Day surgery

My heart sank when I first learned that my one-year-old son, Aiden, needed surgery to remove a benign cyst above his left eye. I wished that I could take his place on the operating table, but knew such things only happen in fairy tales. Somehow, our family would have to get through this operation, in the real world.

No matter how routine, the prospect of surgery is frightening for most parents and children. Day surgery or outpatient surgery refers to minor operations that usually take less than two hours. Children are allowed to go home the same day because they don’t require post-operative monitoring or significant pain management. The most common paediatric day surgeries are for tonsil and adenoid removal, the insertion of ear tubes, and hernias, as well as for a range of conditions that Peter Fitzgerald, head of paediatric surgery at McMaster Children’s Hospital in Hamilton calls “lumps and bumps” — cysts, minor skin lesions and treatment of undescended testicles.

Even though these procedures are considered medically minor, it can still be a big deal for parents and children. Krista Nicholson’s 3½-month-old son, Nathan, had surgery to insert ear tubes. In the days leading up to the procedure, she asked people “not to bring it up so that the waterworks didn’t start!” Though worrisome, surgery also often solves a chronic medical problem. “Our daughter had the same throat infection nearly every month for a year,” says Shelley Cowin, whose daughter Kelsey had her tonsils and adenoids removed at 22 months. “So, in a way, we were relieved that she was going to have surgery.”

Watch what you say. Debbie O’Rourke, a child life specialist at McMaster Children’s Hospital, says that no matter how nervous you are, “be really, really careful about how you talk to a toddler about the hospital. If your child hears that you’re afraid, then it just reinforces that there is a reason to be afraid.” At the same time, it’s important to be truthful, Fitzgerald adds. “It’s not like the old days where parents used to tell their children they were going somewhere else and then drop them off at the hospital.”

Visit the hospital. Most offer a preoperative tour for parents and children when the operation is discussed and everyone has a chance to see some of the medical equipment and the operating room. O’Rourke says it can be useful to take a baby as young as six or seven months to the hospital in advance, just to let them get used to the place. “Go to the cafeteria or the coffee shop and point out the doctors and nurses and other babies who are also at the hospital. Give them a chance to see the hospital in a non-threatening way.”

Read stories and play doctor. At home, O’Rourke also suggests reading “hospital visit” stories (see Books to Read). Role-playing with a good toy medical kit is another excellent way to help prepare your toddler. “Get her used to a blood-pressure cuff” (something toddlers tend to dislike), she says. “I call it a balloon that gives them a little hug.” O’Rourke also suggests showing a toddler a mask, even a paper dust mask, so he can get used to the idea of it slipping over his face. This might help to reduce anxiety when he is approached with the real mask in the operating room.

Bring some support. Unfortunately, there is not much you can do to prepare a baby for day surgery. O’Rourke advises parents to come together to the surgery and suggests that a single parent bring a family member or a good friend for support. (Fitzgerald notes that infants less than two months will always be kept in for overnight monitoring to ensure that they are breathing well — but reassures parents that post-operative problems are rare.) Healthy babies over two months are handled in much the same way as toddlers or older children.

During your preop visit a few weeks before the surgery, you will likely have been instructed not to allow your child to eat or drink in the eight hours preceding surgery. Most hospitals try to schedule babies and toddlers early in the morning to cut down on non-eating-and-drinking awake time. O’Rourke says that if you’re scheduled for the afternoon, you should “beg for an earlier time,” but adds, “this is not always possible.” If you end up with an afternoon appointment, think in advance about how you’ll cope. “Get your child away from the house, perhaps come to the hospital early or go for a drive, as long as it doesn’t involve a drive-through!” says O’Rourke. “Don’t go to play-school or playgroup because there is always the snack issue.”

You’ll be asked to arrive at the hospital one and a half hours before the procedure to register, and perhaps to allow time for any additional tests. Then you’ll be moved to a small waiting room close to the operating room. Here parents face their biggest challenge — handing their children over to the nurse for the operation. Children react very differently at this point: Some will cry and others will go “willingly and without clinginess or tears” as did Cowin’s daughter, Kelsey.

