When Your Child Has Surgery

Hepatitis B virus affects the liver. Those who are infected can become lifelong carriers of the virus and may develop long-term problems, such as cirrhosis (liver disease) or cancer of the liver.

Immunization Schedule

Hepatitis B vaccine (HepB) usually is given as a series of three injections:

1. shortly after birth
2. at 1–2 months of age
3. at 6–18 months of age

If the mother of a newborn carries the hepatitis B virus in her blood, her baby must receive the vaccine within 12 hours after birth, along with another shot — hepatitis B immune globulin (HBIG) — to immediately provide protection against the virus. If a newborn’s mother shows no evidence of the virus in her blood, the baby can receive the HepB vaccine within 24 hours after birth.

Why the Vaccine Is Recommended

The HepB injection usually creates long-term immunity. Infants who receive the HepB series should be protected from hepatitis B infection not only throughout their childhood but also into their adult years.

Eliminating the risk of infection also decreases risk for cirrhosis of the liver, chronic liver disease, and liver cancer. Young adults and adolescents also should receive the vaccine if they did not as infants.

Possible Risks

There is a very small chance of an allergic reaction with any vaccine. Serious problems associated with receiving the vaccine are rare. Problems that do occur tend to be minor, such as mild fever and soreness or redness at the injection site.

When to Delay or Avoid Immunization

The vaccine is not recommended if your child:

• is currently sick, although simple colds or other minor illnesses should not prevent immunization
• had a severe allergic reaction (anaphylaxis) after a previous dose of the vaccine or is allergic to baker’s yeast

Caring for Your Child After Immunization

The vaccine may cause mild fever and soreness or redness in the area where the shot was given. Check with your doctor to see if you can give either acetaminophen or ibuprofen for pain or fever and to find out the appropriate dose. Very young infants should not be given either of these medicines.

When to Call the Doctor

• Call if you’re not sure of the recommended schedule for the HepB vaccine.
• Call if you have concerns about your own hepatitis B carrier state.
• Call if moderate or serious side effects appear after your child has received a HepB injection.

When your child is having any kind of procedure or surgery that requires anesthesia, it’s understandable to be a little uneasy. You probably have plenty of questions about everything — from how the anesthesia is given, to what your child will experience, to where you’re allowed to be.

What happens will, of course, depend on the type of procedure your child is having and the kind of anesthesia that will be used, either:

• general — in which your child would be “asleep”
• regional — when one large area of the body is numbed
• local — when one small part of the body is numbed

To ease your mind and feel better informed, here’s a quick look at what may happen before, during, and after on the day of your child’s procedure at a hospital or surgery center.

Before Surgery

Although you might be able to talk to the anesthesiologist a day or two before the operation, you may not meet until that day. Either way, the anesthesiologist will go over your child’s medical history and information thoroughly, so that he or she can make the right choice of anesthetic medicines to meet your child’s individual needs.

The anesthesiologist also may order some tests (such as X-rays or blood or laboratory tests) to help figure out the best possible personalized anesthetic plan for your child.

Besides doing a physical examination of your child’s airways, heart, and lungs, the anesthesiologist will also want to get your child’s medical history, which will include asking about:

• your child’s current and past health
• your family’s health
• any medicines, supplements, or herbal remedies your child takes (consider bringing a list of exactly what your child takes, detailing how much and how often)
• any previous reactions your child or any blood relative has had to anesthesia
• any allergies (especially to foods, medicines, or latex) your child may have
• whether your child smokes, drinks alcohol, or takes recreational drugs (this usually applies to older teenagers)

The anesthesiologist, surgeon, or someone on the nursing staff will let you know whether your child can eat or drink before surgery. It’s important to make sure that your child doesn’t eat anything before surgery (usually nothing after midnight the day before the operation). You’ll get specific instructions based on your child’s age, medical condition, and the time of day of the procedure.

Why is eating before surgery an issue? Because the body normally has reflexes that prevent food from being aspirated (or inhaled) into the lungs when it’s swallowed or regurgitated (thrown up). But anesthetic medicines can suspend these reflexes, which could cause food to become inhaled into the lungs if there is vomiting or regurgitation under anesthesia. Sometimes, though, the anesthesiologist will say it’s OK to drink clear liquids or take specific medicines a few hours before surgery.

To ensure your child’s safety during the surgery, it’s extremely important to answer all of the anesthesiologist’s questions as honestly and thoroughly as possible. Things that may seem harmless could interact with or affect the anesthesia and how your child reacts to it.

Questions to Ask

You can also ask plenty of your own questions. If you don’t meet the anesthesiologist before the day of the operation, you may want to ask your doctor or surgeon these questions days, or even weeks, beforehand so you and your child can have all the answers you need:

• Am I allowed to be with my child before surgery? If so, for how long?
• Am I allowed to be with my child while the anesthesia is being given?
• What kind of anesthesia will my child be given?
• How will the anesthesia be administered — with an injection, through an IV, or with a breathing mask or tube in the throat?
• Will my child be sedated before the anesthesia is given?
• Approximately how long will the surgery take?
• Will my child still have an IV in or be hooked up to any monitors or equipment after the surgery is over?
• How long will it take my child to fully wake up from general anesthesia or feel the area if local or regional anesthesia was used?
• Will my child feel pain and/or discomfort (such as nausea or vomiting) after surgery? If so, how long will it last and what can be done about it?
• How soon after the surgery can I see my child?
• How soon after the surgery can my child eat, drink, go to school, or drive [if you have a teen]?
• How soon after the surgery can my child come home?

When you meet with the anesthesiologist, you’ll also be asked to sign an informed consent form, which authorizes the use of anesthesia. It’s important to make sure to have all of your questions answered before signing the form.

If your child is younger than 3 years old and is scheduled to receive general anesthesia or be under sedation for 3 hours or more, talk with the doctor or surgeon about possible risks related to brain development.

Just before going into the operating room and drifting off to sleep, young children may be given a special, sweet-tasting drink (that kids may call “silly medicine”). Depending on a child’s age or ability to cooperate, this “silly medicine” might be given by spraying it into the nose. The medicine is absorbed well through the stomach or nose and lets a child be sedated before going into the operating room.

For minor procedures, a sedative may not be needed. In fact, some children may prefer not to be sedated. Depending on what’s best for your child, the decision of whether or not to use sedation beforehand is made by the anesthesiologist, using your input.

In the Operating Room

If general anesthesia is used, the anesthesiologist will start transitioning your child from the normal awake state to the sleepy state of anesthesia. This is referred to as induction, which is usually done by either injecting medicine through an IV or by inhaling gases through a mask.

If, like many kids, your child is afraid of needles, the good news is that he or she may not have to get one while awake. Pediatric anesthesiologists often will begin the induction process by giving inhaled medicine. This is helpful because kids can have a hard time staying still and calm. The mask delivers medicine to make kids sleepy and help them relax before and during the surgery. That way, they’ll already be asleep when the IV is inserted for general anesthesia or when a shot is given to numb a certain part or area of the body for local or regional anesthesia.

