Helping Your Child Prepare for Surgery

When we think of childhood, we picture playgrounds and school yards, not operating rooms. So when a child needs surgery, it can be a shock to the child and their caregivers. Adults often know how to ask questions and gather information that will help alleviate their fears, but children, and even adolescents, are still learning those skills and may not be able to say exactly what they’re afraid of. Sometimes, the only thing a toddler who needs ear tubes knows for certain is that she is absolutely not leaving her mother’s side. The anesthesia team at Texas Children’s Hospital is prepared for this situation, and many others, and they’re willing to take time to create a positive surgical experience. 

Relying on a team

Everyone involved in the surgery will meet with you and your child beforehand. It can be quite a few people, including the surgeon, the anesthesiologist, advanced practice providers and nurses, but this process allows the child to hear a similar message from multiple providers and ask questions throughout their visit. 

“We all talk to each other to determine what is best for the child and how we can separate from the caregiver and administer anesthesia the most successfully. How can we help this child so that we don't subject them to something traumatic?” said Kathleen Chen, MD, pediatric anesthesiologist at Texas Children’s. 

Sometimes additional providers from the Child Life Department can offer unique options to prepare children for surgery. By picking out candy flavors to apply to their anesthesia mask or showing them what their perioperative journey would look like through pictures, child life specialists can be another calming influence and help a child understand the surgery in a way that is developmentally appropriate. 

Building trust

Pediatric anesthesiologists are well trained in the use of medications necessary for surgery, but they also spend years honing the soft skills that make children and families feel comfortable before and after surgery. 

“I try to minimize pharmacological interventions. The hardest part is separating a child from parents for surgery. If I can build trust and work well with a patient, I would rather not add any extra medication to ease that transition,” said Dr. Chen.

To build trust, Dr. Chen’s approach varies depending on the age of the child. A rattle might work for an infant. A wagon ride can help by providing a trial separation period for a toddler before the surgery. At all ages, however, Dr. Chen returns to the room frequently, allows space for the child to ask questions and explains the next steps clearly. 

“I think at the end of the day, anxiety usually stems from feeling a lack of control,” said Dr. Chen. “We can give one or two choices that we feel would help a child and check in frequently to see how they're feeling.”            

Childhood Anxiety Reduction through Innovation and Technology (CHARIOT) program

Texas Children’s was the second pediatric program in the nation to implement CHARIOT, which uses technology as a means of distraction and relaxation before a procedure to minimize the use of sedating medications. 

“We use devices such as virtual reality goggles and video projectors to engage child and adolescent patients, if they would like, to help with any intraoperative or perioperative experiences,” said Dr. Chen.

For example, through CHARIOT, a video screen can be fixed to the foot of a child’s transportation bed, so that when it’s time to leave their family to go to surgery, “Bluey” can accompany them all the way to the operating room. Similar tools have been used at Texas Children’s by radiology to help children stay calm and still for an MRI scan and by a psychologist to aid in guided meditation. 

Working together

Regardless of the type of surgery or procedure planned, parents and anesthesiologists can work together to help a child feel confident and prepared. Talking at home about the steps of the procedure, talking to a friend or family member who had a successful surgery and looking at operating room pictures online can set the stage for education and support from the anesthesia team once in the hospital. 

“When my child had surgery, a couple of days beforehand I took time to talk about it. You can help your child know that this is happening and we’re going to do this, but you’re in a space where we can talk about this, and we can find answers to all your questions,” said Dr. Chen.

Learn more about Texas Children’s Anesthesiology and the CHARIOT Program.