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Introduction

Your child is scheduled for surgery. At Centre for Children of Kokilaben Dhirubhai Ambani Hospital, we understand how important this is to both you and your child. Knowing more about the procedure and the hospital stay will help you prepare.
This booklet offers suggestions on how you can prepare and provide support to your child for surgery. It also offers information given to you by your doctors, nurses or other healthcare team members. We are committed to providing excellent care to you and your family.

Before Surgery

Contacting Your Child’s Surgeon

Please contact the surgeon’s office if you have any questions about the date and time of your child’s surgery or the pre-surgical instructions. It is important to notify your surgeon if there is any change in your child’s health before surgery.

Pre-surgical Tours

Our Centre can provide a pre-surgical tour for you and your child to help ease anxiety about his or her upcoming hospital experience. During the tour, you will meet the hospital staff, visit the preoperative waiting areas, the Operating Room when available, and other areas you may see on the day of surgery. If your child will be staying overnight in the hospital, you may also be able to tour the pediatric unit (which includes a patient room, the nursing station and playroom).

This is an excellent way to help your child learn about the process and adjust to the environment. Your child will have the opportunity to see, hear and touch medical equipment, ask questions and meet friendly staff.

How Do We Prepare for Surgery?

Food and Drink

  • The table in this section outlines the required NPO guidelines you should follow based on your child's age. NPO means "Nothing by Mouth" including food, chewing gum and liquids. If your child should eat or drink within the required fasting period, the surgery may be postponed or rescheduled. For safety reasons, anaesthesia cannot be given unless your child has an empty stomach.
  • If your child takes medication, you will be given specific instructions whether to give the medicine the morning of surgery.
  • If you have any questions regarding NPO requirements, please contact your child’s Surgeon. Our team has a commitment to explain our procedures in order to provide excellent care for your child.
  • Types of Liquid or Food Do Not Drink or Eat
    Clear Liquids 4 hours before test or procedure
    Breast Milk 4 hours before test or procedure
    Infant Formula 6 hours before test or procedure
    Non-human Milk 6 hours before test or procedure
    Solid Food 8 hours before test or procedure

    Other Preparations

    • Remove all jewellery, including all piercings.
    • Remove all nail polish and make-up.
    • Leave valuables at home.
    • Bring a container for eyeglasses or contact lenses. If your child wears contacts, consider using glasses during the hospital stay.
    • Bathe your child the night before or morning of surgery. You may be asked to use a special soap the evening before surgery to help prevent infections. Place your child in clean clothes and sleep on clean sheets. Do not use any lotions, colognes, powders and deodorant or hair products.
    • If your child has long hair, braid it before surgery and secure with an elastic band (no metal clips).
    • Dress your child in comfortable clothes.
    • You may bring a favourite toy or blanket that helps your child go to sleep or feel comfortable. Please label it with your child’s name. Wash blankets and toys before bringing them to the hospital.

    How Do I Talk to My Child About Surgery?

    In addition to getting your child physically prepared for surgery, there are other ways to get ready so that your child feels as comfortable as possible. These methods vary depending on your child’s age and experience. Remember to give honest, simple explanations. If you don’t know the answer, it is okay to say “I don’t know, but I will find out.”

    Infants and Toddlers (ages birth – 2 years) On the day of surgery, it is most important that you remain your child’s greatest source of comfort. Continue to hold and comfort your child while staff is setting up. While you are waiting for your child’s surgery, you may want to bring a favourite book, blanket, stuffed animal or toy.

    Pre-schoolers (ages 3 – 5 years) During the days leading up to your child’s surgery, you may want to talk about going to the hospital and what your child can expect to see there. Read books about the hospital and bring the hospital into daily play (doctor kits, adhesive bandages, etc.). You can emphasize that your child’s surgery is the best way for the doctors to help your child feel better or to fix something in his body. Be sure to tell your child that it is not his fault and that surgery does not happen because he did something wrong.

