Children and Adolescents


Southwest Surgical Center accepts infants 6 months of age or more for placement of ear tubes. For all other procedures, children need to be one year of age or more.

It is very common to have many questions when a child or adolescent is scheduled for surgery. As a parent, you can help your child or teenager to cope. When children cope successfully with a surgical experience it often leads to healthier perception of medical care in the future, as well as a positive sense of self.

Sources of stress include fear of separation and fear of the unknown. This stress can be dealt with by communicating simply and honestly, as appropriate to the age of the child.

Parent presence during the initiation of anesthesia is another method of reducing your child’s stress. At the Southwest Surgical Center, one parent is permitted to accompany his/her child back to the operating room. You would be assisted to wear a gown to cover your clothes, as well as a mask, hair cover, and shoe covers. Your role is to provide emotional support to your child. You might hold hands, verbally reassure them, sing, rub an arm or leg, encourage and count deep breaths, etc. Before children go to sleep, they commonly lose control of their actions. Do not be alarmed if your child fights, kicks, swings arms/legs, has eyes that get large, glossy or unfocused, has eyes that roll back, says things that do not make sense, or coughs/gags. Once your child is asleep, you will be directed to the lobby to wait for the surgeon to come speak with you. Your child will be watched carefully throughout the surgery by the knowledgeable and caring members of the Southwest Surgical Center staff.

Facility tours are also helpful in decreasing pre-procedure stress in children. Please call to schedule an appointment with one of our nurses.

Web Sites
Your child may be interested in visiting these web sites designed to introduce children to medical information:

http://kidshealth.org/

http://www.evelinakids.nhs.uk/kids/search/index.html

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Infant / Toddler (6 months – 3 years old)

Try to keep the baby’s normal routine the day before surgery. Make sure your baby and you are well-rested. The period before surgery when an infant cannot eat or drink can be challenging. Rock, walk, or otherwise try to distract the baby during this time. If you are breastfeeding, your baby will usually be able to continue up to a few hours before surgery. You will receive instructions regarding how many hours prior to surgery you will have to stop. Since you may have to miss several breastfeeding sessions, you should plan ahead to pump your breasts to maintain your milk supply and to relieve discomfort. In most cases, breastfeeding can resume when your baby awakes from anesthesia.

Infants and toddlers can sense a parent’s stress. The biggest fear for children in this age group is separation from parent. Bring familiar toys, stuffed animals, blankets, pacifiers, music, etc. the day of surgery. The day of surgery, hold him/her and stay calm.

Surgical education and preparation for toddlers should take place only one or two days in advance, if possible. Preparation too far in advance can increase the anxiety in a toddler.

Useful methods of preparing toddlers for surgery include:

  • Reading books about surgery
  • Role-playing with dolls or stuffed animals
  • Use very simple explanations and words. For example, say, “The doctor is going to fix your ears.” Do not say, “The doctor is going to cut a hole inside your ear.”
  • Let your toddler help choose the security objects that will be brought to the surgical center.

Click here to see a list of helpful books for you and your toddler

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Preschool Children (3-5 years old)

Preschool children may have heard the word surgery, but they are not able to fully understand. Reassure your child that you will be there with them. Common fears for this age group include: fear of being left alone, thinking he/she is having surgery because he/she is being punished, fear of needles and shots, fear of waking up during surgery, fear of damage to body parts, and fear of pain. Three to seven days before surgery is the ideal time to begin preparing a preschool age child for surgery. Be patient with your child. It would not be uncommon for a preschool child to resume previous behaviors such as temper tantrums, bedwetting, or thumb-sucking due to the stress of the surgery.

Useful methods of preparing preschoolers for surgery include:

  • Let children of this age take the lead with medical role play. For example, taking a doll’s “pulse” or listening to its “breathing” with toy instruments.
  • Reading books about surgery
  • Role-playing with dolls or stuffed animals
  • Use very simple explanations and words. For example, say, “Yes, it will hurt, but it will go away quickly.” Do not refer to anesthesia as “being put to sleep”, or the preschooler may refer to a pet that has died and wonder if he/she will die too. A better choice would be, “A doctor will help you sleep during the operation, and he/she will wake you up when it is over.” Explain the benefits of the surgery in words your child will understand. As an example, “After the doctor fixes your ears, you will hear better and have less ear aches.”
  • Facility tours may be helpful.

