Osteogenesis Imperfecta (Brittle Bone Disease)

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Preparing Your Child for Surgery

Preparing Yourself

Your child needs elective surgery and a date has been scheduled. Unlike emergency surgery, an elective procedure isn't done as an immediate matter of life and death. Having an elective procedure gives you the time to prepare your child psychologically for the hospital and the surgery.

Good preparation can help kids feel less anxious about the anesthesia and surgery and get through the recovery period faster. But, like parents everywhere, you're probably uncertain about the best way to prepare your child.

The key is to provide information at your child's level of understanding, correct misunderstandings, and get rid of fears and feelings of guilt. Help your child understand why the surgery is needed and become familiar with the hospital and some of the procedures he or she will undergo.

Kids of all ages cope much better if they have an idea of what's going to happen and why it's necessary. To do that, prepare yourself first and correct any misconceptions of your own. If a parent is anxious and nervous, a child will often reflect these feelings and behaviors as well. It's a good idea to educate yourself, feel comfortable with the process, and make sure all your questions are answered.

Ask Questions

The horror stories you heard from grandparents and parents about traumatic parent/child separations and very limited hospital visiting hours belong to days gone by. Hospitals have changed enormously and have become more family-friendly and patient-centered. For example, many surgeries are now "same-day" procedures requiring no overnight or prolonged stays; most kids are back home, in their own beds, the same night.

Furthermore, most U.S. hospitals permit at least one parent to stay with the child at all times except during the operation. After the surgery, you may return to your child in the recovery room. As your child awakens, he or she will not even realize you left.

Ask the doctors, nurses, or staff for the information you need about what will take place so that you can prepare your child and deal with your own fears or concerns. To parents, one of the most fearful aspects of surgery is anesthesia. Anesthesia is much safer today than in the past, but still carries some risk. You should discuss any concerns you have in advance with the anesthesiologist.

When hospitalization is required overnight or longer, most hospitals avoid separation anxiety by permitting at least one parent to stay with the child day and night. Check with the hospital about its rules regarding parents staying over and when other close family members can visit.

As soon as your child is able, he or she may be playing with other children, toys, and games in a children's recreation room — even if that involves taking along an intravenous (IV) bag on a rolling support.

Explain the Problem

Now that you're more at ease, start preparing your child. Begin by explaining the reason for the surgery in simple, nonthreatening words. Explain — at your child's level of understanding — about the medical problem and why surgery is necessary. Don't use alarming language like "the doctor will cut you," "open you up," or "sew you with a needle." Say that the doctor will fix the problem, and explain that many kids have this problem and must get it fixed at the hospital.

Although they seldom express it, kids may fear that their parents aren't telling them everything — that their health problem is worse than they've been led to believe. To build trust, don't mislead your child — tell as much of the truth as your child can understand.

Handle Fears

Many kids fear that an operation will be painful. It can help to explain that a special doctor, called an anesthesiologist, gives medicine to make patients sleep very deeply so they won't feel anything during the operation and once it's finished, they'll wake up. (Older kids, in particular, need special assurances that they will wake up.)

Again, avoid frightening language — don't say, "You'll be given gas" or "You'll be put to sleep." Young kids may confuse "gas" with the fuel that can poison or kill and "put to sleep" with what can happen to sick pets.

Explain that you'll be there when your child wakes up — and a favorite toy can come along, too. Tell your child that if anything feels sore right after the operation, a doctor or nurse can give medication that will make it feel better.

Common surgery-related fears of young children are the possibility of separation from (or abandonment by) parents and the possibility of pain. School-age kids also fear needles, knives, and damage to their bodies. Give a child this age clear, rational information as well as assurances that the surgery is to fix an existing problem, not create a new one.

The fears of teens go well beyond those of younger kids. Besides pain, change of appearance, and disfigurement, a teen might be afraid of losing control, missing out on events, being embarrassed or humiliated in public, and sounding childish by expressing fear, anxiety, or pain. A teen may also be afraid of waking up during the operation — or not waking up afterward.

Anticipate these fears, then emphasize that expressing fear, anxiety, and response to pain is quite normal (and OK) at any age, even adulthood. Correct any misconceptions about disfigurement or injury. And explain that anesthesia is very safe today and that patients do not wake up during operations but will certainly wake up afterward.

Encourage your teen to read up on the medical condition and share the information with the family. Reading and sharing information is an excellent coping mechanism.

One further fear that affects kids of all ages is being seen naked and having their "private parts" touched. If the operation involves the genital or anal area, your child will cope better if you explain in advance that although it might be embarrassing, doctors and nurses will need to examine these private areas, especially to check if they're healing after the operation. Explain that doctors, nurses, and parents are the only exceptions to the rules about privacy.

Encourage your child's questions about the health problem and hospital experience, so that other fears and anxieties can be expressed. Take all questions seriously and answer them to the best of your ability. If you don't know an answer, tell your child that you'll find it out, and explain that the doctors and nurses are happy to answer questions, too.

Relieve Guilt

Children often believe that their medical problem and operation are really punishments for "being bad." They may not say so, but they may feel guilty and believe that they've brought events on themselves.

Explain that the medical problem is not the result of anything your child may have done or failed to do, and that the operation is not a punishment, but simply the way to "fix" the problem.

On the other hand, if the medical problem was caused by an accident that could have been avoided by obeying safety rules, make sure your child understands the reason for the rules and will follow them in the future.

Explaining What Will Happen

Find books, appropriate to your child's level of understanding, about what to expect at the hospital. Reading together and discussing the surgery will make the hospital seem less threatening. Discuss each idea and encourage your child's questions.

Young kids also will benefit from practicing on a doll or stuffed teddy bear with toy doctor-kit "instruments." Your child can take the toy's "temperature" and "pulse" and listen to its "heartbeat" and "breathing."

Ask your doctor for suggested videos or multimedia tools for parents or kids that can help explain the procedure.

As you discuss the hospital and surgery, remember that in addition to your words, your nonverbal cues convey assurance: your tone of voice, facial expressions, gestures, and body language send powerful messages. If you appear fearful, your child is likely to feel fearful regardless of the words you use.

Pre-Operative Orientation and Tour

Many hospitals offer special pre-operative children's programs, family orientations, and hospital tours, conducted by specially trained nurses or licensed child-life specialists. Child-life specialists are a valuable resource for parents and children. They are professionals trained to talk to kids and teens about medical procedures, comfort them if they're upset or need extra support, and organize "play time" for hospitalized kids and teens to get together and hang out.

Call the hospital to schedule a pre-operative tour, program, or orientation as soon as possible, even from the doctor's office when the appointment for the surgery is made. It's best to schedule the appointment for a few days before the surgery.

An orientation program can remove the mystery of the surgery for kids and their families by making the hospital familiar and friendly and the experience predictable.

On the Day of Surgery

When you arrive on the day of surgery, your young child can play with toys and books you bring from home or sit on your lap and be cuddled during the waiting time.

You won't be allowed to stay in the operating room during the surgery, but afterward, you'll be escorted to the recovery room to be with your child as he or she awakens. Upon discharge, you'll receive instructions for further recuperation at home and for a follow-up visit to the surgeon.

During recovery, there may be times of discomfort for your child. It can help to explain that your child may be sore or uncomfortable, but will get better.

Distracting your child, whether with a new book or a visit from a relative or friend, also can make recovery more pleasant. Just make sure your child gets plenty of time to rest and recuperate.

Reviewed by: Yamini Durani, MD
Date reviewed: November 2011