An Overview of Pediatric Surgery

Pediatric surgery is any surgery performed on a patient under the age of 18. While the definition of pediatric surgery is simple, the reality of having a child who needs surgery is very different. 

Parenting a child who is ill or in need of a surgical procedure can be very challenging. The questions your child asks can be difficult, and you may not know what to say or how to explain what will be happening. Your child may be scared by the idea of surgery (and you may be, too) and in need of comfort and reassurance.

Take the time to understand the treatment your child needs, why they need it, and what alternatives may be available. In addition to your role providing comfort for your child, you will also be their medical advocate and you will be making their decisions for them, so you will need to educate yourself about the entire surgical experience. One of the most important things you can do, as a parent, is to choose the surgeon performing the procedure wisely. Once you have found the right surgeon, you will need to determine how best to explain what will be happening to your child. 

Nurse attending child in bed

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Explaining Surgery to Your Child

Giving your child accurate information when preparing him for surgery is essential to their being calm before and after surgery. Explain the procedure to your child as accurately as possible, telling your child “I don’t know, but I will find out” if you do not know the answer to a question. For example, don’t tell your child that you will accompany them to the operating room if you are not sure this is possible.

A normal part of surgery, like saying goodbye in the pre-surgery area, can be traumatic when the expectation was that goodbyes would occur after being escorted into the operating room.

"I don’t know, but we can ask your healthcare provider or nurse" is preferable to providing information that is wrong, which can cause significant distress for the child when their expectations are different from what they are experiencing. Just remember to obtain the correct answer, especially if your child asks the same question repeatedly while waiting for an answer.

Some facilities offer a tour before surgery, which helps prepare your child for surgery by showing them where they will be and introducing them to the hospital. This can be of great assistance when trying to prepare your child for the experience of being in the hospital and operating room. 

Important Questions to Ask Before Your Child's Surgery

If you have questions for your child's surgeon, be sure to write them down before your appointment. That way you won't forget them during your visit. You may also want to write down the answers you receive. 

Some questions you may want to ask when you are meeting with the surgeon:

  • What type of anesthesia will be used? Will my child be asleep during surgery?
  • While my child is awake will they receive medication through a breathing mask, an IV, or both?
  • Will I be able to escort my child to the operating room? Will both parents be able to be present?
  • Do you have any suggestions regarding preparing my child for surgery?
  • Will my child be given sedation prior to surgery?
  • Are there any shots my child will be given before surgery?
  • Where will my child wake from surgery? Can I be present?
  • What kind of pain will my child have after surgery?
  • Can my child eat or drink before surgery? Will my child be able to eat or drink after surgery?
  • Will my child be able to have overnight visitors after surgery?
  • Is a tour of the facility available for my child, including the operating room?
  • Will my child have IVs, devices or a breathing tube after surgery?
  • What kind of recovery can my child expect to have?
  • Will my child be in the hospital after surgery? For how long?
  • How quickly will my child be discharged after outpatient surgery?

Things Your Child Should Know About Surgery

Children are very wary of surgery and may have questions or concerns that they never mention. These are important topics that you may want to address before your child has surgery, depending upon their age.

  1. Anesthesia prevents pain during surgery.
  2. You are not having surgery because you were bad—surgery is not a punishment.
  3. If there is pain after surgery, medication is available to make it better, so you have to tell your parent, healthcare provider, or nurse when you hurt.
  4. Your surgery is not the same as ____’s (grandma, brother, friend, person, on TV) surgery.
  5. Your ____ may hurt more (or less) after surgery.
  6. After surgery, your _____(body part) will have a (cast, bandage, IV, stitches)
  7. We will see you when you (wake up, leave the OR, surgery ends, you are back in your hospital room).
  8. The healthcare providers and nurses will be dressed in hats and masks and some even wear funny glasses to see better during surgery.
  9. Surgery in real life is different from surgery on TV.
  10. You will get special medicine to make you sleep during surgery, the medicine makes sure you don’t wake up before the surgery is over.
  11.  You will wake up after the surgery when the healthcare provider is completely finished.
  12. Some people feel like they are going to throw up after surgery. There is medicine to help with this, so if you think you have to throw up, let _____ (Mom, Dad, the nurse) know so we can help you. Nausea and vomiting are common after surgery and can be prevented in most cases.
  13. Sleep can be difficult after surgery, especially when you have to sleep in a hospital. This is normal. It can also be hard to sleep because you are hurting. Make sure you tell someone if you are hurting. For some children, a mild medication that helps with sleep, such as Benadryl, can be given.