Click here to see a list of helpful books for you and your preschool-age child

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School-Age Children (6-11 years old)

School-age children typically understand what surgery means. They may fear the experience and can benefit from education a week or two before surgery. Common fears for this age group include: fear of having a body part injured or destroyed, fear of being away from school and friends, fear of pain, fear of needles and shots, fear of dying during surgery, loss of control, and thinking he/she needs surgery because he/she is being punished.

School-age children are very aware of physical image and body changes. They are usually embarrassed during body examinations, and it is important that these children should be given privacy when possible. Serious medical conversations should not take place in front of a school-age child. Include your child in conversations with the medical team members in the room to promote a sense of control.

Useful methods of preparing school-age children for surgery include:

  • Facility tours are recommended.
  • Reading books about surgery.
  • Expressing emotions through drawing and play.
  • This age group may not ask questions if they think they are supposed to know. Make sure your child knows why they are having surgery, using words he/she can understand. Have your child explain what is going to happen related to the surgery. School-aged children sometimes listen carefully, but do not understand everything that was said. Explain the benefits of surgery in terms your child can understand. For example, “After your arm has healed, you will be able to play baseball again.” Use words such as sore instead of pain, or poke instead of shot to ease anxiety.
  • Encourage your child’s friends to visit at home, by phone, or by computer during the recovery period.
  • Emphasize that surgery is not a punishment, and that your child has not done anything wrong.
  • Tell your child that it is alright if they cry or if they are afraid. Encourage him/her to ask questions of the medical team.
  • Give your child compliments and hugs. Hold their hand during tests and procedures.
  • If your child will miss more than a day of school, try to pick up homework so they do not get behind.

Click here to see a list of helpful books for you and your school-age child

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Teenagers (12-18 years old)

Although teenagers understand the reason for a surgery, they may not admit to the anxiety that they are experiencing. Encourage the teen to ask questions and talk with you about their concerns. Teenagers want to be active participants in decisions regarding the care they receive. Common fears for this age group include: fear of having a body part damaged or changed in appearance, fear of being away from school and friends, fear of surgery and its risks, fear of pain, fear of dying during surgery, fear of the unknown, fear of what others will think about them having surgery, and loss of control.

Useful methods of preparing teens for surgery include:

  • Encourage your teen to learn about the surgery by reading books and using the Internet.
  • Encourage your child’s friends to visit at home, by phone, or by computer during the recovery period.
  • If your child will miss more than a day of school, try to pick up homework so they do not get behind.
  • Encourage your teen to bring comfort items from home, such as music players or hand-held gaming devices.
  • Tell your child that it is alright if they cry or if they are afraid. Encourage him/her to ask questions of the medical team.
  • Do not keep secrets from your child. Teens may become angry if they suspect that you are keeping secrets. They need to understand what is happening to their body.
  • Remember that privacy regarding body, feelings, and thoughts is very important to a teen, and their privacy should be respected.
  • Please be aware that any female that is of childbearing age and/or menstruating will be required to have a pregnancy test prior to surgery.

Click here to see a list of helpful books for you and your teen

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Sibling Care

When a sibling needs to have a surgical procedure, siblings may experience a wide range of emotions. The sibling may be angry over the change in routines, or jealous if their sister or brother temporarily is not required to follow family rules (such as TV time or foods eaten). The child may feel guilty about being angry toward the ill sibling, or they may believe that they somehow caused the condition leading to surgery. They may be embarrassed by a sick sibling’s behavior, appearance, or level of attention from family, friends, or neighbors. The sibling my feel sad and lonely if they are spending more time alone or away from parents. The child may feel afraid that the sibling undergoing surgery will not return, or will die, or that they or their parents will have the same medical problem in the future.

These feelings by a sibling may be expressed verbally, or through behavioral and physical changes. The behavior changes may include: reverting to outgrown behaviors (bedwetting, thumb sucking, etc.), seeking more attention, acting out, poor school performance, or ignoring the sibling needing surgery.

Strategies for family coping include attempting to maintain normal routines, reserving quality time for all of your children, finding quiet times to talk with the children about the impending surgery and their feelings, informing teachers of the impending surgery, and encouraging expression of feelings and stress through play, journaling, or art.

