Pediatric surgery can be especially daunting when it’s your child having the procedure. Even if you have had surgery yourself, you might not know what to expect, or how to best prepare your family. Pediatric outpatient surgery is fairly common; I know in our house, we have had four ambulatory procedures. Two surgeries for our kindergartener, and one for each of our younger daughters.
Is Pediatric Surgery Necessary?
To begin, parents need to determine if a particular surgery is even needed. It is essential to find a primary care provider that your family can trust. This provider can help you determine if a referral to a specialist, or directly to a surgeon, is the best path. Make sure to ask for a particular surgeon’s name when soliciting a referral, not just the name of a practice.
A provider should base their clinical decision making on a combination of their experience and the latest research. Once your child has an initial visit with the recommended surgeon, don’t hesitate to get a second opinion if you are uncomfortable with the first answer. I have found, both in my professional and personal lives, that if surgery is warranted and believed to be safe, most surgeons are willing to perform a procedure.
In our current economic climate, most insurance companies won’t cover particular procedures without the appropriate diagnostic criteria being met. This cuts down on unneeded expenses and decreases patient risk. If the health system or surgery center wants to get reimbursed for the procedure they are completing, then it is the responsibility of the surgeon to make sure the patient meets the criteria for reimbursement. For example, when our kindergartener had her tonsils out, she met three of the required criteria: signs of a disrupted sleep pattern, repeated strep infections, and cryptic tonsils that blocked her airway.
Preparation for the Procedure
At your child’s initial visit with the surgeon, it is important to ask how to handle their medications leading up to surgery, even over-the-counter items. Many medications have bleeding as a side effect (Ibuprofen/Advil is probably the most common for kids), and can take a long time to get out of your child’s system. But, if your child requires medication on a daily basis (such as insulin, antibiotics, or an inhaler), it is critical to discuss this with the team to determine the best course of action for your child.
In order to decrease aspiration risk (or the chance that food or liquids will migrate to the lungs from the stomach while under anesthesia), the surgery center will ask that you stop food and drink for your child prior to the procedure. Make sure to strictly adhere to the guidelines given. The anesthesiologist can refuse to sedate your child if they haven’t, since the aspiration risk is too great.
In an ambulatory surgery setting (meaning your child comes in from home for a procedure), the scheduler typically calls families the day prior to the procedure to let them know what time to arrive. It is usually two hours prior to the surgery start time. A general rule of thumb is that the youngest children are the earliest cases, so that they do not have to go a long time without breastmilk or formula.
Make sure to stock up on items that can help during the recovery period. Our girls really appreciated clear liquids (popsicles, jello, Gatorade), special treats, Tylenol, movies, magazines, and books. If there are other children to care for, make sure to arrange childcare for them during the procedure, and potentially for the days following.
When it is possible, keep the child away from germs. Even a runny nose or cough can cancel a procedure, since it increases the risk of a post-operative infection. If your child is especially nervous about the procedure, or just wants to better understand what goes on, this video does an excellent job of showing what happens during ambulatory surgery.
The Day of the Surgery
Make sure to allow plenty of time for traveling the morning of the procedure. Even though the hospital is my second home, my perspective shifts dramatically when it is my family receiving care. I have been known to forget all previously acquired knowledge when my scrubs are at home!
Watch your child closely, at home, in the car, and in the surgical center, to ensure that they do not have anything to eat or drink. It is amazing how many fountains, old water bottles, vending machines, and stray snacks a hungry child can find!
Also, it is helpful to bring your own entertainment to pass the time. Even a quick procedure seems to take forever when it is your child. You might read the same paragraph 14 times, but at least you won’t be starring at the board that tells you when your child’s surgery is over!
Once the procedure is completed, your child will be moved to the post-anesthesia care unit (PACU). Typically, parents are allowed to come back and see their child once their breathing tube has been removed and they have woken up from the anesthesia. For children who typically take a nap during the day, they might treat surgery as an extra long nap! This might be the longest part of your separation from your child.
Common side effects from anesthesia include nausea and constipation. Make sure their discharge instructions include a plan for helping with these side effects. Barring any complications, your child will be able to leave the PACU two hours after their procedure is over.
After the Surgery
During the pre-op appointment, try to get a clear picture from the surgeon as to the anticipated recovery time for your child. It can range from hours to weeks, depending on the procedure, the age of your child, and their past medical history. Plan for the longest recovery anticipated, and then you can be pleasantly surprised if it is shorter than you thought.
Common complications following surgery include infection, bleeding from the incision site, pain, as well as constipation and nausea (both common with anesthesia and narcotic pain medication). Discharge instructions must include when and how to notify the surgical team if your child experiences a complication. If you aren’t sure if your child meets this criteria, it doesn’t hurt to call and ask.
Allot time to pay special attention to your other children, if you have them. My oldest was exceedingly jealous of all the attention her little sisters received, especially in the week following their surgeries. Also, give yourself and your partner a chance to take a break. Even if your child doesn’t require a great deal of care following their procedure, the stress and worry of having your child experience surgery can take its toll.
We found it especially helpful when our friends and family offered support following the procedure. Meals delivered to our door, and other children taken to activities gave us the opportunity to focus on our child during their recovery.