Things to Avoid Saying to Your Child Before Surgery

Children are very sensitive to the words used to explain what surgery is, what will happen, and how surgery is performed. These are some key phrases to avoid using, as children are prone to misinterpreting what is being said.

  1. They will give you “gas” - To children, gas is something that we put in cars or a rude substance that comes from one’s bottom.
  2. “Anesthetize” - This word sounds like "euthanize" and can cause problems if your child knows the word euthanize, searches the internet, or hears the word euthanize used in another setting. Anesthesia is a foreign word to children and needs to be explained. 
  3. They will give you medicine to “knock you out” - To most people, being knocked out means being hit hard enough to be rendered unconscious.
  4. “The healthcare provider is going to make you take a nap” or “It’s just like bedtime” - Try to avoid confusing surgery with a normal daily ritual at home. If your child is afraid of surgery, they could become afraid of naps at home. It could also lead to fears of waking prior to the end of surgery.
  5. “You will be put to sleep” - Many children are aware that when we put animals to sleep they die and may assume they too will die.
  6. “You won’t wake up” - It is important to stress that they will sleep through the surgery without feeling pain, but that they will wake after surgery is completed. Children fear both never waking and waking during the procedure.
  7. “Be a big boy and don’t cry” - Children need to be encouraged to talk about their fears prior to surgery and their pain after surgery. Surgery is scary and children need to be encouraged to discuss their fears so they can be discussed and alleviated.
  8. “It is just like on TV” - Surgery isn’t like the surgeries on TV, where actors jump on top of patients and perform CPR and patients die after the less than successful heroics of the fictional staff.

Preparing Infants and Toddlers for Surgery

At the infant and toddler stage of development preparing for surgery is mostly about preparing the parents for what is happening and what to expect after surgery. Toddlers will require very simple and straightforward explanations of what is happening with minimal information. For example, you may want to say “the healthcare provider is going to make your leg better,” rather than a detailed explanation that will merely confuse your child.

Before surgery children may be tearful or fussy, as they will be required to go without food or drink before surgery as an adult would. The hospital, with different noises, faces, and activities can be upsetting, and your child may require much more comforting and want to be held more than usual.

Like their older counterparts, children will often take on the attitudes of their parents, so if you appear to be upset and concerned, they will also be upset. Presenting a calm, happy attitude when around your child will help considerably when trying to keep them calm and comfortable.

After surgery, you can expect your child to be fussy, and in some cases, difficult to console. The combination of pain from the procedure, an empty stomach, and feeling strange due to the anesthesia typically results in a crying baby that will need to be held and comforted. Be sure to use pain medication as the healthcare provider recommends, as small children are unable to verbalize their need for pain relief in some cases.

If the surgery is one that takes an extended recovery, you may need to enlist help from friends and family to take turns comforting your child, so that you are able to sleep while the baby has the care they need.

Preparing Your Preschooler for Surgery

Children at the preschool level of development are old enough to be scared by the thought of surgery. Preschool-aged children tend to fear separation from their parents, mutilation of their bodies, and fear pain from any source.

These typical fears can guide your conversation with your child, giving you the opportunity to explain that you will be with them, that the surgery will make them better and not hurt their body, and that medication will be available if they have pain.

Keep in mind that your preschooler may be comforted by having familiar objects present with them, such as their favorite blanket and stuffed animal. Consider bringing their typical activities with them to the hospital, such as reading a book before nap time or brushing their teeth before bed.

After surgery, expect your preschooler to be irritable and much more difficult to deal with than normal. As difficult as it may be, it is essential for you to exhibit patience with your child during this trying time. This should be a temporary phase, decreasing as your child’s pain level is relieved and life returns to normal. Do not hesitate to enlist help caring for your child from friends or family during this stressful time.

If your child enjoys coloring, you may want to use printable surgery coloring books to help explain surgery to children.

Preparing an Elementary-Aged Child for Surgery

Children of elementary age are old enough to require clear and concise information about surgery. While they are old enough to have significant fears about surgery, they tend to keep their worries to themselves and will silently worry about concerns that may seem strange to an adult. Your preschool-aged child will require reassurances that they are not being punished, that they will survive the surgery, and that their pain will be controlled.