When using general anesthesia, the anesthesiologist will monitor your child’s heart rate, blood pressure, breathing rate, and oxygen level; continue to deliver anesthesia; and keep your child as comfortable as possible throughout the operation.

To help your child breathe and/or to help deliver general anesthesia during the operation, the anesthesiologist may use an endotracheal tube (a plastic tube that’s placed into the windpipe through the mouth or nose) or laryngeal mask airway (LMA — a mask with a tube that fits into the back of the mouth).

After Surgery

Once the operation or procedure is over, the anesthesiologist will reverse the anesthesia process and help your child “wake up” (if your child received general anesthesia).

Your child will then be taken to the recovery room or PACU (post-anesthesia care unit). In the PACU, nurses and the anesthesiologist will monitor your child’s condition very closely to make sure he or she is making a smooth and comfortable transition from an anesthetized state to an awakened state.

When your child’s medical condition is stable, you’ll be asked to come to the PACU to be with him or her during the recovery period. If general anesthesia or sedation were used, don’t expect your child to be fully awake right away — it may take a while and he or she may doze off for a bit. It usually takes about 45 minutes to an hour for kids to recover completely from general anesthesia. In some cases, it may be a bit longer depending on medicines given during or after surgery.

Your child may feel groggy, confused, chilly, nauseated, scared, alarmed, or even sad while waking up. Depending on the procedure or surgery, your child may also have some pain and discomfort, which the anesthesiologist can relieve with medicines. After recovering from the anesthetic, your child will be evaluated to make sure he or she is ready for discharge from the recovery room.

For many outpatient procedures, kids are allowed to come home soon after the surgery. In cases where hospitalization is required, most hospitals allow at least one parent to stay with their child day and night.

Before you leave the hospital, you’ll get instructions for further care and recovery at home and for a follow-up visit with the surgeon. Talk to the surgeon and/or the anesthesiologist about what to expect after the surgery and how you can help your child be as comfortable as possible.

After discharge, call the hospital or surgeon’s office if you have any concerns at all about your child’s medical condition or if your child:

• has unusual bleeding from the surgical site
• has a fever higher than 101°F (38.3°C)
• has unusual redness on or discharge from the surgical site
• has unusual pain
• can’t keep anything down
• can’t take fluids by mouth

As you prepare for the surgery or procedure, it may help to remember that anesthesia is very safe. In today’s hospitals and surgery centers, highly trained professionals use a wide variety of modern medicines and monitoring technology to make sure that kids are stable and as comfortable as possible before, during, and after their procedure.

No doubt about it, getting an operation can be stressful for kids and adults alike. If your child is scheduled for surgery, you may have questions or concerns about anesthesia. The thought of your child being unconscious or temporarily losing sensation can be downright unnerving, whether your child is 7 months or 17 years old.

From a minor procedure with a shot to numb the area to a more serious surgery in which your child will be “asleep,” knowing the basics about anesthesia may help answer your questions and ease some concerns — both yours and your child’s.

About Anesthesia

Anesthesia is the use of medicine to prevent or reduce the feeling of pain or sensation during surgery or other painful procedures (such as getting stitches). Given as an injection or through inhaled gases or vapors, different types of anesthesia affect the nervous system in various ways by blocking nerve impulses and, therefore, pain.

In today’s hospitals and surgical centers, highly trained professionals use a wide variety of safe, modern medications and extremely capable monitoring technology. An anesthesiologist is a doctor who specializes in giving and managing anesthetics — the medicines that numb an area of the body or help a person fall asleep and stay asleep. A pediatric anesthesiologist has additional specialized training that certifies him or her to care for children.

In addition to giving anesthesia medicines in preparation for the surgery, the anesthesiologist will:

• monitor your child’s major body functions (such as breathing, heart rate and rhythm, body temperature, blood pressure, and blood oxygen levels) during surgery
• address any problems that might arise during surgery
• manage any pain your child may have after surgery
• keep your child as comfortable as possible before, during, and after surgery

Others who work with the anesthesiologist and surgeon — such as a specially trained certified registered nurse anesthetist (CRNA), fellow or resident physician, or student nurse anesthetist — may assist with giving your child anesthesia. CRNAs may work under the supervision of an anesthesiologist or on their own — it all depends on the state or hospital.

Types of Anesthesia

Anesthesia is broken down into three main categories: general, regional, and local. All of these can be given through various ways using medicines that affect the nervous system.

Think of the brain as a central computer that controls all the body’s functions and the nervous system as a network that relays messages back and forth from the brain to different parts of the body. It does this via the spinal cord, which runs from the brain down through the backbone and contains threadlike nerves that branch out to every organ and body part.

General anesthesia. The goal is to make and keep the patient completely unconscious (or “asleep”) during the operation, with no sensations, feeling of pain, awareness, movement, or memory of the surgery. General anesthesia can be given through an IV (which requires a needle stick into a vein, usually in the arm) or by inhaling gases or vapors.

Regional anesthesia. An anesthetic drug is injected near a cluster of nerves, numbing a larger area of the body (such as below the waist). Most children who receive regional anesthesia are deeply sedated or asleep for the procedure. Rarely, older kids or those who might be at risk by being asleep may be awake or lightly sedated for this type of anesthesia.

Local anesthesia. An anesthetic drug numbs only a small, specific part of the body (for example, a hand or patch of skin). Depending on the size of the area, local anesthesia can be given as a shot, spray, or ointment. With local anesthesia, a person may be awake, sedated, or asleep. Local anesthesia is often used for minor surgeries and outpatient procedures (when patients come in for an operation and can go home that same day). If your child is having surgery in a clinic or doctor’s office (such as the dentist or dermatologist), this is probably the type of anesthetic that will be used.

Anesthesiologists may also give children a sedative to help them feel sleepy or relaxed before giving a general, regional, or local anesthetic. Many kids are afraid of needles and may have a hard time staying still and calm, so doctors may need to help them relax first. That way, they just need to breathe themselves to sleep by inhaling into a mask. This approach helps ease some anxiety about needles and the overall procedure or surgery.

The type and amount of anesthesia will be specifically tailored to your child’s needs and will depend on various factors, including your child’s age and weight, the type and area of the surgery, any allergies your child may have, and your child’s current medical condition. You and your anesthesiologist can decide what’s best for your child.

Common Side Effects

Your child will most likely feel disoriented, groggy, and a little confused when waking up after surgery. Other common side effects, which should go away fairly quickly, include:

• nausea or vomiting, which usually can be eased with anti-nausea medication
• chills or shakiness
• sore throat (if a tube was used to help with breathing)

What Are the Risks?

