SURGERY & YOUR CHILD

Factors that Increase Stress

• Separation from family
• Strangers

What you can do as a parent

• Provide comfort measures (pacifier, toy or blanket, swaddling, holding)
• Be present whenever possible

What you can expect from your child’s caregivers

• Use a slow approach
• Allow time for familiarity
• Provide consistent caregivers
• Minimize separation from parents
• Assist in decreasing parent’s anxiety
• Facilitate parent or caregiver presence

Preparation and Care of an Infant

• Short attention span (1-2 minutes)
• Prepare the infant just before performing care by telling them what you are about to do (check their temperature, change their diaper, etc.)

Thinking Characteristics

• Egocentric (self-centered – don’t understand other’s views)
• Magical thinking (for example: may believe they will slip down the drain)

Factors That Increase Stress

• Separation from family or caregivers
• Pain

Approach and Education Methods Parents and Staff May Use

• Minimize separation from parent
• Use picture books
• Use play to demonstrate
• Let play with equipment (mask, teddy bear, etc.)
• Provide comfort measures (own toy or blanket, holding, singing)

Preparation by Parents and Staff

• Should occur immediately before event  – too far in advance increases anxiety
• Keep explanations simple

The following is normal for this age group

• Any actions by healthcare providers (taking a temperature, checking a blood pressure) may cause your child to become upset.

Thinking Characteristics

• Egocentric (self-centered – don’t understand other’s view)
• Magical thinking (that thinking something may cause it to happen)
• Highly literal with words (saying ‘you have a stomach bug’ will make the child believe they have a bug in their stomach)
• Basic ideas about their bodies
• Difficulty in differentiating “good” hurt (will make you feel better) with “bad” hurt (illness or injury)

Factors That Increase Stress

• Separation from family
• Loss of control
• Fear of bleeding and punctures (fear their insides will “leak out”)
• Emotional reaction of others can increase their anxiety
• Lack of preparation for procedure

Approach and Education Methods Parents and Staff May Use

• Minimize separation from parent
• Use play to explain procedures and activities – encourage verbalization
• Use pictures, story books and puppets
• Use models and actual equipment – hands on practice with equipment
• Describe what child may feel, hear and taste
• Give choices whenever possible
• Allow child to bring a favorite item (toy, book, blanket)

Preparation by Parents and Staff

• Acknowledge and accept fears and anxieties
• Be concise, simple and concrete. Short attention span. Limit length of explanation to 5 minutes.
• Prepare 1 to 3 hours before minor event (Dr. visit) and days in advance for major event (surgery).
• Repeat explanations every time something is being done. Do not assume the child will remember.
• Do NOT tie evaluations of the child’s behavior with the procedure (do not say he is a “good boy” for holding still but rather, “That was helpful to hold still.”).
• Do not tell the child they will feel better after surgery. They will likely feel worse in the postoperative period.
• Emphasize child will wake up after surgery.
• Repeat often that the child has done nothing wrong and is not being punished.

The following are normal for this age group

• You may see regression, detachment, avoidance or despair in your child.
• You may see verbal uncooperativeness, physical aggression or tantrums. You may even see this with experiences like taking a temperature.

Thinking Characteristics

• Still tend to be literal with words but beginning to think logically (knows that a ‘stomach bug’ is not an actual bug in their stomach)
• Better ability to understand relationship between illness and treatment
• Can listen attentively to everything being said without always understanding
• Reluctance to ask questions or admit they don’t know something

Factors That Increase Stress

• Fear failure to live up to expectations of others
• Fear loss of control, bodily injury, mutilation, procedures involving genitals, and death.

Approach and Education Methods Parents and Staff May Use

• Minimize separation from parent
• Respect increasing need for privacy
• Establish limits (example: will be allowed to go home but have to eat and drink first)
• Stress peer group (friends, people their age) can be maintained
• Encourage verbalization and questions
• Acknowledge fears
• Reassure they have done nothing wrong
• Offer choices to provide measure of control (flavor of anesthesia gas, which book to read while waiting, etc.)
• Hands-on practice with equipment
• Use photographs, books, diagrams, charts, or videos to explain
• Standardized multimedia education may be helpful
• Likes learning scientific terminology
• They may want to have a familiar, comforting item with them. Encourage them to bring the item(s). This might include a stuffed animal, toy, game, or music.

Preparation by Parents and Staff

• Introduce days ahead for minor events (such as a Dr. visit) to weeks ahead for major events (such as surgery)
• Respond honestly to request for factual information
• Ask them what they understand
• They want to know what a procedure is for, if it will hurt, how it will make them well and what injury or harm could result.
• The following are normal for this age group:
• Your child may show disinterest or withdrawal

Thinking Characteristics

• Beginning to think beyond basic meaning of words
• Able to think logically
• Still some magical thinking (thinking something can make it real – feel guilty for illness)
• Has some understanding of structure and workings of the human body
• Loss of control
• Altered body image
• Separation from peer group
• Strong need for privacy
• Information sensitivity – adolescents react not only to what they are told but also to the manner in which they are told
• Attention span up to 60 minutes

Approach and Education Methods Parents and Staff May Use

• Tactfully explore what they know
• Allow as many choices and control as possible
• Allow to bring favorite item (music, book, tablet)
• Use photographs, books, diagrams, charts, and videos
• Provide tours and equipment and models to examine.
• Audio video and multimedia computer-based programs may be helpful
• Introduce preparatory materials up to 1 week in advance for minor events and weeks for major events. This is vital for adolescent’s ability to cope, cooperate and comply.
• Use collaborative approach – support independence and decision making
• Stress how much they can do and how important their compliance is to their recovery. Be honest about consequences.
• Assure ability to maintain contact with peer group.
• Teach relaxation methods: deep breathing, self-comforting talk or use of imagery.

Preparation by Parents & Staff

• Privacy: Inform them that certain procedures will be conducted only after start of anesthesia (hair removal, skin preparation); they will be allowed to leave undergarments on when appropriate; and only surgical area is exposed.
• Reassure that they do not need to worry about talking or doing anything embarrassing under anesthesia.
• Discuss approximate time they will be in each area of the building (Admission, PreOp, Surgery, PACU, and PostOp).
• Tendency toward hyper-responsiveness (may seem extreme in relation to what they are reacting to) to pain.
• May alternate between dependence and exerting independence.
• Pain is perceived on three levels: physical, emotional and mental.

The Following is Normal For This Age Group

• Not unusual for teens to deal with pain through regressive behavior as seen with: increased dependence on parent; expectation that nurses should know they are in pain; belief that they should not have to ask for pain medication.