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December 2006
Preparing Your Little Patient for Surgery
by Michele Bush Kimball, Ph.D.

Preparing for surgery is a daunting prospect for most adult patients, but it can be overwhelmingly frightening when the patient is a child. However, there are several ways parents can prepare their children for surgical procedures and lessen the intimidation and fear that might accompany the treatments.

When Sarah Stevens of Silver Spring readied her 3-year-old son TJ for eye surgery this past fall, she started by readying herself. She and her husband wanted to try to eliminate TJ’s worries by making sure they were calm and assured when they discussed the surgery with their son. "We didn’t act nervous," Stevens said, "and I think that’s really important."

She said they spoke as candidly as they could with TJ about the procedure he was about to face. They told him he was going to the hospital, and he would receive medicine that would help him sleep. Then they said that while he was sleeping, his ophthalmologist would work on his eyes.

Like many kids, TJ’s most important question was whether the surgery was going to hurt. "We have a no-lying-to-the-kids policy, so we didn’t say, ‘No it won’t,’" Stevens said. "We said that we didn’t know if it would hurt or not."

Stevens said she and her husband kept talking to TJ about his surgery right up until it took place. On the way to the hospital, TJ started acting very nervous. When Stevens asked him what was worrying him, it turned out it was not about the surgery at all. He wanted to be sure that both of his parents would be available to him if he needed them. They assured him that they would be at the hospital throughout the surgery. "I think that was comforting to him, too," Stevens said.

Child Life Specialists

Several hospitals in the area provide child life specialists to help people like the Stevens family bring their children through surgery in the most comfortable way, both mentally and physically. The specialists often use play therapy to help reduce the stress and anxiety children may experience before surgery. They also try to educate their young patients about what they will see and feel during the surgical process.

Michele Kim, a child life specialist at the Children’s National Medical Center, said her patients are often more fearful of surgery than adults are because their imaginations run wild and they don’t have life experiences to give them a base in reality. "Kids are imaginative," she said. "They don’t have the cognitive understanding of adults."

Kim said her most important advice for parents is to be as open and honest as possible about medical procedures. She recommends parents do that by using toy medical kits or story books to explain procedures. She said it is especially helpful to explain the sequence of events in the medical procedure.

Using the services of a child life specialist goes a long way toward preparing children for surgery. Specialists can let patients touch and play with medical equipment to help alleviate their fears. For example, Kim said, her patients are often very nervous when they feel oxygen masks come near their faces because they think they won’t be able to breathe with it over their noses and mouths. She said she has her patients hold masks and put them on and take them off to see that they are not air tight, and they are not scary or painful. "It’s really giving them the opportunity to play and ask questions."

Kim said she recommends that parents remain aware of the amount of information their kids can, and want to, understand. Younger kids may not need to have specifics of surgery, but they really want to know about particular elements, like anesthesia. Very young kids won’t know or understand what happens. Older kids and adolescents tend to like as many details as possible, she said. "Find out how much they want to know," Kim said.

Offering Reassurance

Linda Jung, the child life specialist on the pediatric floor of Georgetown University Hospital, said her patients’ treatments are easier on them when they are aware of what the procedures will entail. "It makes the whole process go a lot easier if they know what to expect," Jung said. "It’s very important to honestly know what is going to happen."

Some of the ways Jung prepares her patients is by using dolls to show how IVs work or how to put in central lines. She uses coloring books to show what will happen to them, and also reads stories that put hospital experiences in children’s terms to help them understand. Jung said many of her patients are afraid that they won’t wake up from anesthesia. They are often very worried about experiencing pain and are also afraid of being alone without their parents. Jung said it is extremely important to help ease these fears in young patients by parents constantly reassuring their children that they will be fine.

That kind of reassurance can have a definite effect on the medical process, said Dr. Aziza Shad, a professor of neuro-oncology and childhood cancer and the director of the Division of Pediatric Hematology/Oncology, Blood and Marrow Transplantation at Georgetown University Hospital. She has seen patients come in from other countries and medical centers who have not received adequate comfort and encouragement from their parents or the medical team.

"They lose trust in their parents; they lose trust in their doctor because they don’t know what’s coming next," Shad said. Preparing children for surgery is a team effort between the patient’s parents and surgical team. One of the most important parts of the process is making sure the patient understands what will happen in a nonthreatening way, she said. "If the children are not prepared, it’s a very terrifying experience," Shad said.

Shad recommends using models to show the patient what will happen. She also recommends reading books about medical procedures, such as books in the Berenstain Bears series.

Preparing children for surgery continues from beginning to end. The advice Shad often gives her patients’ parents is to explain the surgery and continue to assure their children throughout the medical process.

"I think children need to be helped every step of the way," Shad said.


Michele Bush Kimball is a freelance writer based in Springfield. She is a stay-at-home mom to a 3-year-old boy and a 2-year-old girl.
Tips:
  • Contact your hospital to see if it has a child life specialist.
  • Tour the hospital to see what the rooms will look like.
  • Explain as much as possible about the procedure, as honestly as possible.
  • Tell the child about the sequence of events so he is aware of what will happen each step of the way.
  • Try to find out what worries the young patient.
  • Bring dolls, music, blankets — anything that will help the child feel more secure — from home.
  • Bring something to occupy the child’s mind while waiting for the procedure to begin. Some examples are books, toys, video games.
  • Use toy medical kits at home to discuss procedures.
  • Use story books to help young kids understand the surgical process. Some recommendations: The Berenstain Bears Go To The Doctor and Curious George Goes To The Hospital.
  • Be aware of how much information the child will be able to process.

For more information and resources, consult the Child Life Council’s website at www.childlife.org.


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