Anesthesia today is very safe. In very rare cases, anesthesia can cause complications in children (such as strange heart rhythms, breathing problems, allergic reactions to medications, and even death). The risks depend on the kind of procedure, the condition of the patient, and the type of anesthesia used. Be sure to talk to your child’s doctor, surgeon, and/or anesthesiologist about any concerns.

If your child is younger than 3 years old and is scheduled to receive general anesthesia or be under sedation for 3 hours or more, talk with the doctor or surgeon about possible risks related to brain development.

Most complications can be prevented by giving the anesthesiologist complete information before the surgery, such as:

• your child’s current and past health (including diseases or conditions such as recent or current colds, or other issues such as snoring or depression)
• any medicines (prescription and over-the-counter), supplements, or herbal remedies your child is taking
• any allergies (especially to foods, medications, or latex) your child has
• whether your child smokes, drinks alcohol, or takes any recreational drugs (this usually applies to older teenagers)
• any previous reactions your child or any family member has had to anesthesia

To ensure your child’s safety during the surgery or procedure, it’s extremely important to answer all of the anesthesiologist’s questions as honestly and thoroughly as possible. Things that may seem harmless could affect how your child reacts to the anesthesia.

It’s also important that your child follow the doctor’s recommendations about what not to do before the surgery. Your child probably won’t be able to eat or drink (usually nothing after midnight the day before) and may need to stop taking herbal supplements or other medicines for a certain period of time before surgery.

The thought of surgery and anesthesia can be scary for parents and kids alike. But you can rest assured that the safety of anesthetic procedures has improved a lot over the years, thanks to advances in technology and the extensive training anesthesiologists receive.

The more informed, calm, and reassuring you are about the surgery and the safety of anesthesia, the easier the experience will be for both you and your child.

Appendectomy is the surgical removal of the appendix when an infection has made it inflamed and swollen. This infection, called appendicitis, is considered an emergency because it can be life threatening if untreated — occasionally, an inflamed appendix bursts after a day of symptoms. So it’s very important to have it removed as soon as possible.

Fortunately, appendectomy is a common procedure and complications are rare. And if appendicitis is promptly diagnosed and an appendectomy is performed, most kids recover quickly and with little difficulty.

About Appendicitis

Located in the abdomen, the appendix is a small organ that isn’t important to a person’s health. One end of the appendix is closed and the other opens into the large intestine, the organ that absorbs water from waste (or stool) and moves it out of the body through the anus.

Causes

Doctors aren’t always exactly sure what causes appendicitis. Because the appendix is so close to the large intestine, it can become clogged with stool and bacteria. Other times, mucus produced by the appendix can thicken and cause a blockage. In both cases, once the opening to the appendix is congested, it can become inflamed and swollen. Bacteria inside the appendix can multiply and cause appendicitis.

Signs and Symptoms

Appendicitis can cause sudden pain in the middle of the abdomen, usually concentrated around the bellybutton. The pain often moves to the lower right part of the abdomen. At first, pain might come and go, then become persistent and sharp.

Appendicitis also can cause:

• loss of appetite
• fever
• nausea
• vomiting
• diarrhea
• sometimes painful or frequent urination

If the appendix bursts, a child can develop a high fever, and pain will move throughout the abdominal area.

The Surgery

A child who needs an appendectomy will be admitted to the hospital. The surgeon will describe the procedure and answer your questions. Ask the surgeon to explain anything about the procedure that you don’t understand.

An anesthesiologist or a certified registered nurse anesthetist (CRNA) will come in to talk to you about the type of anesthesia to be used.

The surgical team will determine and discuss with you which of these two common surgical types of appendectomy is appropriate for your child:

1. Open Appendectomy
   An open appendectomy is the “traditional” way of removing an infected appendix. Basically, a surgeon makes an incision in the abdomen and locates the infected appendix. The appendix is cut away from the large intestine and removed from the body. The incision is then closed with stitches.
2. Laparoscopic Appendectomy
   Laparoscopy is a type of surgery that uses a tiny video camera called a laparoscope to help surgeons see inside the body. The thin tube of the laparoscope is inserted into the body through a small incision and guided to the appendix to act as the surgeon’s “eyes.” Other small incisions are made so medical instruments can be guided to the area, and the entire operation is done while the surgeon looks at a TV monitor.

Sometimes appendectomy is done using a combination of procedure types. In rare cases, a surgeon might start with the laparoscopic procedure but change to an open procedure during surgery. This can happen because the surgeon has trouble finding the appendix with the laparoscope or previous surgeries might have left the patient with abdominal scar tissue that makes it difficult to remove the appendix through laparoscopy.

If this happens, the surgeon will either close up the small incisions and immediately begin the open appendectomy or end the surgery and reschedule the appendectomy.

After Surgery

After the surgery, your child will be taken to a recovery room, which is sometimes called the “post-op” (post-operative) room or PACU (post-anesthesia care unit).

It usually takes about an hour for a child to completely wake up from the anesthesia. People react to anesthesia in a variety of ways, and while most feel fine afterwards, it’s possible your child may feel groggy, confused, chilly, nauseated, scared, alarmed, or even sad when waking up.

Also, your child might feel some pain near the incision site, but medication can help lessen it so be sure to let doctors or nurses know if your child is uncomfortable or in pain.

Caring for Your Child

Typically, a child stays in the hospital for 2 to 3 days after an appendectomy, a little longer if the appendix burst before it was removed. Many hospitals allow at least one parent to stay with the child throughout the day and overnight.

When your child is discharged from the hospital, you’ll get instructions on home care and when to come back for a follow-up visit with the doctor (usually within a few weeks).

Other things to think about as your child recovers at home:

• Eating and drinking: There probably won’t be any food or drink restrictions after the surgery, but it’s likely that your child won’t have much of an appetite at first.
• Caring for the incision: Be sure to keep the area clean and watch for signs of infection. Call your doctor if you notice any redness or swelling around the incision, or your child develops pain or a fever greater than 101° F (38.3° C).
• Returning to school: The doctor will tell you when your child can return to school and resume normal activities. In many cases, that’s within a week of surgery, longer if the appendix burst.
• Resuming physical activity: The doctor might recommend that your child not participate in gym class, sports, and other physical activities for a few weeks.

With a little rest and care, most kids recover from appendicitis and an appendectomy with little difficulty.

When your child is having any kind of procedure or surgery, it’s understandable to be a little uneasy. But it helps to know that appendectomies are common procedures and complications are rare. However, as with most procedures, there are some risks, which your doctor will review with you. If you have any other questions or concerns, speak with your doctor.

A blood transfusion is a fairly simple medical procedure. In a transfusion, a patient receives whole blood or one of its parts through an intravenous line, or IV. This is a tiny tube that is inserted into a vein using a small needle.

