Child Surgery

Each year 4 million children undergo surgery and almost 8 million parents stress over the well being of their children through this dramatic period of their lives. All types of questions pop into a parent's mind, and the uncertainty can create a great deal of anxiety both for parents and child.
A study from Yale University by Dr. Zeev Kain showed children who were less anxious, have a much smoother course through the surgical process. They required less anesthesia for surgery, they had fewer side effects and needed less pain medication following surgery. This all translated into shorter hospital stays for these children. Families that are familiar and well oriented with the surgical process for their children, tend to have children who are less anxious and more cooperative through the course of care.

It is important to maintain regular visits with your child's pediatrician. This helps to ensure that the normal development of the child is monitored and abnormalities are detected earlier. Some abnormalities such as inguinal hernias are easier treated when they are small than when they are larger. The recovery time is also shorter when certain abnormalities are detected early. For this reason if an abnormality is detected and if you pediatrician refers your child to a surgeon or requests for tests to be performed to find out more about the abnormality, it is vital to make these appointments and to follow through with your physician's instructions promptly.

It is also vital for parents to familiarize themselves and their children in an age appropriate manner about what lies ahead. These days many physicians are extremely busy with their schedules, but have time, or have office staff and printed materials that can help with the process. There are a few books and many internet sources that can help enlighten your path. Please check the sources very carefully for reliability of the source. Many of these internet sources are commercially driven. Stay with sources that are objective and provide information without commercial bias. Stay away from sources that are not thorough in their medical background unless you are dealing with a support group. These sources again can vary in reliability and quality of information. Many large medical centers have FAQ sites.

Care for children has become specialized over the years because of the recognition that children's medical care needs are sometimes different than those of children. Children also become frightened easily and if we as adults are not able to make them feel more comfortable in the medical care environment, then their care can potentially become more challenging and even difficult. If children become more comfortable and able to accept the medical care we offer them, then they would be willing to cooperate more and our care for them becomes easier and their experience less traumatic. We need to do this in a very realistic, non threatening, and reasonable means that is age appropriate for the child. If you have a choice of taking your child to a specialist or a medical center that specializes in the care of children, then take advantage of this option. The more experienced a specialist or a center is with caring for children, more likely it is that the care will be customized for the needs of your child.

Occasionally there are many steps between a pediatrician's office and the actual surgery. There may be need for many tests, or consultations with healthcare professionals. A parent's role becomes crucial in maintaining appointments and sometimes coordinating information and services if care can encompass different sites for lab work, radiographic work ups (X-rays) and medical specialist consultations. Unless all of these services are performed under one roof, on occasion a parent may need to cart information, test results and consultation reports. In this day and age of electronics, it is less common for this scenario, but in certain regions of this country we still rely on paper to disperse and provide information. It may come to rest on a parent's shoulders the facilitation, and cooperation of information and care coordination between different medical specialists.

Once the surgical specialist has been consulted with and need for surgery is determined, then the preparation for surgery will begin. As healthcare providers we try not to subject children unnecessarily to tests. Certain surgical procedures may require to obtain blood levels if there is potential for blood loss, or blood chemistry levels if the surgery, medication administered or fluids provided intravenously during care impact these levels during or after surgery.

You will be given a package that will help with the registration process at the medical center. These packets can vary in content from being very simple in just obtaining medical information for the hospital, to pre surgical visit with a nurse or an anesthesiologist at the hospital, to an orientation tour of the medical center. Each surgical center is different in how they approach to the registration process. It would be beneficial for you and your child to familiarize yourself with the policies of the surgical center, even if you need to call and speak to an individual to clarify policy, hospital procedure in registration, or care, or to speak to an anesthesia care provider about the anesthetic implications of care for your child. If you are not scheduled to meet with the anesthesia care provider, it may be wise to call or meet in advance to obtain an understanding of what is expected. Whether your child will be pre-medicated prior to surgery, or if a parent is allowed to accompany a child to the operating room or an induction suite where the child would drift off to sleep. An anesthesiologist may be able to provide information that will help make the care of the child less stressful, and help reduce your anxiety.

You will also receive instructions for medications if your child needs them prior to surgery and dietary restrictions. Dietary restrictions can vary depending on the type of procedure. It is standard that a child be restricted from food and any pulp containing or non clear fluids for more than 6 to 8 hours. Most medical centers allow the consumption of water 2 to 4 hours prior to surgery. Please check with your surgeon and anesthesiologist regarding this restriction. Surgeons and anesthesiologists become very upset if this restriction is violated because it endangers the life of the child. Retained stomach contents can easily slip into the windpipe and create a life threatening complication.

On the day of the surgery provide yourself plenty of time to reach the surgical center. Should you be delayed, please call ahead so that the surgical center can make arrangements for your arrival and prevent additional delay or cancelation. Always bring with you extra change of clothes and towels. On occasion the surgery or the anesthesia may not agree with the child and he or she may become ill on the ride home if they are having outpatient surgery. After the registration, the child will be taken to the waiting area if he or she is having outpatient surgery. The child will change into a provided gown. If the anesthesiologist has requested pre-surgery medication, then the nurse may provide this at this time. It may make the child groggy, sleepy and sometimes silly. This helps with the cooperation. In some surgical centers one parent may be allowed to go to the operating room with the child. It is very important to follow all instructions, and to help maintain the integrity of the sterile environment of the surgical center. Once the child has began to drift off to sleep, you will be asked to step into the waiting area.

When the surgery is complete, the surgeon may meet with you to inform you how the surgery went and on occasion provide you with some instructions. In the recovery room the child may cry, this may not be due solely to pain. Children are often disoriented or frightened upon emergence from anesthesia. The children are medicated in the PACU with pain medication to help lessen the discomfort from pain when appropriate. If the child is an ambulatory patient, then he or she will be discharged with instructions once criteria for this discharge are met. The recovery varies from surgery to surgery and at times from child to child. If the child is discharged home it is important to provide the child with a safe environment with very little stimulation to help them rest. Children are often disoriented and their judgment impacted with anesthesia and pain medication. It is important to reduce the likelihood of the disruption of the wound and bleeding. You will be provided with instructions to watch for excess bleeding, swelling and even signs of infection over the next few days. If instructions are not clear do not hesitate to contact the surgeon or the hospital. If pain medications are provided, then it is important to follow all guidelines provide to you by your surgeon. The surgical process is very stressful any child and parent, but with the proper information the process can be a bit smoother both for parents and child.