Published by Children's Hospital of Richmond at VCU, on Apr 4, 2019

A little preparation and extra comfort go a long way for a child facing surgery. Our child life team has special training – and lots of real-life kid experience – in just what can help. From the weeks leading up to surgery to “no food” the night before and a special send-off when you leave your child’s side, there are several ways you can support your child and ease their stress and worry throughout the experience.

When it’s weeks away

Ask questions! Ask as many questions of your child’s doctor as you need so you feel prepared for what to expect and can be prepared for questions your child may have. Write down what the doctor or nurse says so you can refer back to it when answering your child’s questions or reviewing the information yourself. It helps to have a second caregiver present when discussing the surgery for extra support and to help remember what was discussed.

Be honest and encourage your child to ask questions. If you don’t know the answer to a question, it’s OK to say “I don’t know.” However, let your child know that you’ll ask the doctor or find out the answer together. (Note: We don’t recommend “googling” answers to questions about surgery; instead check in with a member of your child’s care team or send us your questions through the patient portal. We’re here to help!)

Be patient and available, offering extra cuddles, compliments and reassurances. Having surgery is stressful, no matter how “easy” a surgery may appear, and the time leading up to it can be stressful too. Young children may be extra fussy or difficult to console; older children may be grouchy or frustrated. It’s also just as important to take care of yourself so you can be there to be supportive when your child needs it most.

Plan ahead. Make arrangements for siblings to be taken care of by other caregivers the day of the procedure and arrange for pick up from school and aftercare if needed. If they’re coming with you that day, consider reserving a spot in our Sibling Center. Keep in mind that the time leading up to a surgery can be stressful for siblings too and they may also need reassurance, support and sometimes some preparation. Our child life team is available to provide help and guidance for siblings, and this includes helping prepare them for visiting their brother or sister after the surgery.

In the days before

Depending on your child’s personality, they may benefit from spending time with you talking about the surgery and some of the specifics of what will happen that day – what to expect at check in, for example, and how there will be a lot of people in scrubs asking a lot of the same questions. (Our Preparing for surgery as a family blog has more on what’s helpful and appropriate to share.)

When you talk about it, reinforce that the surgery is NOT a punishment, but a way to fix something that needs to be fixed. Or in the case of something being removed, that the doctors are taking away something that’s broken or not working anymore.

If you think your child will be nervous about the anesthesia mask, ask for one to practice with. Have your child put the mask on a favorite doll or stuffed animal or on you so they can get used to how it looks, feels and smells. Then hold the mask gently over their nose and mouth and have them sing a song or count and practice taking deep breaths with the mask on.

If your child is going to need an IV placed before they’re given anesthesia, it helps to prepare them for it so it doesn’t come as a surprise. Your child’s certified child life specialist can help walk you through the appropriate way to do this. They can also help work with your child at their bedside. If at any point in the process you think your child would benefit from preparation for an IV being placed, support during an IV placement, preparation for the anesthesia mask or other support for starting anesthesia, ask your nurse or doctor to request a child life specialist.

Encourage your child’s participation in getting ready. Let them pick out an outfit to wear to the hospital and pack a bag of their favorite toys and games. Encourage them to bring along something they find comforting or that reminds them of home too (favorite blanket, favorite books to read at night, photos of family). It can be a good idea to pack these items even for an outpatient procedure. Often, a child may not be able to eat or leave the room before surgery and having something familiar or entertaining can help pass the time when waiting. (On a side note: Bringing extra underwear/diapers is always a good idea in case of accidents or mishaps.)

Don’t forget to pack a bag for yourself. Include items for your personal needs and any medications you take regularly. Even if you’re just there for the day, having what you need to keep yourself comfortable can help you better focus on your child. And if your child’s stay ends up longer than expected, it’s good to be prepared.

When friends and family ask how they can help, one thing to consider is asking them to write cards your child can read while waiting on the day of surgery or as they recover in the hospital. Bringing these with you for your child to open can help your child feel loved and supported at a stressful time. It can be a nice way to pass the time too and can make SUCH a difference.

No food or drinks the night before

It’s common for a child to be instructed not to have anything to eat or drink (including chewing gum) after a certain time the night before surgery. The phrase you might hear is that your child will “need to be NPO.” (NPO is a medical instruction that means “to withhold food and fluids.”) If you’ve received these instructions, it’s very important that you NOT allow your child to eat or drink after the set time or the surgery will have to be delayed or cancelled for your child’s safety. Be sure to check for specifics. Instructions may differ depending on the type of surgery and a child’s age. It’s also important to find out ahead of time if this applies to any medications your child normally takes in the morning.

To help your child through the hours they’re unable to eat, we recommend picking a long or more-involved activity such as putting together a puzzle, reading books or watching a movie or planning a special activity if it’s safe and feasible for your child. (Decorating their hospital room can be a nice way to pass the time if your child is staying in the hospital.) Encouraging a child to sleep is another good option whether you’re at home or here.

Often families will plan a fun meal for everyone to eat together the night before, perhaps allowing the child who’s having surgery to choose one of their favorite/comfort foods or pick a restaurant to go to. This makes the night before surgery less scary, can be a happy memory for the child to think about, and can give a child a sense of pride that their family is supporting and celebrating them before a big day.

Many families will allow their child to stay up or will set an alarm to wake them up so the child can have a late-night snack or meal prior to being NPO. This can help the child sleep longer in the morning and/or be more likely to nap before surgery – and the shorter the fasting time, the less stressful it will be overall. When they’re older (school-age to teen) this can also be a fun chance to “get away with” staying up later. It’s important to note that this extra snack/meal is not meant for your child to overeat or eat excessively and risk becoming sick to their stomach. And if they’re not interested or too sleepy, don’t force them to stay awake or participate.

Some parents/caregivers will opt to voluntarily make themselves NPO to show support for their child. While we understand the reasoning behind this and the desire to “suffer with your child,” we don’t recommend this practice as it is important that parents/caregivers are physically, emotionally and mentally able to be present and strong for their children. It is appropriate to choose NOT to eat or drink in front of your child as some children find this very frustrating. Stepping out of the room to have a snack and something to drink to keep from feeling faint or to keep up your own strength and patience is recommended.

The day of surgery

Remind your child about some of things you’ve talked about and walk them through what’s going to happen in simple steps: “First, we’ll check in. Then you’ll get in your gown, we’ll play or read until the doctors come, then I’ll kiss you on the cheek three times and the nurses will take you to the room for surgery. They’ll put a mask on your face with special medicine to help you fall asleep. When you wake up, I’ll be here and you’ll be done.” Being familiar with what to expect can reduce anxiety and increase their willingness to participate/cooperate.

Play their favorite songs to boost them up on the ride in or if they need a pick-me-up. You can let them pick a soundtrack or “power song” ahead of time for this and download it on a phone or tablet so it’s ready to go when needed.

Have a special sign or saying that you can share with your child before they go down for surgery. A special handshake, a message like “See ya soon,” or simply blowing kisses can provide comfort, familiarity and a timely distraction. You can come up with what you’d like this to be together.

Above all, be positive and encouraging when you’re with your child that day. Too often we see parents who are scared themselves start to cry and it can be difficult for the child to see this as their last memory of their parent before going to surgery.

Along the way

You’ll have many opportunities along the way to affirm your child’s feelings and offer them emotional support in the weeks and moments leading up to surgery.

Surgery IS scary no matter how old you are. Let them know that it’s OK to be nervous. And always remind them there’s a whole team of specialists dedicated to keeping them safe and seeing them through their surgery.

By Siri Garrett, certified child life specialist