Q1. What’s the best way to explain to a child what will happen to them while they’re asleep during surgery, especially the fact that the doctor will be “opening them up”?
Talking about surgery needs to be tailored to the child’s age and developmental level. However, for children of all ages it is important to avoid frightening language when discussing anesthesia and the surgery itself. Avoid phrases like “you will be put to sleep” or “you will get gas” as they may be associated with the death of a pet or toxic fumes (either from real life experience or media exposure). Explain that a doctor (an anesthesiologist) will give a special medicine to go into a deep sleep during the surgery and they will not feel anything. Stay away from language such as “open you up” or “cut you open.” For younger children it is best to say the doctor will “fix your bones” or “make you walk better.” Make sure the child does not think the surgery is a punishment for bad behavior. For older children, use language such as “make a small opening.” Sometimes teenagers may have more serious concerns and it is important to reassure them about their fears.
Q2. Are there any procedures that are harder to explain to kids than others? How in-depth should doctors or parents go when describing something complex?
Again, speaking to kids about surgery needs to be age-appropriate. It is always best to be truthful and honest. If a child asks a question and you do not know the answer, say you don’t know, but that you will find out if you can. Most children do not need in-depth details for even complex surgery. For young children, explaining which part of the body (leg, arm, back, etc.) and why (to make your eyes work better) is sufficient. Also, letting them know what kind of bandage or cast will be used so they are not surprised when they wake up is appropriate. For older children, particularly teenagers, simple diagrams may be helpful. Teenagers may be concerned with being disfigured after the surgery; explaining how the area will look afterward (covered, casted, etc) and some information about scarring is often helpful. Some children will ask a lot of questions and want to know details; it is best to provide them with useful information to prepare them but not too much information that may lead to unnecessary fear.
Q3. If a child gets nervous or upset when they go to the doctor, how does hospital staff work to calm them down in order to prepare them for surgery?
One way parents can prepare their children for surgery is to be prepared themselves. It is natural to feel nervous when your child needs surgery. Your child will sense any anxious feelings you have, so calm body and verbal language is essential. The hospital staff can help by making sure parents’ questions are answered and concerns are addressed. At HSS we are committed to preparing families and children for surgery. We have pamphlets and a DVD (available in hard copy and online) about having surgery, what to expect and ways to prepare. We have pediatric doctors, nurse practitioners, nurses and a child-life specialist available during the preoperative period. During preoperative visits we go over what to expect at the hospital. We encourage children to bring favorite toys or stuffed animals when they come to the hospital. We also encourage books, toys, and portable devices from home (laptops, tablets, etc.) as useful distractions prior to surgery. When appropriate we have parents talk to other families whose children have had similar procedures. We give tours of the in-patient unit so kids can see where they will stay in the hospital.
On the day of surgery, the families and children meet with the anesthesiologist. For any blood work or IV, insertion numbing cream can be used on the area to lessen any pain. For children who are extremely nervous about needles or the procedure itself, liquid medicine can be given that will help calm the child. Parents are encouraged to be with the child until they are asleep and when they wake up to help the child feel secure and safe.
Dr. Stephanie Perlman
is a Pediatrician with Hospital for Special Surgery’s Lerner Children’s Pavilion.
