are placed on his or her chest to measure the heart rate and breathing rate of your child. They connect to the monitor.
• The pulse oximeter machine attaches to the patient’s finger with an elastic band aid. It measures how much oxygen is in the blood.
• There will be a blood pressure measuring machine that automatically inflates the blood pressure cuff on your child’s arm.
• An electrocautery machine uses high-frequency electrical signals to cauterize or seal off blood vessels. They may also be used to cut through tissue with a minimal amount of bleeding.
• If needed, a heart-lung machine or other specialized equipment may be in the room.

If your child is awake and still has questions about the equipment once he or she goes into surgery, the surgical staff can answer them. Ask the child life specialist what words to use to describe the operating room equipment to your child’s ideas.

Things Your Child Should Know

Children are very wary of surgery and may have questions or concerns that they never mention. These are important topics that you may want to address before your child has surgery, depending upon their age.

1. Anesthesia prevents pain during surgery.
2. You are not having surgery because you were bad, surgery is not a punishment.
3. If there is pain after surgery, medication is available to make it better, so you have to tell your parent, doctor, or nurse when you hurt.
4. Your surgery is not the same as ____’s (grandma, brother, friend, person on TV) surgery.
5. Your ____ may hurt more (or less) after surgery.
6. After surgery, your _____(body part) will have a (cast, bandage, IV, stitches)
7. We will see you when you (wake up, leave the OR, surgery ends, you are back in your hospital room).
8. The doctors and nurses will be dressed in hats and masks and some even wear funny glasses to see better during surgery.
9. Surgery in real life is different from surgery on TV.
10. You will get special medicine to make you sleep during surgery, the medicine makes sure you don’t wake up before the surgery is over.
11.  You will wake up after the surgery when the doctor is completely finished.
12. Some people feel like they are going to throw up after surgery. There is medicine to help with this, so if you think you have to throw up, let _____ (Mom, Dad, the nurse) know so we can help you. Nausea and vomiting is common after surgery and can be prevented in most cases.
13. Sleep can be difficult after surgery, especially when you have to sleep in a hospital. This is normal. It can also be hard to sleep because you are hurting. Make sure you tell someone if you are hurting. For some children, a mild medication that helps with sleep, such as Benadryl, can be given.

Preparing Yourself

​​Having a sick child who needs surgery can be extremely stressful for a parent. It is important to know that you are not alone and that many parents experience the stress of a child having surgery each day. Have a support system during this difficult time can be very helpful for both you and your child, as children are usually very aware of their parent’s state of mind. Some hospitals offer support groups for parents during the hospitalization of their child, whether or not the child needs surgery.

You don’t need to do everything yourself, every minute of the day. If you have a support system of family and friends, seriously consider enlisting help before the procedure in preparation for the time following surgery, especially if your child is expected to be tearful and will need to be held and consoled after surgery.

Remember that your child will be cared for by professionals while in the hospital and that it is absolutely encouraged that you take some time for yourself to sleep, shower and eat. Taking care of yourself will help you provide the support your child needs.

References

Stanford Children’s

Verywell Health