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Surgery and Your Child

SURGERY & YOUR CHILD

DEDICATED TO THE CARE OF YOUR CHILD

The staff at the Richland Hospital are dedicated to the care of you and your child. We understand that surgery can be an emotional time, especially when it is to be performed on your child. Children who are less anxious and less fearful have an easier time before and after surgery. There are things you can do to decrease the chance of transferring your fears and anxieties about surgery to your child.

UNDERSTANDING AND HELPING YOUR CHILD AS SURGERY APPROACHES

The information that follows lists characteristics children tend to have in common. The list does not cover all tendencies and does not apply to every child. We hope the information will increase your understanding of what you may observe in your child, what you can expect from us as caregivers, and we hope we can assist you in preparing your child for their surgery.

Infants 0 to 12 Months

Factors that Increase Stress

  • Separation from family
  • Strangers

What you can do as a parent

  • Provide comfort measures (pacifier, toy or blanket, swaddling, holding)
  • Be present whenever possible

What you can expect from your child’s caregivers

  • Use a slow approach
  • Allow time for familiarity
  • Provide consistent caregivers
  • Minimize separation from parents
  • Assist in decreasing parent’s anxiety
  • Facilitate parent or caregiver presence

Preparation and Care of an Infant

  • Short attention span (1-2 minutes)
  • Prepare the infant just before performing care by telling them what you are about to do (check their temperature, change their diaper, etc.)
Toddlers 1 to 3 Years of Age

Thinking Characteristics

  • Egocentric (self-centered – don’t understand other’s views)
  • Magical thinking (for example: may believe they will slip down the drain)

Factors That Increase Stress

  • Separation from family or caregivers
  • Pain

Approach and Education Methods Parents and Staff May Use

  • Minimize separation from parent
  • Use picture books
  • Use play to demonstrate
  • Let play with equipment (mask, teddy bear, etc.)
  • Provide comfort measures (own toy or blanket, holding, singing)

Preparation by Parents and Staff

  • Should occur immediately before event  – too far in advance increases anxiety
  • Keep explanations simple

The following is normal for this age group

  • Any actions by healthcare providers (taking a temperature, checking a blood pressure) may cause your child to become upset.
Pre-School 3 to 6 Years of Age

Thinking Characteristics

  • Egocentric (self-centered – don’t understand other’s view)
  • Magical thinking (that thinking something may cause it to happen)
  • Highly literal with words (saying ‘you have a stomach bug’ will make the child believe they have a bug in their stomach)
  • Basic ideas about their bodies
  • Difficulty in differentiating “good” hurt (will make you feel better) with “bad” hurt (illness or injury)

Factors That Increase Stress

  • Separation from family
  • Loss of control
  • Fear of bleeding and punctures (fear their insides will “leak out”)
  • Emotional reaction of others can increase their anxiety
  • Lack of preparation for procedure

Approach and Education Methods Parents and Staff May Use

  • Minimize separation from parent
  • Use play to explain procedures and activities – encourage verbalization
  • Use pictures, story books and puppets
  • Use models and actual equipment – hands on practice with equipment
  • Describe what child may feel, hear and taste
  • Give choices whenever possible
  • Allow child to bring a favorite item (toy, book, blanket)

Preparation by Parents and Staff

  • Acknowledge and accept fears and anxieties
  • Be concise, simple and concrete. Short attention span. Limit length of explanation to 5 minutes.
  • Prepare 1 to 3 hours before minor event (Dr. visit) and days in advance for major event (surgery).
  • Repeat explanations every time something is being done. Do not assume the child will remember.
  • Do NOT tie evaluations of the child’s behavior with the procedure (do not say he is a “good boy” for holding still but rather, “That was helpful to hold still.”).
  • Do not tell the child they will feel better after surgery. They will likely feel worse in the postoperative period.
  • Emphasize child will wake up after surgery.
  • Repeat often that the child has done nothing wrong and is not being punished.