Depending upon the age of your child, they may worry that they will be left alone and may repeatedly ask where you will be during the procedure. They may also fall into the “are we there yet” syndrome, so giving children more than a week’s notice may not be a good idea, based upon the maturity of the child.

After surgery, children this age will want to be in touch with their friends, and visits should be encouraged when appropriate. At this point in recovery, your child may be caught between feeling like a child and wanting to be mature at the same time. Hugs and reassurances are important for all age groups, but preschool-aged children may require more than other children but be unwilling to express the need.

If your child enjoys coloring, printable surgery coloring books may help to answer their questions and provide entertainment at the same time. This age group will also be very receptive to having a tour of the hospital and operating rooms when they are available.

Preparing Your Adolescent or Teenager for Surgery

Older children, such as those of junior high and high school age, share many of the same fears regarding surgery. As a whole, children in these age groups fear dying during surgery, being disfigured or obviously different from their peers after surgery and showing weakness or a loss of control.

Your child is old enough to understand what happens during surgery and will require a more detailed explanation than younger children. They should have an opportunity to ask questions of their surgeon and should be included in any discussions about the surgery if they so desire. Children of this age may feel information is being withheld from them if they are excluded from decisions and discussions about their health.

This age group is more likely to deny having any pain when they are indeed in pain after surgery, in an effort to maintain control of the situation. They are more likely to deny they have any symptoms of surgical complications, especially if the complication is potentially embarrassing like constipation or the inability to urinate.

One way to help this age group deal with the stress of surgery both before and after the procedure is to allow them to bring their headphones, books or other personal items that provide a distraction with them.

Preparing Your Child Emotionally for Surgery

Preparing a child for surgery emotionally is one of the most important things parents can do when their child is facing a surgical procedure. Surgery, without proper explanations and preparation, can traumatize children.

Preparing a child for surgery is not difficult, but it is essential to understand that many children will adopt their parent’s attitudes about health care and surgery. If the parent is frightened or hysterical, the child is much more likely to be frightened or hysterical.

It is also important that your body language matches your words. If a parent is saying, “It’s going to be OK," but their body language says, “I’m terrified”, the child will usually adopt the attitude of fear. This may be easier said than done, as most parents do feel fear when their child needs surgery, but being aware of the issue can be helpful.

The worst thing a parent can do before surgery is to not prepare the child at all, so surgery is a surprise and they are completely unaware of what is happening to them. Children who are shocked by the fact they are having surgery often act out, crying, screaming, and attempting to bite, kick or hit staff and family members. These children can be left with a fear of hospitals, surgery, doctors, nurses, other healthcare providers and health care in general.

How much you share with your child and how early you share the information is a personal decision. Anyone who has been on a long car ride knows that children often go into "are we there yet?" mode and have trouble with the idea that the end of the ride is many hours away. The same is true of future events, children often struggle to understand that a birthday or vacation or even Christmas may be months away. So the decision to start talking to your child days, weeks or months prior to their surgery is a very individualized one. 

Children traumatized by surgery have been shown to regress in the weeks and months after surgery. Potty-trained children may begin wetting the bed, or they may want a bottle after having moved on to regular foods. In these cases, patience is essential, providing affection and support while the child works through the experience.

Preparing Yourself for Your Child's Surgery

Having a sick child who needs surgery can be extremely stressful for a parent. It is important to know that you are not alone and that many parents experience the stress of a child having surgery each day. Have a support system during this difficult time can be very helpful for both you and your child, as children are usually very aware of their parent’s state of mind. Some hospitals offer support groups for parents during the hospitalization of their child, whether or not the child needs surgery.

You don’t need to do everything yourself, every minute of the day. If you have a support system of family and friends, seriously consider enlisting help before the procedure in preparation for the time following surgery, especially if your child is expected to be tearful and will need to be held and consoled after surgery.

Remember that your child will be cared for by professionals while in the hospital and that it is absolutely encouraged that you take some time for yourself to sleep, shower and eat. Taking care of yourself will help you provide the support your child needs.

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  • Surgery Guide. Nationwide Children’s Hospital.

By Jennifer Whitlock, RN, MSN, FN
Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.