While patients are likely to feel a brief pinch of the needle, a blood transfusion is mostly painless. Still, because it involves a needle, kids might be anxious if they have to get one. So it helps to understand how a transfusion is done. That way, you can feel confident about what is happening and help put your child at ease.

About Blood Transfusions

Blood is like the body’s transportation system. As blood circulates, it delivers oxygen and nutrients throughout the body. It also collects waste products and carries them to the organs responsible for making sure the wastes leave the body.

Whole blood is a mixture of cells and liquid, and each part has a specific job:

• Red blood cells carry oxygen to the body’s tissues and remove carbon dioxide.
• White blood cells help defend the body against infection by producing antibodies, which help destroy foreign germs in the body.
• Platelets, the smallest blood cells, help to clot the blood and control bleeding.
• Plasma, the pale yellow liquid part of whole blood. It’s a mixture of water, proteins, electrolytes, carbohydrates, cholesterol, hormones, and vitamins.

A blood transfusion can make up for a loss of blood or any part of the blood. Although whole blood can be transfused, it is rarely used. Instead, more specific parts of blood are transfused as needed. Red blood cells, the most commonly transfused part, are used to increase the blood’s ability to carry oxygen and prevent tiredness and other complications.

Transfusions take 1 to 4 hours, depending on how much blood is given and the blood type. No special recovery time is needed.

Most transfusions are done in a hospital, but can be done elsewhere when necessary. In most cases, the blood comes from volunteer donors. The blood of the donor, which is carefully screened to ensure its safety, must be compatible with the blood type of the person receiving it.

There are four major blood types, each with a different chemical marker that’s attached to a person’s red blood cells. These markers determine if someone has type A blood, type B blood, type O blood, or type AB blood. Each blood type also can be positive (+) or negative (-).

Why Blood Transfusions Are Performed

The three main reasons why a child may need a blood transfusion are:

1. Loss of blood during surgery or from an injury or an illness.
2. An inability to make enough blood. Some illnesses and treatments can harm the bone marrow’s ability to make blood (e.g., chemotherapy decreases production of new blood cells).
3. To prevent complications from an existing blood or bleeding disorder, such as sickle cell disease, thalassemia, or anemia caused by kidney disease, hemophilia, or von Willebrand disease.

Where the Blood Comes From

Because there’s no manmade substitute for blood, the blood supply used for transfusion must be donated. The three types of blood donation are:

1. Autologous (ah-TOL-uh-gus) blood donation. Sometimes, when people know in advance that they are going to need a transfusion (for a planned surgery, for example), they may donate their own blood beforehand. There’s no age requirement, but in general, kids don’t donate their blood for their own use until they’re over age 12.
2. Directed donation. This is when a family member or friend with a compatible blood type donates blood specifically for use by a designated patient.
3. Volunteer donation. Since there’s no medical evidence that blood from directed donors is any safer than blood from volunteer donors, most patients receive blood donated through blood drives, which are often run by independent collection agencies like the American Red Cross. The minimum age for donating blood is 16 or 17 years old, depending on where a person lives.

Some people worry about getting diseases from infected blood, but the United States has one of the safest blood supplies in the world. Many organizations, including community blood banks and the federal government, work hard to make sure that the blood supply is safe.

The risk of getting a disease like HIV or hepatitis through a transfusion is extremely low in the United States today because of very stringent blood screening. Also, the needles and other equipment used are sterile, and are used only on one person and then thrown away in special containers.

Preparing for a Blood Transfusion

If your child needs a blood transfusion, the doctor will speak with you about the procedure. If you have questions, be sure to ask. When you feel comfortable with the information and your questions have been fully answered, you’ll be asked to sign an informed consent form. This form states that you understand the procedure and its risks, and give your permission for your child to have the blood transfusion.

If the situation is not a life-threatening emergency, two tests will be done before the transfusion:

1. Blood typing. To confirm your child’s blood type, a nurse or technician will draw a sample from a vein in your child’s arm using a sterile needle. (Except for the brief needle stick, this isn’t painful and only takes a few minutes.) This blood is immediately labeled with your child’s name, birth date, and medical record number, and an armband with matching information is made for your child to wear. The blood is then sent to the hospital’s blood bank lab, where technicians test it for blood type.
2. Cross-matching. Once typing is complete, a compatible donor blood is chosen. As a final check, a blood bank technologist will mix a small sample of your child’s blood with a small sample of the donor blood to confirm they are compatible. If they clump together, the blood is not compatible. If the blood mixes smoothly, they are. Blood that is considered compatible is then labeled with your child’s name, birth date, and medical record number and delivered to where your child will be receiving the transfusion.

Most transfusions are done in a hospital setting, often at a patient’s bedside, or in the operating room, emergency room, or chemotherapy unit. They also can be done in an outpatient care clinic or even at home, if necessary.

As long as the transfusion is not being done during surgery, you can stay with your child, who will be awake. Your child can sit comfortably in a reclining chair or lie down on a bed, watch a movie, listen to music, or play quietly, and might be able to eat and drink, walk around a bit, and use the bathroom.

Starting an IV Line

A nurse will begin an intravenous line (IV). After the needle is inserted into an arm or hand, a small sample of blood is taken and sent to a lab to confirm the blood type. Once the results are in, a tiny plastic tube is left in the vein and attached to the IV tubing, which is then used to connect to the bag containing the blood.

Since puncturing the skin involves a small needle, starting an IV can cause a little bit of pain (kind of like a small pinch). To reduce discomfort, a nurse might put some numbing cream on your child’s skin a half hour before inserting the needle.

Though the vein is typically in the arm or hand, it can be done in other places, if necessary, especially if conditions like severe dehydration or blood loss have made the veins harder to find. For example, babies often receive transfusions through veins in their foot or scalp.

Children who need many transfusions may require a central line (a tube inserted into a larger vein in the chest) or a PICC line (a longer tube inserted through a vein near the bend of the elbow). These lines allow easy access and also spare smaller veins the damage that can come from repeated punctures.

Most kids don’t need any special medicines before or during a blood transfusion. However, if your child had a mild reaction during a previous transfusion, the doctor might give your child some medicine just before the procedure, either by mouth or through the IV.

Two nurses will read to each other the names and identification numbers on your child’s armband and on the blood that came from the blood bank. The transfusion won’t begin unless there is a match.

Transfusing the Blood

The blood bag is hung upside down from an IV pump that controls the speed of the flow.

The nurse will measure your child’s blood pressure, body temperature, and pulse before, during, and after the transfusion. Your child also will be watched closely for any signs of an allergic or other type of reaction, including rash, fever, headache, or swelling.

After the transfusion, if your child is going home, the tiny plastic tube is removed from the vein and a bandage is placed over the area. The site may be slightly sore or tingly for a little while. Medicine may be given for any mild side effects, such as fever or headache. If your child is having surgery or is in the hospital, the IV line will stay in place.

