Under the knife

As five-year-old Lachlan was being wheeled into surgery to have his tonsils removed, he looked up at his father, his big blue eyes brimming with tears. After battling recurring sore throats and infections for years, the doctors decided Lachlan’s tonsils had to go.

For many adults, the prospect of surgery is a daunting experience – but for young children, it can be a frightening ordeal.

According to experts, preparing your child beforehand can go along way towards easing their fears.

For young children, offer a simple explanation the day before surgery, suggests Dr Meredith Craigie, Senior Consultant, Department of Anesthesia and Pain Medicine at Flinders Medical Centre. “For older children – give them a weeks’ advance warning so they can process what’s going on and ask questions.”

Encourage your child to talk about how they’re feeling. Let them know it’s ok to feel scared, and reassure your child that you will be there to comfort them.

It’s also a good idea to choose your words carefully. Tell your child they’ll be ‘put to sleep’ like your faithful old dog, and you may inadvertently fuel their anxiety.

Calm your own fears

When mother of three, Colleen had her tonsils and adenoids removed as a child, surgery didn’t go as planned. “I stopped breathing under the anesthetic, and started to turn blue,” she says.

Years later, Colleen had to put her own fears aside when her five-year-old daughter Helana, had her adenoids removed and grommets inserted.

“I was terrified, but I hid my anxiety and kept a poker face – until they wheeled her away,” says Colleen.

Keeping your own emotions in check is one of the most helpful things you can do for your child, according to Professor Roy Kimble, Paediatric Surgeon University of Queensland.

“A calm and relaxed parent before surgery nearly always equates to a calm and relaxed child,” he says.

Will it hurt?

If your child asks if the procedure will cause them some pain, you might be tempted to bend the truth to try to protect them. But sidestepping the reality or avoiding the truth altogether only sabotages the trust you’ve built between you and your child.

“If your child asks if it’s going to hurt – say it may feel a bit uncomfortable, but doctors and nurses are there to help you, to make you feel better,” says Prof Kimble.

Get informed

When two-year-old Mitchell was scheduled for surgery to fix an undescended testicle, his parents armed themselves with as much information as they could.

“I felt if I knew a bit about the operation, and what to expect, it would be less traumatic for all of us,” says his mother Gaye.
Gathering knowledge is empowering for parents, agrees Dr Craigie.

“Parents are often concerned about pain management, or if they can be with their child right up to surgery. Don’t ever be afraid to ask questions,” she says.

Make it a positive experience

Ten-year-old Bree is an old hand at hospital visits – she’s had over 40 procedures in the last four years, 10 of them required general anesthetic. Bree suffers from a neurological condition that continues to baffle medical experts.

Despite her ongoing ordeal, Bree doesn’t see hospital as a scary place. She happily helps to pack her bag before each hospital visit, says her mum Dee.

“She takes along her favourite doll, and the nurses put an armband on it too. And when the procedure is over, and she’s feeling well enough, we plan something special with just us,” she says.

What to expect

Before surgery, parents are usually given the chance to cuddle and reassure their child. “We’ll put snuggly blanket around them, and some parents sing to them, or tell their child a story to calm them,” says Dr Craigie.

General anesthetic is administered either by breathing oxygen and anesthetic gas in a mask, or via an intravenous cannular into a vein.

After the operation, the anesthetist begins the wake-up process. “When we’re sure the patient is breathing nicely, their condition is stable, and there is no ongoing bleeding, they’re taken to the recovery room,” she says.

When it’s time to go home, the hospital will usually provide written guidelines to help you care for your child during the recovery period.

After you return home your child will need lots of TLC, according to Dr Craigie.

“A trip to hospital is a major event in a child’s life, they may have sleep disturbances, and be very unsettled and clingy for several weeks – even for minor procedures,” she says.

There are many reasons your child might need to undergo surgery. These are the top five.

Grommets

If your child suffers from hearing loss, or frequent ear infections they can develop a condition called glue ear – a thick, sticky fluid that sits behind the ear drum. If the fluid remains, your doctor might suggest surgery – tiny ventilation tubes called grommets are inserted into the ear under a microscope. These help to drain the fluid.

“It’s probably the most common childhood medical procedure, involving only 10 - 15 minutes in the operating theatre,” says Dr Craigie. After a few months the grommets fall out of the child’s ears on their own.

Inguinal Hernia

Hernia is described as a protrusion, usually of the small bowel or fatty material, through a weakness in a muscle wall. This condition is something many children are born with or they develop it within early childhood, says Prof Kimble. The condition is far less common in girls.

“During the operation the surgeon will divide the peritoneum or sack, tie one end and leave the other end open,” he says. It’s a very straightforward procedure.

Tonsillitis and Adenoids

Tonsils help to fight infection, but they can become inflamed, causing your child pain and discomfort. With recurrent bouts of tonsillitis your doctor may suggest removing them. Removal of the adenoids, which sit just behind the soft palette is another common procedure – especially in the under fives according to Dr Craigie. “Adenoids can cause problem snoring, and on occasion obstructive sleep apnoea,” she says.

To remove the adenoids the surgeon uses a scoop with a blade on one edge. A tonsillectomy usually involves a combination of surgical treatments - cutting, laser or an electric current to fuse the blood vessels. These procedures can be day surgery, or involve an overnight stay. There is a slight risk (one in 20) that a child will have post operative bleeding, but new surgical techniques are dramatically reducing the risk.

Appendicectomy

The appendix is a small worm like appendage attached to the large bowel. A painful inflamed appendix may need to be removed in emergency surgery. The surgery is performed either by key hole surgery (laparoscopy), or via a single incision in the lower part of the abdomen.

After surgery your child will be given pain medication, and will need to stay in hospital for several days, says Professor Kimble. If the appendix has burst, that’s a more serious outcome and requires a longer hospital stay.

Undescended Testicles

Sometimes one or both testicles aren’t where they should be at birth. “No one really knows why this occurs,” says Professor Kimble. “Around one in 20 children are born with one testis in the abdomen, somewhere in the groin, or high up in the scrotum.”  A simple day surgery procedure is performed to free up the testis from where it is located and position it into a pouch in the scrotum.

By Carrol Baker