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All children need special attention when preparing for anaesthesia and surgery. The effects of hospitalisation on your child will be related to age; length of stay; parental factors; and your child’s previous experiences of hospital or medical care. These in turn affect how long it will take you to prepare your child and also what information your child should be given.
The most important message is: Always be truthful when telling children what is going to happen to them at the hospital.
The first time in hospital
The first hospital experience is the most important one and influences all subsequent visits. It is therefore extremely important to try and make it as pleasant an experience as possible.
Length of stay
The expected length of the hospital stay also determines the extent of psychological preparation. An overnight stay has a different effect from a day visit to the hospital. Children undergoing operations that might require weeks of hospitalisation need careful preparation.
Hospitalisation has less effect on children who are accustomed to parental substitutes and who have been subjected to less protective parenting. Children can also sense parental anxiety, and show similar signs of anxiety and stress, which may not appear until the actual start of the anaesthetic.
What to tell your child
The most important feature of preparing your child for anaesthesia and surgery is honesty. Children expect to be told the truth and will lose confidence in anyone who gives them misleading information. An example is when a parent tells a child that he or she is going to hospital for a ‘visit,’ or worse still when a parent does not tell the child that he or she is going to hospital, let alone having an operation.
The greatest fear children have in relation to hospitalisation is ‘needles’. The prospect of having a needle or injection must be discussed openly. Parents and guardians must never use the threat of a needle by a doctor or nurse as a punishment.
Many things have changed in anaesthetic practice, including the giving of premedication by injection. This is now uncommon – especially for children. If some form of premedication is needed, it is more often given in the form of a tablet or liquid. Also, when injections do need to be given, local anaesthetic cream is commonly applied beforehand, making the process much less painful. As a parent or guardian you are entitled to ask whether or not these options are available for your child from your anaesthetist and hospital.
As well as talking with your child, there are other things that you can do to help with psychological preparation. You should take an active part in any preparation, such as reading books, watching videos, and visiting a preadmission clinic or the hospital with your child. (See: What you can do to help.)
How your child will react to hospitalisation will depend on his or her age. This, in turn, will determine the length of preparation.
Six months to four years
Small children are psychologically most vulnerable and do not understand the necessity for treatment. They recognise threatening situations but are unable to comprehend explanations or reassurances. Preparation will take from a few hours to a day.
Four to six years
These children are more accepting of explanation and reassurance and need to be prepared a few days ahead.
Six to ten years
These children are less likely to have a problem with separation, but there are more fears of anaesthesia, surgery and pain. They may have fantasies of mutilation, but are amenable to reassurance, although they may become irritable or impatient. Their preparation may take a week or so.
Adolescents fear loss of control and dying. They resent restricted activity and lack of privacy, and are more likely to have underlying emotional problems. As a parent you should recognise that preparing your teenager should take at least a week.
Children, and especially infants, do not tolerate long periods of fasting or restriction of fluids, which might quickly lead to dehydration. It is usual to try to minimise the fasting time for children for food or milk to six hours before the operation. Cow’s milk or formula is not emptied quickly from the stomach and is considered to be similar to solid food. Breast milk, on the other hand, is emptied from the stomach more readily and a shorter fasting time is more appropriate. The length of time is often determined by the usual feeding pattern of the infant. Children may drink clear fluids up to two hours before the time of the operation. Parents should consult with the anaesthetist for advice in individual cases.
Children are particularly prone to repeated colds, especially if they have problems with their tonsils or adenoids. It may therefore be appropriate to proceed with the anaesthetic and surgery in the presence of mild symptoms, although ideally, one should choose a time when the child is ‘relatively well’. For complex or prolonged surgery, even mild symptoms may lead to postponement, unless the operation is urgent.
If the child is coughing up phlegm, has a high fever, or is lethargic (looking ill, feeling sleepy, and refusing food), the operation will most likely be postponed. The period of delay of the operation may be up to six weeks, as studies have shown that the airway remains sensitive. The child is more prone to coughing and gagging and is more likely to develop some swelling in the throat during this period after a cold or the flu.
Vaccination may normally result in a mild fever some 7 to 10 days later. If your child has an anaesthetic or surgery around this time, the fever may cause unnecessary concern.
If a routine vaccination by injection is due, there does not appear to be any reason why it cannot be given by the anaesthetist during your child’s anaesthetic. You should discuss the matter with the anaesthetist during the preanaesthetic consultation