Benefits

In kids with anemia or those getting chemotherapy, the greatest benefit of a transfusion is increased blood flow to nourish the organs and improve oxygen levels in the body. This can keep them from feeling extreme tiredness and help give them enough energy for the activities of daily life. Benefits like this often are felt fairly quickly.

For patients with bleeding problems, transfusions with platelets or plasma can help to control or prevent bleeding complications.

Serious reactions to transfusions are rare. But as with any medical procedure, they have a few potential risks, which your doctor will review with you.

When your child is having any kind of procedure, it’s understandable to be a little uneasy. But it helps to know that blood transfusions are common procedures and complications are rare. If you have any questions about transfusions, talk with your doctor.

My son may need surgery, and a friend told me that anesthesia might cause problems with brain development. Is this something I should talk about with my son’s doctor?
– Matthew

Yes. Whenever surgery or a medical procedure is recommended for your child, talk with the doctor about any concerns you have and get all of your questions answered.

Before some surgeries and procedures, medical staff give patients general anesthesia or sedation drugs. The drugs put them into a deep sleep so they don’t feel pain or move around during the surgery.

But repeated use of the drugs, or a single use of general anesthesia or sedation drugs for longer than 3 hours, might hurt the brain development of children younger than 3 years old, according to the U.S. Food and Drug Administration (FDA). Anesthesia given in a woman’s third trimester of pregnancy also could harm the brain development of her baby.

If a child under 3 needs general anesthesia or sedation drugs, parents should ask their health care professional about:

• risks related to brain development
• the timing of the surgery or procedure, and whether it can be delayed without creating health problems
• how long the surgery or procedure will last and if repeated surgeries are necessary

Pregnant women in their third trimester who need general anesthesia or sedation drugs should ask their health care professional about possible brain development risks to their babies.

Surgeries for infants or toddlers that use general anesthesia or sedation drugs for a single, brief period are not likely to hurt brain development, the FDA said. The agency made the warning after looking at study findings, but says that more research is needed.

About G-Tubes

Some kids have medical problems that prevent them from being able to take adequate nutrition by mouth. A gastrostomy tube (also called a G-tube) is a tube inserted through the abdomen that delivers nutrition directly to the stomach. It’s one of the ways doctors can make sure kids with trouble eating get the fluid and calories they need to grow.

Fortunately, a gastrostomy is a common procedure that takes only about 30 to 45 minutes. After spending 1 or 2 days in the hospital, kids who have had a gastrostomy can get back to their normal activities fairly quickly after the incision has healed.

Still, it helps to know some of the basics so you can feel confident about what’s happening during the procedure and how you can support your child once the tube is in place.

Common conditions that might require a child to need a G-tube include:

• congenital (present from birth) abnormalities of the mouth, esophagus, stomach, or intestines
• sucking and swallowing disorders, which are often related to prematurity, brain injury, developmental delay, or certain neuromuscular conditions, like severe cerebral palsy
• failure to thrive, which is a general diagnosis that refers to a child’s inability to gain weight and grow appropriately
• extreme difficulty taking medicines

Before the Procedure

Several tests may be performed prior to G-tube insertion; most commonly, an X-ray of the upper gastrointestinal (GI) system, which allows doctors to see a portion of the digestive system.

Your child’s stomach must be empty on the day of the procedure. Gastrostomy in infants and children is usually performed either under general anesthesia (medication that keeps the patient in a deep sleep-like state) or deep sedation (medication that makes the patient unaware of the procedure but not as deeply sedated as with general anesthesia).

These medications can suspend the body’s normal reflexes and could cause food to become inhaled into the lungs if the child vomits during the procedure. So be sure to follow your doctor’s instructions on when to have your child stop eating or drinking (for babies on breast milk only, this is usually 2 hours before the procedure; for toddlers and older kids, it may be up to 8 hours before).

The doctor will describe the procedure and answer any questions you might have. Be sure to ask the gastroenterologist (gastrointestinal doctor) or surgeon to explain anything you don’t understand.

Then the anesthesiologist or CRNA will take your child back to the operating room to administer the anesthesia or sedation. You’ll go to a waiting area and a hospital staff member will notify you when the procedure is over.

During the Procedure

The three methods for inserting a G-tube are:

1. percutaneous (through the skin) endoscopic gastrostomy (PEG)
2. laparoscopic technique
3. an open surgical procedure

The laparoscopic technique can be used with the PEG approach or with another abdominal operation performed at the same time. All methods are fairly simple and take about 30 to 45 minutes to perform.

The PEG procedure, which is the most common technique, uses an endoscope (a thin, flexible tube with a tiny camera and light at the tip) inserted through the mouth and into the stomach to guide the doctor’s positioning of the G-tube.

The laparascopic technique is done by making several small incisions in the abdomen and inserting a tiny telescope that helps surgeons see the stomach and surrounding organs.

Open surgery is a good approach for placing a gastrostomy tube but usually is reserved for cases where the child’s anatomy won’t allow for a PEG; if there is scar tissue from a previous surgery, procedure, or illness; or if the child requires another surgical procedure at the same time.

After the Procedure

Your child will be taken to the recovery room, sometimes called the “post-op” (post-operative) room or PACU (post-anesthesia care unit), and will be closely monitored by the medical team.

The doctor will let you know how the procedure went and how your child is doing. In most cases, parents can visit their child in the recovery room within a half hour after the procedure.

It usually takes about an hour for a child to completely wake up from the anesthesia. Your child might feel groggy, confused, chilly, nauseated, scared, or even sad when waking up. That is common and usually improves within 30 to 45 minutes.

Your child might feel a little bit of pain near the incision site. If so, be sure to tell the doctor because medications can be given to lessen discomfort. Antibiotics may continue for 24 to 48 hours after the procedure to prevent infection.

Your child probably will remain in the hospital for 1 or 2 days. Many hospitals allow at least one parent to stay with a child throughout the day and overnight. Much of that time will be spent learning about the care of your child’s new G-tube.

The nurses will show you exactly how to care for the tube and the skin around it, keeping it clean and infection free. You’ll also learn how to handle potential problems, such as the tube accidentally falling out. This is important because if the tube falls out of place, the hole can begin to close.

You’ll also be taught how to give a feeding through the tube as well as what to feed. You might hear feedings referred to as “bolus” or “continuous.” Bolus feedings are larger and less frequent (more like a regular meal). Continuous feedings, which often take place overnight, are delivered by a pump to kids who need smaller, slower feedings. A nutritionist will help plan a specific diet and schedule based on your child’s needs.

Kids who have a G-tube aren’t necessarily unable to also eat by mouth. Although tube feedings can be used to replace all oral feedings, in some cases the tube supplements what a child eats by mouth. If your doctor decides that your child is physically able to eat, the medical team will help teach the skills needed for independent eating.