The following are normal for this age group

  • You may see regression, detachment, avoidance or despair in your child.
  • You may see verbal uncooperativeness, physical aggression or tantrums. You may even see this with experiences like taking a temperature.
School Age 6 to 12 Years of Age

Thinking Characteristics

  • Still tend to be literal with words but beginning to think logically (knows that a ‘stomach bug’ is not an actual bug in their stomach)
  • Better ability to understand relationship between illness and treatment
  • Can listen attentively to everything being said without always understanding
  • Reluctance to ask questions or admit they don’t know something

Factors That Increase Stress

  • Fear failure to live up to expectations of others
  • Fear loss of control, bodily injury, mutilation, procedures involving genitals, and death.

Approach and Education Methods Parents and Staff May Use

  • Minimize separation from parent
  • Respect increasing need for privacy
  • Establish limits (example: will be allowed to go home but have to eat and drink first)
  • Stress peer group (friends, people their age) can be maintained
  • Encourage verbalization and questions
  • Acknowledge fears
  • Reassure they have done nothing wrong
  • Offer choices to provide measure of control (flavor of anesthesia gas, which book to read while waiting, etc.)
  • Hands-on practice with equipment
  • Use photographs, books, diagrams, charts, or videos to explain
  • Standardized multimedia education may be helpful
  • Likes learning scientific terminology
  • They may want to have a familiar, comforting item with them. Encourage them to bring the item(s). This might include a stuffed animal, toy, game, or music.

Preparation by Parents and Staff

  • Introduce days ahead for minor events (such as a Dr. visit) to weeks ahead for major events (such as surgery)
  • Respond honestly to request for factual information
  • Ask them what they understand
  • They want to know what a procedure is for, if it will hurt, how it will make them well and what injury or harm could result.
  • The following are normal for this age group:
  • Your child may show disinterest or withdrawal
Adolescents & Teens

Thinking Characteristics

  • Beginning to think beyond basic meaning of words
  • Able to think logically
  • Still some magical thinking (thinking something can make it real – feel guilty for illness)
  • Has some understanding of structure and workings of the human body
  • Loss of control
  • Altered body image
  • Separation from peer group
  • Strong need for privacy
  • Information sensitivity – adolescents react not only to what they are told but also to the manner in which they are told
  • Attention span up to 60 minutes

Approach and Education Methods Parents and Staff May Use

  • Tactfully explore what they know
  • Allow as many choices and control as possible
  • Allow to bring favorite item (music, book, tablet)
  • Use photographs, books, diagrams, charts, and videos
  • Provide tours and equipment and models to examine.
  • Audio video and multimedia computer-based programs may be helpful
  • Introduce preparatory materials up to 1 week in advance for minor events and weeks for major events. This is vital for adolescent’s ability to cope, cooperate and comply.
  • Use collaborative approach – support independence and decision making
  • Stress how much they can do and how important their compliance is to their recovery. Be honest about consequences.
  • Assure ability to maintain contact with peer group.
  • Teach relaxation methods: deep breathing, self-comforting talk or use of imagery.

Preparation by Parents & Staff

  • Privacy: Inform them that certain procedures will be conducted only after start of anesthesia (hair removal, skin preparation); they will be allowed to leave undergarments on when appropriate; and only surgical area is exposed.
  • Reassure that they do not need to worry about talking or doing anything embarrassing under anesthesia.
  • Discuss approximate time they will be in each area of the building (Admission, PreOp, Surgery, PACU, and PostOp).
  • Tendency toward hyper-responsiveness (may seem extreme in relation to what they are reacting to) to pain.
  • May alternate between dependence and exerting independence.
  • Pain is perceived on three levels: physical, emotional and mental.

The Following is Normal For This Age Group

  • Not unusual for teens to deal with pain through regressive behavior as seen with: increased dependence on parent; expectation that nurses should know they are in pain; belief that they should not have to ask for pain medication.