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What part about surgery is most stressful for a preschool child?
Most preschool-age children can understand simple explanations about their operations. Although your child will not fully understand about all the reasons for the operation, he/she needs clear, simple reasons for coming to the hospital. Preschoolers also have very active imaginations and may have misconceptions or fantasies about operations or the hospital. Recognizing what is stressful to your preschool child while in the hospital can guide you in preparing him/her for the surgical experience. Common stressors and fears in the hospital may include the following:
• Fear of being away from family and home, or of being left alone
• Thinking he/she is in the hospital because he/she is in trouble or being punished
• Fear of having a part of the body hurt
• Fear of needles and shots
• Fear of waking up during surgery
• Fear of pain (or the possibility of pain)
• Fear of the dark How can I help my preschooler get ready for surgery? • Learn as much as you can about your child's surgery. Children can tell when their parents are nervous. The more you know, the better you will feel and the more you can help explain things to your child. • It is very important to be honest with your child about having an operation. Many parents worry about upsetting their child by being truthful. However, keep in mind that your child will also be upset once they discover what is going on. It is best to be honest so your child learns to trust you. • One of the major fears preschoolers have is fear of the unknown. Your child should be prepared three to five days before the date of surgery and perhaps even visit the hospital for a tour. Touring the hospital before surgery can help your child see the sights, sounds and events he/she will experience the day of surgery. It can help your child learn about the hospital, and gives him/her time to talk about concerns and questions he/she may have. Contact the hospital's child life department for this service. • Use simple language to explain that the doctors have decided that a part of the body is sick or hurt and needs to be fixed. It is common for this age group to believe that the operation is a punishment for something he/she did wrong (i.e. - “I hit my sister and now I have to have my tonsils taken out.”). Often, kids also believe that needles are given to kids who are "bad." Reassure your child this is not his/her fault and that many children need operations to help their bodies. • Tell your child what they will see, hear, smell and feel while at the hospital. You can get this information from your child's doctor, nurse or child life specialist. • Read stories about going to the hospital. Allow your child to play with pretend medical equipment. Dramatic play is a big part of a preschooler's life. Use pictures, stuffed animals or toy doctor kits may help your child better understand; this is better than simply telling him/her what will happen. Show your child on a doll or stuffed animal which part of the body will be fixed. If your child will have a bandage or special equipment (such as an IV) when they wake up, talk about that in advance and demonstrate on the doll, if possible. Listen or watch for any misunderstandings or concerns your child might have. Make this a fun time for you and your child. • Explain to your child that on the morning of the operation, it will be very important for their stomach (tummy) to be empty. He/she will not have anything to eat or drink for breakfast on the morning of surgery. Someone will call you the day before to tell you the exact time to stop giving your child food and drink. • Tell your child about the special doctor (anesthesiologist) that will give them some sleepy medicine so that they will not feel anything during surgery. Avoid phrases like “be asleep” or “be put to sleep.” Your child may think that he/she will wake up during the operation or may think of the family pet that was put to sleep. Instead, tell your child that it is a special kind of sleep, different than how you sleep at night, and that he/she will wake up when the operation is over. • Reassure your child that you will be with him or her in the hospital, if this is true. • Encourage your child to bring a favorite stuffed animal, blanket or other security item from home to accompany your child to surgery. • Be patient with your child. It is normal for him/her to require more attention. Your child may have temper tantrums or be uncooperative. It is not unusual for your child to return to bedwetting or thumb-sucking. The regressive behavior will usually improve after the stress of the procedure has passed. • Remember, too, to take care of yourself. Simplify your life during this time and do not be afraid to ask for help from family and friends. Remaining positive and calm can help reduce your preschooler’s anxiety. What should I expect the day of surgery? It is extremely important that you have followed all of the instructions that were given to you by your child's surgeon during the preoperative visit. The day before surgery, someone will call you from the hospital to tell you the exact time to bring your child to the hospital. You will be instructed where to go and when to stop giving your child food and drink. It is very important to follow these rules. Arriving at the wrong time or allowing your child to eat and drink after the prescribed times can cause delays in your child's surgery, or perhaps even postpone or cancel it. It is recommended that you make arrangements for other siblings to be cared for at home. Your attention needs to be focused on your child having surgery. Before coming to the hospital, remove any jewelry (i.e., watches, necklaces, or earrings) that your child wears and leave them at home so they are not misplaced. Also, have your child remove nail polish so that the color of the nail beds can be observed during surgery and afterwards. When at the hospital, you may expect the following to occur:
• Before surgery, you and your child will be taken to the surgical holding room. • Your child will change into hospital pajamas and the nursing staff will get your child ready for the operation. • Your child will be given an identification bracelet to wear and the nurse will check your child’s temperature, blood pressure and oxygen level. None of this should be uncomfortable for your child. • You and your child will meet with several people from the surgical team, including the anesthesiologists and operating room nurses. They will ask you many of the same questions about allergies, medications and your child’s medical history. They will also tell you more information about the operating room procedures. • Waiting for surgery can be a stressful time for your child. A variety of toys and activities for all ages of children and teens are available. Playing with toys, reading a story, watching a movie, or playing a video game are all good ways to help your child relax and re-focus. • Most often, children are given relaxing medicine to drink before they go to the operating room. For older children, this medicine may be given through an IV. This medicine helps your child calmly separate from you. • Before your child leaves for the operating room, reassure your child that you will be waiting close by. If you brought your child’s favorite stuffed animal or comfort item from home, this can go with your child to the operating room. Members of the anesthesia team will take your child to the operating room. The nurse will show you where to wait while your child is in surgery. • When the surgery is over, the surgeon will speak with you to let you know how the operation went. What should I expect after surgery? After the operation, your child will be taken to the recovery room (called the PACU or Post Anesthesia Care Unit). Once your child is settled in, you will be able to join him/her. Your child will stay in the recovery room while the anesthesia wears off. Your child’s vital signs will be monitored and your child may be connected to several machines, including an IV (intravenous) pump. Ask the nurse about any equipment you do not understand. Depending on the type of surgery, your child may be sent home or will go t • The children’s unit to recover for 24 hours or less
• The children’s unit to recover for several days
• An intensive care unit to recover, then to the regular children’s unit until time for discharge. Are there any helpful books to help me and my child prepare for surgery? Anne Civardi and Stephen Cartwright. 1993. Going to the Hospital. EDC Publishing. (ages 3 to 6) Fred Rogers. 1997. Going to the Hospital. The Putnam Publishing Group. (ages 3 to 6) Deborah Hautzig. 1985. A Visit to the Sesame Street Hospital. Random House/Children's Television Workshop. (ages 3 to 7) Richard Scarry. 1995. Big Operation: The Busy World of Richard Scarry. Aladdin Paperback. Debbie Duncan, Nina Ollikainen (Illustrator). September 1995. When Molly Was In The Hospital: A Book for Brothers and Sisters of Hospitalized Children. Rayve Productions, Incorporated. (ages 4 to 7) Paulette Bourgeois, Brenda Clark (Illustrator). 2000. Franklin Goes to the Hospital (volume 25). Scholastic, Inc. (ages 5 to 7) Virginia Dooley and Miriam Katin. 1996. Tubes in My Ears: My Trip to the Hospital. Mondo Publishing. (ages 5 to 7) | 