    School-aged children (ages 6 – 12 years) School-aged children are concerned with sensations they will feel, and the sequence of events they may experience. Explain that your child’s anaesthesiologist will make certain she does not wake up during surgery and that she will not feel anything. For example, “The doctor will give you a mask to help you fall asleep. The mask goes over your nose and mouth, and can feel squishy. After some deep breaths, you will be asleep!” Talk about how this surgery may change his or her appearance, if applicable, explaining bandages, tubes, casts, etc.

    Teens (ages 13 -19 years) Teens are concerned with privacy, anaesthesia’s effectiveness, and how a surgery may change their appearance. You can be supportive by encouraging expression of these concerns and reassuring your teen.

    When children do not understand a procedure, they might assume the worst and hold secret fears about what might happen. Many fear that surgery will hurt or that they will not wake up from the anaesthesia. By explaining the procedure appropriately to your child, you may calm these fears and decrease your child’s anxiety.

    Most children are concerned with the sensations they will feel. It will be helpful to explain that before they receive anaesthesia (or “sleep medicine”), they will have their blood pressure and temperature taken, just like at the doctor’s office. They will feel the heart monitor stickers placed on their chest, and it may be a little cool in the pre-surgical area. Nurses can provide your child with warm blankets if needed.

    How Do I Talk to My Child About Anesthesia?

    In addition to getting your child physically prepared for surgery, there are other ways to get ready so that your child feels as comfortable as possible. These methods vary depending on your child's age and experience. Remember to give honest, simple explanations. If you don't know the answer, it is okay to say "I don't know, but I will find out."

    Infants and Toddlers (ages birth – 2 years) On the day of surgery, it is most important that you remain your child's greatest source of comfort. Continue to hold and comfort your child while staff is setting up. While you are waiting for your child's surgery, you may want to bring a favourite book, blanket, stuffed animal or toy.

    Pre-schoolers (ages 3 – 5 years) During the days leading up to your child's surgery, you may want to talk about going to the hospital and what your child can expect to see there. Read books about the hospital and bring the hospital into daily play (doctor kits, adhesive bandages, etc.). You can emphasize that your child's surgery is the best way for the doctors to help your child feel better or to fix something in his body. Be sure to tell your child that it is not his fault and that surgery does not happen because he did something wrong.

    School-aged children (ages 6 – 12 years) School-aged children are concerned with sensations they will feel, and the sequence of events they may experience. Explain that your child's anaesthesiologist will make certain she does not wake up during surgery and that she will not feel anything. For example, "The doctor will give you a mask to help you fall asleep. The mask goes over your nose and mouth, and can feel squishy. After some deep breaths, you will be asleep!" Talk about how this surgery may change his or her appearance, if applicable, explaining bandages, tubes, casts, etc.

    Teens (ages 13 -19 years) Teens are concerned with privacy, anaesthesia's effectiveness, and how a surgery may change their appearance. You can be supportive by encouraging expression of these concerns and reassuring your teen.

    When children do not understand a procedure, they might assume the worst and hold secret fears about what might happen. Many fear that surgery will hurt or that they will not wake up from the anaesthesia. By explaining the procedure appropriately to your child, you may calm these fears and decrease your child's anxiety.

    Most children are concerned with the sensations they will feel. It will be helpful to explain that before they receive anaesthesia (or "sleep medicine"), they will have their blood pressure and temperature taken, just like at the doctor's office. They will feel the heart monitor stickers placed on their chest, and it may be a little cool in the pre-surgical area. Nurses can provide your child with warm blankets if needed.

    Day Of The Surgery

    What Should We Bring to the Hospital?

    In order for the day to go smoothly and to make your child feel comfortable, please bring the following items with you on the day of surgery:

    • List of your child’s current medications
    • Any paperwork such as history and physical done by your paediatrician, or lab results
    • Comfort items such as favourite stuf
    • Favourite books or quiet toys

    When do we come to the Hospital?

    On the day of surgery, please arrive two hours before the scheduled surgery and check in at the Registration Desk.

    Who Will We Meet On the Day of Surgery?