It’s normal to feel a little bit nervous about the tube at first, but it’s important that you feel comfortable taking care of it, so ask plenty of questions and seek extra help if you need it.

Caring for Your Child

By the time your child is ready to leave the hospital, you should have:

• detailed instructions on home care, including practical issues such as bathing, dressing, physical activity, giving medicines through the tube, and venting (releasing gas from) the tube
• a home health care nurse visit scheduled to make sure things are going smoothly
• follow-up visits scheduled with your doctor to check your child’s weight as well as the placement and condition of the tube

Gastric tubes can last for more than a year before needing to be replaced. Replacing the G-tube is easily done by a parent or health care provider without another endoscopic or surgical procedure.

The gastrostomy site can be prone to infection and irritation, so it must be kept clean and dry, and frequent hand washing is a must. Call your doctor if you notice any of these problems:

• a dislodged tube
• a blocked or clogged tube
• any signs of infection (including redness, swelling, or warmth at the tube site; discharge that’s yellow, green, or foul-smelling; fever)
• excessive bleeding or drainage from the tube site
• severe abdominal pain
• persistent vomiting or diarrhea
• trouble passing gas or having a bowel movement
• pink-red tissue (called granulation tissue) coming out from around the g-tube

Fortunately, most complications can be quickly and successfully treated when discovered early.

Once the site is healed, kids who’ve had a gastrostomy have very few, if any, restrictions related to the tube. Some kids might worry about how the tube looks and how others might react. If this happens, ask your doctor to recommend a social worker who can help.

After a few months of healing, your doctor may recommend replacing the longer tube with a “button” — a device that is flatter and lies against the skin of the abdomen. This can often be done without surgery in the doctor’s office, unless your child’s doctor advises otherwise. The button can be opened for feedings and closed in between feedings or medications. For many families, the transition to a button makes tube feedings and care easier and more convenient.

If and when the doctor decides that your child is able to take in enough nutrition by mouth, the G-tube or button may be removed. Removal takes only minutes and is usually done in the office by the doctor or nurse.

Once the button or G-tube is out, a small hole will remain. It should be kept clean and covered with gauze until it closes on its own. In some cases, surgery is necessary to close the hole. Either way, the scar that remains will be small.

When your child is having any kind of surgery, it’s understandable to be a little uneasy. But it helps to know that a gastrostomy is a brief, common procedure and complications are rare. However, as with most procedures, there are some risks, which your doctor will review with you. If you have any other questions or concerns, speak with your doctor.

About Laryngoscopy

Laryngoscopy is a visual examination below the back of the throat, where the voice box (larynx) containing the vocal cords is located. It helps doctors identify the causes of voice and breathing problems, throat or ear pain, difficulty in swallowing, narrowing of the throat (strictures or stenosis), and airway blockages.

Laryngoscopy is relatively painless, but the idea of having a scope inserted into the throat can be a little scary for kids, so it helps to understand how a laryngoscopy is done.

Ear, nose, and throat specialists (also called ENT doctors or otolaryngologists) do laryngoscopies. The three kinds of laryngoscopy are:

1. indirect laryngoscopy
2. flexible laryngoscopy
3. direct laryngoscopy

The indirect procedure can be performed in a doctor’s office using a small hand mirror held at the back of the throat. The doctor will aim a light at the back of the throat, usually by wearing headgear that has a bright light attached, to examine the larynx and vocal cords. Indirect laryngoscopy is not typically used with kids because it tends to cause gagging.

Flexible and direct laryngoscopy examinations allow doctors to see deeper into the throat by using either a flexible or rigid telescope. Rigid telescopes are more often used as part of a surgical procedure in evaluating kids with stridor (a noisy, harsh breathing) and removing foreign objects in the throat and lower airway. They’re also used in collecting tissue samples (biopsies), laser treatments, and in locating cancer of the larynx.

Why Is Laryngoscopy Performed?

Laryngoscopy is performed to:

• diagnose a constant cough, throat pain, bleeding, hoarseness, or constant bad breath
• check for inflammation (swelling and irritation)
• discover a possible narrowing or blockage of the throat
• remove foreign objects, such as small toys swallowed by mistake
• see or get a sample of a mass or tissue in the throat or on the vocal cords
• diagnose swallowing problems
• diagnose suspected cancer
• evaluate causes of persistent earache
• diagnose voice problems, such as weak voice, hoarse voice, breathy voice, or no voice

Preparation

Talk to your doctor about the kind of test being performed, how it will be done, the risks, and the results. Having your questions answered beforehand will help reduce your concerns and give you and your child a better understanding of how the procedure will go.

After examining a child, a doctor might recommend a chest X-ray or CT scan (a type of X-ray that uses a computer to take pictures of the inside of the body). Your child also might be asked to swallow a liquid called barium while a series of X-rays of the larynx and esophagus are taken. Barium liquid is harmless and will pass through the body within a day or two. These tests will help your doctor further understand the physical symptoms your child is having.

For an office laryngoscopy that uses local anesthesia, it is okay for your child to eat or drink beforehand.

If general anesthesia will be used, your doctor may not want your child to eat or drink for a few hours before the exam (this is to prevent vomiting).

During Laryngoscopy

Indirect laryngoscopy and flexible laryngoscopies often are performed in the doctor’s office, usually using local anesthetic. They usually take only 5 to 10 minutes.

Indirect laryngoscopy will require your child to sit up straight in a high-backed chair with a headrest and open his or her mouth wide. The doctor will spray the throat with an anesthetic or numbing medication (which your child will gargle and spit out), then cover the tongue with gauze and hold it down.

The doctor will hold up a warm mirror to the back of the throat and, with a light attached to his or her headgear, will tilt the mirror to view various areas of the throat. Your child may be asked to make high-pitched or low-pitched sounds so that the doctor can view the larynx and see the vocal cords move.

Flexible laryngoscopy uses a flexible laryngoscope (a thin, flexible instrument that lights and magnifies images) for a better view of the larynx and vocal cords.

This might be done in an operating room under general anesthesia or in the doctor’s office, and usually doesn’t require a hospital stay. The flexible scope is inserted through a nostril or the mouth, then the doctor examines the throat area through the scope’s eyepiece. Sometimes the images are displayed on a monitor so that family members can see what the doctor is seeing.

Direct laryngoscopy is done in an operating room and your child will be put under general anesthesia and not feel the scope in the throat. If needed, the doctor will remove foreign objects from the throat, collect tissue samples, perform laser treatment, or remove growths from the vocal cords. This can take as little as 15 to 30 minutes, but might take much longer if specific treatments are required.

After the Procedure

If a local anesthetic or topical numbing spray was used, it will wear off in about 30 minutes. Your child should not eat or drink anything until the spray has worn off and the throat is no longer numb.

