The prospect of undergoing a surgery can be daunting for anyone, but can be especially so for children. Babies and toddlers lack the understanding of what is really going on – which can itself be frightening – while older children, even teenagers, can find cause for alarm because of what they know (or can find on the internet). Parents or guardians (also known as caregivers) should know that regardless of age, each child requires a different type of approach when surgery is required.
The one constant is communication. Children of all ages expect reassurance of some kind from their caregivers, who are in a prime position to help them be as prepared as possible for surgery. This necessitates that the caregiver asks plenty of questions of the surgeon and their team; the result not only better prepares you to answer the child’s questions, but should also allay your own concerns.
A resource you may want to take advantage of is a child life specialist. These certified individuals work closely with the family and healthcare team to minimize the stress of a hospital or outpatient visit and to achieve healthcare goals. More information can be found at: https://www.cham.org/programs-centers/phoebe-h-stein-child-life-program/services.
Remaining calm in front of even the youngest child is key. If you appear nervous, unsettled or stressed, your child will pick up on that behavior and the situation will likely become more difficult.
Babies of course won’t be asking questions, but they will be at best confused and at worst terrified by finding themselves in unfamiliar surroundings with unknown people. Keep your baby’s routine schedule in place in the days leading up to the procedure, and inform hospital staff of those schedules during their stay. At least one caregiver should be with young children as much as possible, offering comfort and support throughout the experience.
Toddlers may be more prone to questions, but providing the answers can be tricky; choose your words wisely. Telling a young child that a doctor is going to “cut your skin open” or “put you to sleep” can be hair-raising indeed. Instead, explain that the surgical team will provide medicine that will be make them sleepy and that the surgeon will be making a little opening to fix what’s wrong and help them to feel better.
Preschoolers and those just starting school may interpret surgery as a “punishment” for something they did wrong. If this occurs, calmly and patiently explain that that is not the case; instead, they are at the hospital so that they can be made more healthy. Assure them that one or both of you will be there when they wake up. And let them know they can bring a favorite stuffed animal or other familiar, soothing object from home to make them even more comfortable.
Children around the age of 4 should be told about their impending surgery two or three days before so they can begin to prepare. This includes what they’d like to bring with them, what they want to wear (to the hospital as well as during their stay, if necessary). Remind them that you will be present most of the time, and that the doctors and nurses are there to help them and to answer any questions they may have.
You may also consider engaging in some roleplay at home before heading to the hospital. You and/or your child can dress up as a doctor and “operate” on a toy, perhaps using a familiar band-aid afterwards.
As children get older, they are more likely to ask the kinds of questions that an adult would. School-age youngsters tend to have an “I can do it myself!” attitude – admirable in many cases, but not when it comes to surgery. Loss of control, as well as other privacy concerns, can be challenging to address. You and hospital staff alike can impress upon the child that they are in a safe place, that they and their body will always be protected, and again that you will be there when they wake up.
Encourage children to ask as many questions as they want, and remain composed even if the questions have been addressed previously. Sometimes a child will become angry or otherwise upset at having to undergo surgery; a simple “We understand” and encouragement to express themselves can be invaluable.
Part 2 of this article, dealing with older children, can be found here.
Dr. Dominique M. Jan is Professor of Surgery at the Albert Einstein College of Medicine and Division chief of Pediatric Surgery at Montefiore - Einstein Children Hospital (CHAM) and a pediatric surgeon at White Plains Hospital’s Pediatric Specialty Center in White Plains.
Dr. Steven Borenstein is an Associate Professor of Surgery at the Albert Einstein College of Medicine and Division chief of Pediatric Surgery at White Plains Hospital’s Pediatric Specialty Center in White Plains.
To make an appointment, call 914-849-5437.