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Children and Pain

Pain intensity can be verbalized by children as young as three. When the child cannot express the intensity of pain clearly, monitor for signs of pain including: agitated body movements, crying, rapid heart beat, sweating, and irritability. Pay attention to what a child is doing, what they are saying, and how the child’s body is reacting. Compare your child’s behavior to their normal behavior when you are assessing pain intensity and considering administration of pain medication or other comfort measures as instructed by the surgeon (ice, heat, etc). Always ask the surgeon about the typical range of pain for your child’s specific surgery.

Explain to your child where they will feel pain after the procedure, and how long they can expect it to last. Tell them that the surgery nurse will ask them how much pain he/she is experiencing. A zero to ten scale or a smiling to frowning face scale (typically ages 3-8) may be used. Zero means no pain, and ten means the worst pain they can imagine. Encourage your child to tell you when they are experiencing pain, and if pain medications do not seem to be helping.

There are many ways to help your child cope with pain. Be honest with your child about what will hurt and how long they may have pain, using simple terms. Encourage your child to express their feelings and to ask questions. Give your child permission to cry and to be upset. The following are suggesting coping strategies for coping with pain:

  • Holding or rocking
  • Comforting – speaking softly, singing, stroking a hand, bringing a favorite toy or blanket
  • Distraction- books, magic wands, music, movies
  • Relaxation- music, relaxing by slowly and gradually tightening and loosening the muscles from head to toe
  • Play
  • Guided Imagery- closing the eyes and thinking about a happy place or time, talking about a favorite television show or vacation, making up a story
  • Deep breathing- Ask your child to take a big, deep breath through the nose and then to release it slowly through the mouth. While breathing out, imagine letting go of pain, negative feelings, fear. Pinwheels, bubbles, and straws can be helpful tools for some children.

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Before surgery

A registered nurse will contact you prior to surgery. The nurse will review your child’s past medical and surgical history, medication taken, and allergies. The nurse will also instruct you regarding the time you should plan to arrive, the approximate time of your procedure, and what medications should be taken the day of surgery prior to arrival. Please feel free to ask the nurse about any other questions you have during this phone call.

YOUR CHILD MUST NOT HAVE ANYTHING TO EAT OR DRINK AFTER MIDNIGHT the night before surgery, unless instructed otherwise by the surgeon or the phone nurse. This means no food, liquids of any kind, candy, mints, or gum. Your child may brush their teeth, but must not swallow water.

Failure to follow these instructions may result in temporary cancellation of the surgery. Despite parent’s best efforts, occasionally a child my break these rules when they are not closely supervised. Should this occur, for the safety of your child, please inform the surgical center staff as soon as possible once the Southwest Surgical Center has opened for the day.

If you are told that your child may have / must have clear liquids at any point in the surgical preparation, these include:

  • Water
  • Apple, cranberry, and grape juice
  • Coffee or tea without cream
  • Jell-O without toppings or added fruit
  • Popsicles
  • Clear Pop (Sprite, 7-Up, ginger ale)
  • Sport drinks or Pedialyte

You should review and / or complete the following forms. Bring them with you the day of surgery.

  • Registration Consent
  • Estimate, Billing, and Payment Expectations
  • Patient Surgery Guide
  • Request to Complete a Patient Experience Survey

If your child has a cold, sore throat, or other illness a day or two prior to surgery, please contact your surgeon.

Try to get your child to sleep on time the night before surgery, so that they are well-rested.

