When Your Child is Going to Have Surgery
Sam Golden, MD
Comer Children's Hospital, University of Chicago
Many parents logically ask, "What should I say to my child before surgery?" While this
question has no clear-cut answers, some general principles can be helpful.
Is it usual for children to experience anxiety prior to
surgery? How can I tell if my child is anxious?
It is not unusual for a child or parent to be anxious prior to surgery. In particular, children who
may be at greatest risk for being anxious include those children with a "shy and inhibited"
personality, children with a history of previous surgeries and hospitalizations, children of
separated parents, and children of very anxious parents. Children may show signs of anxiety
in the surgical pre-operative area in various ways such as not talking or fearing separation
How can we reduce the anxiety my child is experiencing
about her upcoming surgery?
Preparing your child for surgery should begin in the surgeon's office when you and your child
hopefully develop a trust and bond with the surgeon performing the procedure. Many surgeons
have pamphlets in their office for you to read and even videos to watch which will inform you
about the procedure.
Some hospitals offer operating room tours and instruction on coping skills by a Child Life
Specialist prior to surgery. For example, a child life specialist may allow your child to play with
a scented facemask and give instructions on how to breathe with it. If time allows and the
child shows an interest, other medical tools such as stethoscopes and IV catheters may be
shown to the children so that they may be allowed to examine, touch, and play with these
items. By becoming familiar with these items, the entire process tends to be less frightening.
This and other forms of age-appropriate play therapy greatly aid the process of undergoing
surgery.
Your child's anesthesiologist will try to allay these fears by reassuring the child and/or giving
the child a sedative medication. Talk to your child's anesthesiologist to determine the best way
to help alleviate any associated anxiety that may be present. Bringing a familiar item from
home such as a stuffed toy, blanket, PSP or Gameboy may be comforting, distracting, and
help the process.
Parents can help their child be ready for surgery by being ready themselves. Don't be afraid to
discuss any questions or concerns that you have ahead of time with your surgeon and
anesthesiologist. If you are anxious, discuss it with your child's doctors, preferably without the
presence of your child. When you are comfortable and confident, your child will likely be also.
Be careful not to apologize to your child for the decision to undergo surgery or give an
excessive amount of reassurance. Instead, be matter of fact about the surgery; this will
diminish worry and fear.
Do children of different ages have different coping skills
when faced with surgery? How can I decide what kind of
explanation my child needs before her surgery?
Children of all ages need to be reassured that someone will be with them at all times. In
addition, careful choice of words is important; for example, let your child know that medicine
will be given immediately if they feel "sore" after surgery, not that they may have "pain."
Similarly, when explaining the surgery, use the phrase "make an opening" instead of "cut."
Encourage your child to ask any questions they may have at any time prior to the procedure.
If necessary, write them down so they can be answered later.
Adolescents are capable of understanding things in a manner similar to adults. What will
happen to them should be explained in detail, both openly and honestly. Adolescents
frequently are worried about sophisticated concepts such as body disfigurement, pain,
needles, diagnosis, prognosis, and even death. Often they will have such questions without
telling anyone and try to hide their fears. It is important to anticipate your adolescent's
questions by discussing the surgery prior to meeting with the surgeon and anesthesiologist;
you may want to write questions down so that your adolescent's concerns can be answered
despite a reluctance to pose the questions in person.
Similarly, elementary school children require an upfront and honest explanation, at a level that
is appropriate to their age level. In a direct but simpler way they need to be told that although
they will be separated for a while, but they will be reunited when he/she wakes up from sleep.
Reassure your child that nothing bad will happen from the surgery and that it needs to be
done to fix a problem that won't go away by itself. Let your child guide the discussion by
asking what concerns he or she may have, and try to answer them directly.
Young children ages 3-7 are more limited in their capacity to understand but make sure to tell
them they will be separated only a short while from you, they will be OK, and someone will be
with them to make sure they will be fine. Use age appropriate language (e.g. "booboos" and
"band-aids"). As mentioned earlier, instructions on using the facemask and sedation with an
anxiety relieving medicine are helpful at this age. Some parents have tried to hide from their
young child the fact that they are going to have surgery. This is not a good idea because it
fosters distrust and fear later on and serves to increase worries about medical procedures over
time.
Thanks to Dr. Scott Hunter for his valuable comments.
What are the Risks of Anesthesia?
A natural concern of any parent or guardian whose child is having an operation is whether the
anesthesia will cause any harm. Even though anesthesia today is much safer than it has ever
been, all anesthesia has an element of risk. In fact, sometimes it is difficult to separate the
risks of anesthesia from the risks of the operation itself. Anesthesia aims to take away the
pain and discomfort of surgery and make it easier for a procedure to be accomplished
optimally, and these benefits must be weighed against the risks of anesthesia itself.
The specific risks of anesthesia will vary with the type of operation and whether it is an
emergency, the age of the child, and any other problems or illnesses that exist. Also, each
type of anesthetic has a specific set of risks and side effects associated with it. The
anesthesiologist will talk to you about the various types of anesthesia that may be used for
your child, and the risks and benefits (advantages and disadvantages) of each.
Types of Risk
The risks of anesthesia may be considered in terms of side effects and adverse effects.
A side effect is a secondary or unwanted effect of a drug or treatment. Many side effects of
anesthesia drugs and techniques can be anticipated, but may be unavoidable. Although at
times uncomfortable or distressing, most common side effects are not particularly dangerous.
They will either wear off or can be treated easily. Examples of side effects are nausea,
vomiting, drowsiness, dizziness, sore throat, shivering, aches and pains, discomfort during
injection of drugs, and agitation upon awakening from anesthesia.
An adverse effect is a result of a drug or treatment that is neither intended nor expected.
Adverse effects are very rare, but may occur. These may include dental trauma, croup
(swelling of the windpipe), allergic reactions to drugs or latex products, wheezing, vocal cord
spasm or injury, regurgitation of stomach contents with subsequent aspiration pneumonia,
injury to arteries, veins or nerves, alterations in blood pressure, and/or irregular heart
rhythms. Death and brain damage are the most feared of all anesthetic risks, but fortunately
these complications are extremely rare. In the United States, the chance (risk) of a healthy
child dying or sustaining a severe injury as a result of anesthesia is less than the risk of
traveling in a car.
Ways to Reduce Risk

Sharing all information about your child's health (including all medications your child is
taking, even those that can be obtained without a doctor's prescription) with the
anesthesiologist prior to the procedure. This will allow the anesthesiologist to make a

decision as to which type of anesthesia and drugs are safest for the patient
Adhering to the guidelines you are given regarding limiting eating and drinking before

the operation
Continuing usual medications unless the anesthesiologist or surgeon recommends


against it
Ensuring that any other chronic illnesses are being optimally treated
Having an anesthesiologist who is experienced in the care of children
Most children who undergo anesthesia will be quite comfortable and have no
complications. They will often be able to go home the same day as the procedure if the
surgery is not too extensive.