After a direct laryngoscopy, your child will be watched by a nurse until fully awake and able to swallow. This usually takes about 2 hours. In some cases, an overnight hospital stay may be required. Your child may have some nausea, general muscle aches, and feel tired for a day or two.

Gargling and sucking on throat lozenges will help with the soreness. You can also give pain medication according to your doctor’s recommendations, if needed. Your child may sound hoarse or have noisy breathing for a few days after the procedure. This is normal. If the hoarseness persists or your child has difficulty breathing, contact your doctor.

Results

The doctor will explain the findings after the procedure. If a biopsy was taken, a laboratory will examine the tissue and report the results to your doctor, who will discuss the results and treatment options with you. Usually, biopsy results take about 3 to 5 days.

Depending on the outcome of the exam, your doctor might schedule an office visit or a follow-up procedure for 4 to 6 weeks after the initial laryngoscopy.

When your child is having any kind of procedure, it’s understandable to be a little uneasy. But it helps to know that a laryngoscopy is considered an extremely effective and routine medical exam and complications are rare. However, as with most procedures, there are some risks, which your doctor will review with you. If you have any questions about laryngoscopy, speak with your doctor.

Providing Support

If your child needs to have an operation, you probably have plenty of questions, many of them about anesthesia. You may wonder if your child will feel pain during the operation, be aware of what’s going on, wake up in the middle of the surgery and be scared, or not feel well afterward.

The concept of your child being unconscious or losing sensation in the body can be unnerving, especially when you’re entrusting his or her health and well-being to someone else. But anesthesia today is very safe. Unlike anesthesia of the past, when doctors often used nothing more than ether and a stethoscope, modern anesthesia in hospitals and surgery centers is given by highly trained professionals who use a wide range of safe medications and monitoring equipment.

Whether your child is scheduled for a minor outpatient procedure or major surgery that requires recovery time in the hospital, it’s important for you to be prepared to support your child. The more educated, calm, and reassuring you are about the surgery and the anesthesia, the easier the experience is likely to be for both you and your child.

What Kids May Fear

Kids’ age and developmental level play a large role in what they find scary about receiving anesthesia. Some kids, especially younger ones, may fear being separated from their parents. So they may feel more secure being with mom or dad in a preoperative holding room or operating room until they fall asleep.

Older kids, however, may have much more complex fears: exposure of body parts during surgery, cutting and scarring of the body, waking up during surgery, loss of control, pain after surgery, and even death.

One common concern among kids, young and old, is whether they’ll receive a needle and, if so, if it will hurt. A kind of local anesthetic can be placed on the skin to remove the pain of needle pricks when starting an intravenous (IV) line. This usually works well to soothe fears of getting a “shot.”

And, depending on the type of surgery and anesthesia being used, in many cases kids can drink medication to help them relax and feel sleepy before going into the operating room. Also, children often are given an inhaled anesthetic so they can breathe themselves to sleep in the operating room before an IV is placed.

Talking to Your Child About Anesthesia

It may help your child handle the stress and uncertainly of the procedure or surgery if you have a conversation ahead of time about what to expect. Here are a few talking points to consider:

Let your child know where you’ll be during the whole experience. Reassure your child that you’ll be in the waiting room nearby during the surgery and in the recovery room when he or she wakes up after the surgery. You may also be able to sit with your child until he or she falls asleep before the surgery. Discuss this with your anesthesiologist.

And explain that (in many outpatient procedures), your child can come home soon after the surgery is done. In cases that require hospitalization, most hospitals allow at least one parent to stay with the child day and night.

Give your child reassuring age-appropriate and developmental stage-appropriate information. For a younger child, for example, less information may be better than more. That doesn’t mean lying — it just means giving the most appropriate information for your child’s age and developmental stage. Giving young kids very detailed explanations might make the experience more frightening or worrisome. Of course, every child is different, so have a discussion based on your child’s needs.

Consider saying something like, “A special doctor will give you a little medicine to make you sleep very deeply so that you won’t feel anything during the operation.” Or you may just want to explain that all he or she has to do is breathe (if your child is getting general anesthesia or will be sedated using a mask). In many cases, the IV and breathing tubes are placed after kids are asleep, so they will have no knowledge or awareness that some other potentially frightening things are even happening.

But preteens and teens, especially, may need to be reassured that they will not wake up during the procedure but that they will wake up afterward.

Avoid frightening language. For example, don’t say, “You’ll be given gas” or “You’ll be put to sleep.” A child may confuse “gas” with the fuel that can poison or kill, and confuse “put to sleep” with what happened to an ailing family pet. Also avoid saying, “You’ll be taking a nap” — young kids may think all future naps mean surgery. Likewise, you should never tell children that they’ll be stuck with a needle if they misbehave or don’t cooperate.

Answer questions honestly. If you don’t know the answer to a question, reassure your child that you will ask the doctor.

Explain that the anesthesia will prevent your child from feeling any pain during the procedure.

Explain that there may be some pain and discomfort after the surgery, but that the doctor can give medicine to help. It’s important for kids to understand that they don’t have to try to be brave or “put on a happy face” after surgery. Explain that it’s OK to let the doctor know about any pain or discomfort so that your child can get help right away.

Explain that it’s normal to feel a little weird after surgery. Although every person has a different experience, a child who was sedated or had general anesthesia may feel groggy, confused, chilly, nauseated, scared, alarmed, or even sad when the medications wear off. That’s all perfectly normal. You may want to tell your child, “You might wake up feeling a little funny, but that’s OK. I will be there with you.”

Make sure whatever you tell your child is in line with what the doctor has told you. Don’t pass on any misinformation — it may scare your child if something happens that’s different from what you’ve explained.

Let your child know that it’s normal to not remember anything about the surgery. That’s one important aspect of general anesthesia.

Encourage your child to read about the present safety of anesthesia. Then share the information with the family — reading and sharing information is an excellent coping mechanism.

Staying Calm

As you discuss the hospital and surgery, remember to use nonverbal cues to communicate assurance: your tone of voice, facial expressions, gestures, and body language convey powerful messages. If you appear fearful, your child is likely to feel scared or confused regardless of the words you use to explain things.

That’s why it’s important to try not to cry or become emotional in front of your child before or after the procedure. If you need to vent your emotions, try to take a few minutes to step out of the room where your child can’t see or hear you.

If you’re a calm, supportive, and soothing presence for your child before and after surgery, the whole experience will probably be easier and far less stressful for you both.

Preparing Yourself

Your child needs elective surgery and a date has been scheduled. Unlike emergency surgery, an elective procedure isn’t done as an immediate matter of life and death. Having an elective procedure gives you the time to prepare your child for the hospital and the surgery.

Good preparation can help kids feel less anxious about the anesthesia and surgery and get through the recovery period faster. But, like parents everywhere, you’re probably uncertain about the best way to prepare your child.