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Day of Surgery

  • Your child should bathe or shower the evening before or the morning of surgery. Do not apply oils or powders. Children should arrive with little or no make-up (especially eye make-up) or fingernail polish. Hair clips and barrettes with metal should not be worn. Plastic hair clips and rubber bands for longer hair are fine.
  • Your child should wear loose, comfortable clothing. Shoes should be low-heeled.
  • Please leave all jewelry and valuables at home. Piercings should be removed. However, we encourage you to bring books, games, or an activity to pass the time or to distract your child. Security objects, Sippy cups, and bottles are encouraged as applicable. CD players for music and a DVD player for movies are available for use.
  • Contact lenses and glasses for your child may need to be removed. Please bring storage cases.
  • Do not bring any of your child’s medications with you, unless instructed otherwise by the phone nurse. Medications that are typically requested to be brought along include inhalers and insulin. DO bring a list of your child’s medications, including the dosage, frequency, and schedule.
  • At least one parent / legal guardian should bring a driver’s license or picture ID, as well as a valid insurance card. If you are a guardian, a copy of the guardianship papers should be brought as well. If you require eyeglasses for reading, please bring them with you, as you will be asked to review a number of documents during your stay.
  • One parent / legal guardian must accompany and stay with a patient under 18 years of age. We recommend that two adults be available to take the child home. Siblings should not be brought along.
  • Please arrive promptly.
  • When you arrive, check-in at the reception desk. When the nurse calls you back, they will answer questions and prepare your child for surgery. Your child will be asked to put on a special gown, cap, and slippers. You will be asked to sign the consent form for your child’s surgery. The anesthesia provider will ask questions about your child’s medical history and current health. The surgeon will check to see if you have any last minute questions.
  • Older children are usually taken to the operating room on a wheeled stretcher. Younger children usually walk or are carried.
  • Your child will be given one of the following forms of anesthesia for surgery:
    • Local- The anesthetic is injected into a small area causing numbing
    • Monitored Anesthesia Care (MAC)- IV medications causing drowsiness in addition to small numbing injections
    • Regional- Numbing one extremity (leg, arm)
    • General- Your child is completely asleep
  • If your child is administered medication to help him/her relax before surgery, remain watchful to prevent any injuries caused by temporarily impaired balance or judgment. Please ask the nurse for assistance if your child tries to get up after the medication has been given.
  • The use of alcohol-based hand sanitizers (located in each room) is encouraged whenever entering and exiting the room.
  • Wireless Internet access is available in the lobby. Cell phones are permitted only in the pre-op area and the waiting room. For your convenience, we offer papers at the reception desk and snacks in the café. Pagers are available to call you back to the waiting area when the procedure is complete.
  • Balloons are allowed for children, but they must be the non-latex (Mylar) type.

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After Surgery

  • Your child will be taken to a recovery area when the surgery is completed. At this time, the surgeon will inform you about your child’s procedure and recovery status. When your child has sufficiently recovered, they will be taken to a room where you will be able to join him / her.
  • Your child may come back from recovery with one or more IVs (a nutrient solution administered into a vein). These stay in until your child is taking adequate amounts of fluids and there is no need for additional IV medication.
  • The nurse will closely monitor the surgical dressing, circulation and feeling in operative extremities, and your child’s temperature, pulse, respirations, and blood pressure.
  • The nurse will work to keep your child as comfortable as possible. If your child is of age, the nurse will ask your child how much pain he/she is experiencing. A zero to ten scale or a smiling to frowning face scale may be used. Please let the nurse know if you feel that your child’s pain medication is not helping.

Your surgeon will establish when your child has recovered enough to be discharged. This typically occurs one to four hours after surgery, but can be longer. If you desire, we can make your child’s prescriptions available at discharge using the Southwest Family Pharmacy. If you have questions after you go home, we are available until 6 pm. After that time, please contact your surgeon’s office or go to Urgent Care or an emergency room. You will be contacted 24 to 48 hours after you go home to see how your child is doing and answer any remaining questions you may have.

Surgery patients often have mild anesthesia side effects, such as sore throat, sleepiness, muscle aches, headaches, dizziness, nausea, or occasional vomiting. These after-effects should diminish quickly following surgery, but may take several days to completely disappear. During the recovery period, the nurse will guide you regarding your child’s readiness to resume fluid intake. Once fluid intake is tolerated, solid foods can be resumed if allowed by the surgeon. Once home, foods that are low fat and easily digested are suggested to lessen the chances of nausea and vomiting.

Your child may also experience a slight (less than 101 degrees) fever after surgery. Encourage your child to drink fluids, and to take deep breaths and to cough to clear the lungs to help eliminate the fever.

If your child had IV sedation or general anesthesia, the following activities should be avoided for 24 hours (longer if instructed by your surgeon):

  • Sports
  • Driving
  • Cooking
  • Strenuous play or activities
  • Operating machinery
  • Walking up and down steps

The Southwest Surgical Center physicians and staff would be honored to provide excellent care to your child!

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