    Nurse - the nurse will meet you and your child in the pre-op area to do an assessment and get your child ready for surgery. A nurse will also be with your child after surgery in the recovery area.
    Clinical Technician—the tech will assist the nursing staff in caring for your child.
    Anaesthesiologist—the Anaesthesiologist's main task is to provide safe and optimal conditions during surgery and to make the entire experience as comfortable as possible. They will administer anaesthesia medications, monitor your child's vital signs during the entire process, and administer pain medications as needed.
    Surgeon—Surgeon is the doctor who scheduled the surgery and will be conducting the procedure.
    Surgical Resident—the Surgical Resident is a doctor who is in the training phase of education. Surgical Residents sometimes assist the Surgeon in procedures.
    Operating Room Nurse—the OR Nurse works with the Surgeon to assist with the procedure. The nurse will introduce him or herself before the surgery and answer any questions you have.

    What Happens On the Day of Surgery?

    Preoperative Area
    When you arrive at the hospital, please check in at the Registration. Here, you will fill out some paperwork, and the staff will verify your child’s name and date of birth.
    The staff will bring you back to the pre-op area after you have registered. There, a nurse will gather your child’s height, weight and blood pressure, temperature, and pulse oxygen level. He or she will also verify your child’s medical history, allergies, and surgical procedure. Next, we will have your child change into hospital pajamas.
    The anaesthesiologist and surgeon will also meet you in the pre-op area to go over the surgical plan, get your consent, and answer any questions that you may have. The surgeon will mark the surgical site with a special marker to verify the procedure. During the entire process, staff will ask you and your child’s name, birth date, and surgical procedure several times. This is done for the safety of your child.

    The Operating Room
    When it is time to go back to the Operating Room, the OR Nurse and Anaesthesia provider will come to the pre-op area and conduct another safety check. If your child is given an IV in the preoperative area, the anaesthesiologist may pre-medicate your child with relaxing medicine before going back to the OR.

    When your child is in surgery, the staff will bring you to the main pre-op waiting area. You may go to a nearby coffee cart or café if you need to, but we ask that one parent remain in the waiting area to be present for any information or updates. The total length of time in surgery varies with each child and depends on the type of procedure being done.

    When your child’s surgery is complete, he or she will be brought into the Pediatric Post Anaesthesia Care Unit (PACU). Your child may or may not be awake when you arrive in the PACU because every child awakens from surgery at a different rate. The nurse in the PACU will watch your child closely as they recover from their anaesthetic and treat pain or nausea.

    How Do I Help My Child With Pain?

    Appropriate pain medications will be given based on your child’s needs. Sometimes pain is not just from surgery, but can also occur from gas, muscle aches, and other sources. It is our commitment to control your child’s pain to keep him or her very comfortable. You can also help your child by:

  • Position your child in a comfortable position
  • Listening to your child’s cues and validating when they are feeling uncomfortable
  • Encourage your child to tell you and your nurse when he or she feels uncomfortable so we can address it
  • Holding your child when able
  • Softly touching your child
  • Speaking softly to your child
  • Using distraction techniques such as singing, playing, and watching movies
  • Helping your child self-soothe by guiding him or her through deep breathing or counting
  • Offering choices where possible
  • Encouraging your child to move and walk, when appropriate
  • Allowing for adequate rest

  • After Surgery

    When your child is fully awake and recovered, the staff will go over discharge instructions with you. They will then help you and your child out to your vehicle. If your child needs to stay in the hospital after the surgery, he or she will be taken to a room as soon as one is available. The staff will take you and your child to their room and make sure that you get settled in. We encourage one parent to stay overnight with children to make the experience more comfortable. The nurse will give you written instructions when your child is ready to go home. It is important that you follow these instructions and any special instructions from your child/s doctors. Please contact the doctor's office if you have any questions.

    It is normal for some children to have behavioural reactions after a hospitalization. If you notice that your child's behaviour is different, understand that these changes are normal and temporary. Common changes might include regression (sucking his/her thumb or bed-wetting), a change in eating habits, a new need for more attention or affection, or being afraid of the dark or going to sleep. Validate your child's feelings and offer emotional support. Reassure them and try to keep your routine as normal as possible. Having an ongoing conversation and allowing your child to express their feelings is the best way to uncover misconceptions and fears that your child may have.

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