Sam Golden, MD
Comer Children's Hospital, University of Chicago
Many parents logically ask, "What should I say to my child before surgery?" While this question has no clear-cut answers, some general principles can be helpful.
Is it usual for children to experience anxiety prior to surgery? How can I tell if my child is anxious?
It is not unusual for a child or parent to be anxious prior to surgery. In particular, children who may be at greatest risk for being anxious include those children with a "shy and inhibited" personality, children with a history of previous surgeries and hospitalizations, children of separated parents, and children of very anxious parents. Children may show signs of anxiety in the surgical pre-operative area in various ways such as not talking or fearing separation
How can we reduce the anxiety my child is experiencing about her upcoming surgery?
Preparing your child for surgery should begin in the surgeon's office when you and your child hopefully develop a trust and bond with the surgeon performing the procedure. Many surgeons have pamphlets in their office for you to read and even videos to watch which will inform you about the procedure.
Some hospitals offer operating room tours and instruction on coping skills by a Child Life Specialist prior to surgery. For example, a child life specialist may allow your child to play with a scented facemask and give instructions on how to breathe with it. If time allows and the child shows an interest, other medical tools such as stethoscopes and IV catheters may be shown to the children so that they may be allowed to examine, touch, and play with these items. By becoming familiar with these items, the entire process tends to be less frightening. This and other forms of age-appropriate play therapy greatly aid the process of undergoing surgery.
Your child's anesthesiologist will try to allay these fears by reassuring the child and/or giving the child a sedative medication. Talk to your child's anesthesiologist to determine the best way to help alleviate any associated anxiety that may be present. Bringing a familiar item from home such as a stuffed toy, blanket, PSP or Gameboy may be comforting, distracting, and help the process.
Parents can help their child be ready for surgery by being ready themselves. Don't be afraid to discuss any questions or concerns that you have ahead of time with your surgeon and anesthesiologist. If you are anxious, discuss it with your child's doctors, preferably without the presence of your child. When you are comfortable and confident, your child will likely be also. Be careful not to apologize to your child for the decision to undergo surgery or give an excessive amount of reassurance. Instead, be matter of fact about the surgery; this will diminish worry and fear.
Do children of different ages have different coping skills when faced with surgery? How can I decide what kind of explanation my child needs before her surgery?
Children of all ages need to be reassured that someone will be with them at all times. In addition, careful choice of words is important; for example, let your child know that medicine will be given immediately if they feel "sore" after surgery, not that they may have "pain." Similarly, when explaining the surgery, use the phrase "make an opening" instead of "cut." Encourage your child to ask any questions they may have at any time prior to the procedure. If necessary, write them down so they can be answered later.
Adolescents are capable of understanding things in a manner similar to adults. What will happen to them should be explained in detail, both openly and honestly. Adolescents frequently are worried about sophisticated concepts such as body disfigurement, pain, needles, diagnosis, prognosis, and even death. Often they will have such questions without telling anyone and try to hide their fears. It is important to anticipate your adolescent's questions by discussing the surgery prior to meeting with the surgeon and anesthesiologist; you may want to write questions down so that your adolescent's concerns can be answered despite a reluctance to pose the questions in person.
Similarly, elementary school children require an upfront and honest explanation, at a level that is appropriate to their age level. In a direct but simpler way they need to be told that although they will be separated for a while, but they will be reunited when he/she wakes up from sleep. Reassure your child that nothing bad will happen from the surgery and that it needs to be done to fix a problem that won't go away by itself. Let your child guide the discussion by asking what concerns he or she may have, and try to answer them directly.
Young children ages 3-7 are more limited in their capacity to understand but make sure to tell them they will be separated only a short while from you, they will be OK, and someone will be with them to make sure they will be fine. Use age appropriate language (e.g. "booboos" and "band-aids"). As mentioned earlier, instructions on using the facemask and sedation with an anxiety relieving medicine are helpful at this age. Some parents have tried to hide from their young child the fact that they are going to have surgery. This is not a good idea because it fosters distrust and fear later on and serves to increase worries about medical procedures over time.
Thanks to Dr. Scott Hunter for his valuable comments.