The key is to provide information at your child’s level of understanding, correct any misunderstandings, and get rid of fears and feelings of guilt. Help your child understand why the surgery is needed and to become familiar with the hospital and some of the procedures he or she will undergo.

Kids of all ages cope much better if they have an idea of what’s going to happen and why it’s necessary. To do that, prepare yourself first and correct any misconceptions of your own. If a parent is anxious and nervous, a child will often reflect these feelings and behaviors. So educate yourself, feel comfortable with the process, and make sure all your questions are answered.

Ask Questions

You might have heard horror stories in the past about traumatic parent/child separations and very limited hospital visiting hours, but those days are over. Hospitals have changed greatly and are more family-friendly and patient-centered. For example, many surgeries are now “same-day” procedures requiring no overnight or prolonged stays; most kids are back home, in their own beds, the same night. And most U.S. hospitals permit at least one parent to stay with the child at all times except during the operation.

After the surgery, you may return to your child in the recovery room. As your child awakens, he or she will not even realize you left.

Ask the doctors, nurses, or staff for the information you need about what will take place so that you can prepare your child and deal with your own fears or concerns. To parents, one of the most fearful aspects of surgery is anesthesia. Anesthesia is much safer today than in the past, but still carries some risk. You should discuss any concerns you have in advance with the anesthesiologist.

When hospitalization is needed overnight or longer, most hospitals avoid separation anxiety by permitting at least one parent to stay with the child day and night. Check with the hospital about its rules regarding parents staying over and when other close family members can visit.

As soon as your child is able, he or she may be playing with other children, toys, and games in a children’s recreation room — even if that involves taking along an intravenous (IV) bag on a rolling support.

Explain the Problem

Now that you’re more at ease, start preparing your child. Begin by explaining the reason for the surgery in simple, calming words. Explain — at your child’s level of understanding — about the medical problem and why surgery is necessary. Don’t use alarming language like “the doctor will cut you,” “open you up,” or “sew you with a needle.” Say that the doctor will fix the problem, and explain that many kids have this problem and must get it fixed at the hospital.

Although they seldom express it, kids may fear that their parents aren’t telling them everything — that their health problem is worse than they’ve been led to believe. To build trust, don’t mislead your child — tell as much of the truth as your child can understand.

Handle Fears

Many kids fear that an operation will be painful. It can help to explain that a special doctor, called an anesthesiologist, gives medicine to make patients sleep very deeply so they won’t feel anything during the operation and once it’s finished, they’ll wake up. (Older kids, in particular, need special assurances that they will wake up.)

Again, avoid frightening language — don’t say, “You’ll be given gas” or “You’ll be put to sleep.” Young kids may confuse “gas” with the fuel that can poison or kill and “put to sleep” with what can happen to sick pets.

Explain that you’ll be there when your child wakes up — and a favorite toy can come along, too. Tell your child that if anything feels sore right after the operation, a doctor or nurse can give medicine that will make it feel better.

Common surgery-related fears of young children are the possibility of separation from (or abandonment by) parents and the possibility of pain. School-age kids also fear needles, knives, and damage to their bodies. Give a child this age clear, rational information as well as assurances that the surgery is to fix an existing problem, not create a new one.

The fears of teens go well beyond those of younger kids. Besides pain or change of appearance, a teen might be afraid of losing control, missing out on events, being embarrassed or humiliated in public, and sounding childish by expressing fear, anxiety, or pain. A teen also may be afraid of waking up during the operation — or not waking up afterward.

Anticipate these fears, then emphasize that expressing fear, anxiety, and response to pain is quite normal (and OK) at any age, even adulthood. Correct any misconceptions about disfigurement or injury. And explain that anesthesia is very safe today and that patients do not wake up during operations but will certainly wake up afterward.

Encourage your teen to read up on the medical condition and share the information with the family. Reading and sharing information is an excellent coping mechanism.

One further fear that affects kids of all ages is being seen naked and having their “private parts” touched. If the operation involves the genital or anal area, your child will cope better if you explain in advance that although it might be embarrassing, doctors and nurses will need to examine these private areas, especially to check if they’re healing after the operation. Explain that doctors, nurses, and parents are the only exceptions to the rules about privacy.

Encourage your child’s questions about the health problem and hospital experience, so that other fears and anxieties can be expressed. Take all questions seriously and answer them to the best of your ability. If you don’t know an answer, tell your child that you’ll find it out, and explain that the doctors and nurses are happy to answer questions, too.

Relieve Guilt

Children often believe that their medical problem and operation are really punishments for “being bad.” They might not say so, but they may feel guilty and believe that they’ve brought events on themselves.

Explain that the medical problem is not the result of anything your child may have done or failed to do, and that the operation is not a punishment, but simply the way to “fix” the problem.

On the other hand, if the medical problem was caused by an accident that could have been avoided by obeying safety rules, make sure your child understands the reason for the rules and will follow them in the future.

Explaining What Will Happen

Find books, appropriate to your child’s level of understanding, about what to expect at the hospital. Reading together and discussing the surgery will make the hospital seem less threatening. Discuss each idea and encourage your child’s questions.

Young kids also will benefit from practicing on a doll or stuffed teddy bear with toy doctor-kit “instruments.” Your child can take the toy’s “temperature” and “pulse” and listen to its “heartbeat” and “breathing.”

Ask your doctor for suggested videos or multimedia tools for parents or kids that can help explain the procedure.

As you discuss the hospital and surgery, remember that in addition to your words, your nonverbal cues convey assurance: your tone of voice, facial expressions, gestures, and body language send powerful messages. If you appear fearful, your child is likely to feel fearful regardless of the words you use.

Pre-Operative Orientation and Tour

Many hospitals offer special pre-operative children’s programs, family orientations, and hospital tours, led by specially trained nurses or licensed child-life specialists. Child-life specialists are a valuable resource for parents and children. They are professionals trained to talk to kids and teens about medical procedures, comfort them if they’re upset or need extra support, and organize “play time” for hospitalized kids and teens to get together and hang out.

Call the hospital to schedule a pre-operative tour, program, or orientation as soon as possible, even from the doctor’s office when the appointment for the surgery is made. It’s best to schedule the appointment for a few days before the surgery.

An orientation program can remove the mystery of the surgery for kids and their families by making the hospital familiar and friendly and the experience predictable.

On the Day of Surgery

When you arrive on the day of surgery, your young child can play with toys and books you bring from home or sit on your lap and be cuddled during the waiting time.

You won’t be allowed to stay in the operating room during the surgery, but afterward, you’ll be escorted to the recovery room to be with your child as he or she awakens. Upon discharge, you’ll be given instructions for further care at home and for a follow-up visit to the surgeon.

During recovery, there may be times of discomfort for your child. So explain that even if this happens, your child will get better.

Distracting your child, whether with a new book or a visit from a relative or friend, also can make recovery more pleasant. Just make sure your child gets plenty of time to rest and recuperate.