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surgery preparing a child is tough

March 4, 2007 12:36 am

BY MARCIA ARMSTRONG

Surgery.

The very word can strike fear into a parent's heart.

Your child's operation may be scheduled or come as a complete shock. Either way, sending your offspring to the operating room is the toughest thing you'll ever do.

I knew from the moment I committed to adopt my then-3-year-old daughter, Anna, from China, that surgery was in her future. Her dislocated left hip needed to be put back into place. Surgery was the only answer.

In January, the orthopedic surgeon performed three procedures to get Anna's hip into its socket and keep it there. Then, so her bones had a chance to heal, the doctor placed Anna in a body cast for 12 weeks.

I didn't how my lively 4-year-old would cope with a cast that would render her completely immobile. I agonized over how to get her ready for the event. How much do you say? How and when do you say it?

Preparing a child for hospitalization is essential to avoid long-lasting emotional trauma, said Carolyn Bergquist, certified child-life specialist at Shriner's Hospital for Children Intermountain in Salt Lake City, where Anna had her surgery. This is especially true for kids facing more than one medical procedure.

"If they are scared during the first hospitalization, when they come back for the second time, they are highly anxious," Bergquist said.

The extent and timing of an explanation depend on a child's age, said Kathy Herring, pediatric nurse manager at Mary Washington Hospital.

Infants won't understand any clarification. Toddlers have no sense of time, so it's best to offer a short account of the event just a few days before the surgery.

"And the biggest thing a 2-year-old needs to know is that Mommy and Daddy are going to be right there with them," Herring said.

Bergquist uses dolls as well as bandages, intravenous lines, casting material, anesthesia and oxygen masks to explain medical procedures.

"I tell the child that what is happening to her doll is the same thing that is going to happen to her," she said. "As she touches and experiments, she absorbs information."

In Anna's case, a medical assistant gave me a small doll sporting the same type of cast Anna would wear. I showed the doll to my daughter and told her about the hip repair, hospitalization and resulting "hard pants." She accepted the news well, especially knowing that her cast and the doll's cast would match.

We arrived at Shriner's early on the morning of the operation. Hospital personnel checked Anna's weight and blood and took a final X-ray of her hip. Then the nurse gave her an oral sedative that made her loopily unaware that she would be leaving us to go to the operating room. Only after she was asleep in the OR did the nurses perform the painful IV and Foley catheter insertions.

Whatever type of surgery a child undergoes, expect her to spend about 30 minutes in recovery before the medicos permit you to see her. Use that time to prepare yourself for the sights and sounds of your post-surgery baby. Wires measuring heart rate and oxygen saturation snake to a phalanx of beeping machines. If your child's operation was long, she might be puffy from the IV fluids.

After I made sure Anna was alive and comfortable, I lifted her blankets to get a good look at her body cast, to meet what was simultaneously her prison and her savior.

Anna did not wake up happy. As she passed in and out of postoperative consciousness, she fixated on ripping a set of oxygen prongs out of her nose. She was adamant about getting her cast off.

The best way to respond to such a request is to acknowledge the child's feelings, Herring said. Then distract, and let the child make what decisions she can.

"She can't decide to have the cast off, but she can decide what movie we're going to watch today or what to eat for lunch," Herring said.

Post-surgery, expect your child's feelings to range from compliant to extremely cranky. On Anna's second day post-op, she was irritable, uninterested and sad. Such behavior was most likely the aftereffect of anesthesia coupled with frustration over her cast, Bergquist said.

To counteract such gloom, Bergquist recommended a wheelchair tour of the hospital's common area. We explored the play area, read books and parked near the window to watch the snow falling outside. By the time Anna returned to her room an hour later, her good spirits had returned. She was on the road to recovery.