An Insider’s Guide

By Jodi Craft, M.Ed., Child Life Specialist

My daughter, Bella, was scheduled to get a cyst removed from her inner lip. A relatively minor thing, but it didn’t seem that way to a seven-year-old, or her parents, especially as anesthesia was required. Preparing her for the pre-op visits and the surgery was not an issue for me: As a child-life specialist at a hospital, I had done this for countless children. What I had not taken into account, however, was that it might not come so easily to another parent, namely, my husband.

Early on I encouraged my husband to participate in Bella’s doctor’s visits. What I forgot to do was prepare him adequately for the surgery day. He was not overly worried, but I neglected to consider what he would not know. Only one of us would be allowed to accompany Bella to the OR, for example. I wished we had discussed that beforehand: I naturally assumed it would be me. But discussing it at the hospital upset my husband: He had wanted more of a say in the decision. I tried to convey my reasons for not having him be the one to hold her hand while she went under, but he remained irritated. This was not a great state of mind in an already stressful situation.

He did end up seeing Bella roll by unconscious, and he became very emotional. I anticipated him reacting more than me, which is why I had wanted to be the one to go with Bella: I knew what to expect and my husband didn’t. His reaction would not have helped Bella remain calm before surgery, but I should have opened up a discussion about this before we got to the hospital.

There were other things that I knew to do to help Bella cope with and process the day. I asked the nurses for the oxygen mask to take home after the surgery, for example, so that Bella could show it to her younger siblings: This gave Bella a sense of greater control over her experience, and all of them enjoyed her teaching her sisters and brother what it was like to have an operation.

There are a number of simple things parents can do to make their medical encounters go more smoothly for their children and themselves.

Parent: Take Control

Consider yourself a partner with your doctor and expect clear communication. Be polite but persistent in managing the various aspects of your child’s healthcare.

• Be prepared: Do research beforehand and come to every doctor’s visit armed with information. This should include bringing a list of concerns.
• Bring a pen and paper to write down what the doctor says.
• Ask questions: Don’t stop asking until you are satisfied that you understand what you’re being told. Also, do not stop questioning until you feel your questions have been adequately addressed. Be polite but persistent. If you feel shy or put off, remind yourself that this is your child’s health! Do not be afraid to call back/email after a doctor’s visit if there is something you were not comfortable with or need clarification about.
• A question to ask your doctor: What should we expect before, during and after surgery? Many parents do not realize how anesthesia can affect children (or anyone, for that matter), and seeing their child “out of it,” vomiting or crying inconsolably with smelly medicine breath and glazed-over eyes can be traumatizing. (My husband would have fainted had I not been there to prepare him. He did cry when they wheeled her back in, but she didn’t see that.)
• Speak up if you disagree with any medical professional.
• Ask your doctor how to contact him or her via email; though often considered impersonal, it’s an excellent way to communicate with the doctor. Often parents dread a call to the doctor because they have to be put on hold, wait for a call back, and God forbid they miss it, or what if they went through all that and just had a very simple question? We realize that doctors are very busy (my family averages a good 30 minutes in the waiting room) and we don’t like to disturb them, but we must advocate for our children. Our surgeon gave me his email address and encouraged me to contact him with any concerns. In addition, he contacted me by email after the surgery to inquire about my level of satisfaction with the experience. That was enormously thoughtful and caring, and showed great bedside manner (electronically speaking)!

Child: Reduce Their Nervousness

It is essential to prepare children for potentially stressful situations like a doctor’s visit or surgery. You need to access what is going on inside their minds so you can teach them to cope effectively and healthily.

• Play: The goal is to remove the mystery and unfamiliarity of medical situations. Every child should have in their toy collection a doctor’s bag with equipment and clothing. Play through a specific scenario: “This shot may pinch a bit, but the pain goes away fast!” “I’ll give you a cool sticker when we are through.” Here’s another idea, which is unusual but worked with my kids: We used long cardboard boxes to make hospital beds and then played “swine flu” in the backyard. My kids loved treating me as the patient and giving me Kool-Aid from a medicine dispenser.
• Use kid-friendly language. Translate medical terms into something they can understand. “Anesthesia” can be “medicine that makes you sleep for a bit,”
  “OR” can be “the room where you’ll get your _____ removed (or fixed).”
• Give your child enough information to prepare them and minimize fears, but not too much information that they become nervous and afraid. Matter-of-fact is the best way to go. An example of too much information: “When they wheel you into the OR, a bunch of people dressed in blue will approach you and put a mask over your face and put you to sleep and I will leave while they operate.”(Yikes!)
  Enough information: “I will be there for you when you take your nap and when you wake up from it.” (Remind them that they will wake up… lots of kids get the putting to sleep, but wonder about the waking up.)
  Bad: “When you wake up, you might throw up.”
  Better: “Some kids feel funny when they wake up at first, but it goes away pretty fast, especially if you sleep a bit more.”
• Prompt questions: Ask your child what their thoughts are regarding the doctor’s visit or surgery. Offer general prompts like: “Some kids wonder about the IV,” rather than “Are you worried about the IV?” That way you don’t hand them a negative feeling, which is what you want to avoid.
• Build confidence: Show your child that you trust and are confident in the medical professionals involved (“They know what’s best!”).
• Make your child feel special, that they will have “the inside scoop” of being in a hospital that not a lot of other kids have.
• Make the surgery day a special occasion. Clear your calendar. Take off work. Get a sitter for siblings. Don’t be afraid to spoil them a bit. (I let my daughter download a game on my iPhone just for that day. That was huge, because I never allow them to touch my phone and I have no games on it. I also reminded her that that was a special treat and we would delete the game later on.)
• Use your support system; call relatives and friends to assist in any aspect of the day. (When Bella was tearful because her eyes were blurry, we asked her if she wanted to “phone a friend”: Auntie Barbie, who always makes her feel better.)
• Pay attention to the discharge summary and know what to do/whom to contact if something goes awry (like stitches coming out after-hours).
• Handle your stress: Get control over any anxiety you may have. Your child senses your emotions; your (relative) calm will translate into their comfort.

Jodi Craft, M.Ed., is a child-life specialist, a caregiver who is trained to address the emotional and developmental needs of children in the hospital. Jodi has four children. She is also one of 12 siblings, five of whom are nurses.