The waiting game

According to O’Rourke, most parents cry once their children have been taken into the operating room. Even if a parent is allowed to stay with a child while she receives the general anaesthetic (McMaster Children’s Hospital is one of only a very few hospitals in North America that allow this), it is still a difficult time for the parents. If you think your child will be upset at the moment of separation, O’Rourke suggests that you ask, in the preop visit, whether children can bring a special blanket or toy into the operating room. Also, try to get the nurse to spend a few minutes with you and your child before it’s time to go.

Then the waiting game begins. Nicholson suggests having something to do during the surgery, as “there is nothing worse than watching the clock.” Also, you might want to make use of hospital volunteers who can let you know whether your child is still in surgery or whether they are en route to the recovery room. They can also provide reassurance and comfort.

Most hospitals allow parents into the recovery room (where children are closely monitored while the effects of the anaesthetic wear off). Parents need to be prepared for just about anything: “Some children wake up happy from the anaesthetic; others are agitated and crying,” says Lida Jones, nurse coordinator for the paediatric surgery clinic at McMaster Children’s Hospital. Nicholson remembers that her son whimpered when he came out of the anaesthetic. “It was tough to see him that way —he just lay there so helpless. Kelsey Cowin was crying when she awoke. “It was difficult to see her crying, especially since she still had some blood around her mouth and nostrils.” O’Rourke says that no matter how a child awakens, it’s hard on parents to see him looking so small and fragile, but there will be many experienced nurses around to see you through.

Once your child is alert and stable, he will be taken to the same day surgery room. Here nurses will make sure that he is drinking well and urinating. Some children recover very quickly and are ready to go home within a few hours; others take longer. “They can have a little bit of nausea, they can have a lot of nausea, and they can have some vomiting. It depends on the child, what anaesthetic they’ve had, and how long they have had it,” says Jones, who also tells parents that “it can take 24 hours for the anaesthetic to wear off. So where possible, try to keep him quiet. He may be groggy and may fall or trip.” Jones also advises parents to leave the hospital with a telephone number to call if they have questions or concerns.

Nicholson says Nathan was groggy after surgery, but recovered “amazingly fast both physically and emotionally.” Fitzgerald confirms that in his experience “young children usually bounce back much more rapidly than adults.” Nevertheless, O’Rourke suggests taking a few days off work just in case there are any complications, and also to help kids cope with any residual anxiety. If he’ll be returning to daycare, make sure his caregivers know about the surgery. “It’s not unusual for kids to experience some separation anxiety,” observes O'Rourke.

My own son’s physical recovery was remarkably quick. Aiden awoke on the morning after his surgery ready for Cheerios and play, despite the bruising and swelling around his eye. My husband and I were relieved, the cyst was gone, and our son was happy. We soon discovered, however, that the experience wasn’t quite behind us. Aiden needed lots of extra emotional support in the coming weeks. He was wakeful at night and unusually clingy in the daytime. Fortunately, the remedy for his anxiety was simple — lots of love and oodles of attention. So make sure you set aside some time for stories, cuddles and special treats in the post-operative period — you’ll find that they’re the best medicine of all!

What to take with you
• Your child’s favourite toy or blanket (or both)
• A few changes of clothing for you and your child in case she’s throwing up after the surgery (for kids, bring really comfortable clothes like tracksuits or pyjamas and, of course, extra diapers)
• Toys and books to pass the time in the preop waiting room — the hospital will have stuff, but sometimes babies and toddlers like their old favourites
• If you’re nursing, bring a breast pump because it may be several hours before your baby feels up to breastfeeding

Hospital tour from home
Wouldn’t it be great if you could show your child what the hospital will be like? The Sainte-Justine University Hospital Center in Montreal gives families a close-up look at the hospital’s facilities, medical teams and equipment — all from the comfort of home! Eight units are featured in their online Virtual Tour, along with information about how to prepare for the procedure, a look at the operating room and info about going home.
– Cathie Kryczka

Books to Read

Franklin Goes to the Hospital
by Paulette Bourgeois (Kids Can Press 2000).

A Trip to the Hospital
by Kim Watson, a “Little Bill Book” (Simon Spotlight 2001).

Clifford Visits the Hospital
by Norman Bridwell (Scholastic 2000).

What to Expect When You Go to the Doctor
by Heidi Murkoff (HarperCollins 2000).