General Anaesthetic / for 4 Year Old

[LDN1]

Hi all,

Following on from my last thread regarding some dental issues with our DD4, there are two teeth that never fully formed and they are causing issues. We have been given the options (we see a well respected specialist this weekend so will see if there's any other options) - of a potential crown situ' or removal of the two teeth in question.

Now... with DD4 being very timid and nervous, we've already been told that gas might not be an option, which leaves general anaesthetic.

Of course, with her being only 4, we have some reservations and anxiety about that. Rather than lean on Google and the rabbit hole that might bring, I wanted to ask on here... has anyone else had their child, as young as 4, go under GA?

I just wanted to say thanks again to everyone. It's so interesting and informative reading everyone's accounts and experiences.

Am I right in thinking that GA can ONLY be done in a hospital environment?

Am I right in thinking that GA can ONLY be done in a hospital environment?
Assuming you're in Britain, yes, the days of general anaesthesia being given in dental surgeries are thankfully long gone. Your child will be treated in hospital with the same standards of staffing, equipment and monitoring as any other procedure under GA.

My son has, I was very worried but he was absolutely fine. He has had several GAs since and always been fine. Good luck

You do realise anaesthetists are fully trained doctors, taking 7 or 8 years to qualify?

My son had his first general anaesthetic at 5 months, then at 17 months and 29 months. He was fine after all of them. He has felt worse after the ones he has had as an adult. I was always allowed to be with him until he actually went through the theatre doors and was waiting for him when he came back out. That was nearly 40 years ago but I'm sure that won't have changed.

Yes, and depending on your area only specialist doctors can do it on kids.

I was in A&E in our local hospital who said 'he needs to go to the sick kids for GA we can't do that here'

It took a while to twig what GA meant!

I had my 20 month old go under anaesthetic. Traumatic having her go floppy but she was fine, just upset waking up without me being there, was dopey for a couple of days after.

You do realise that Anaesthetists won't operate outwith their qualifications.

Yes mine had multiple GAs under 3. They were always brilliant with him in the hospital. I stayed with him till the last moment and was called up to recovery as soon as he was awake and been checked, so he never really knew I was gone. Minimal after affect.

Re paed anaesthetists - we all train to anaesthetise kids safely even in 'smaller' hospitals. Some anaesthetists have more of a particular interest in paed anaesthetics, just like some people prefer obstetrics, some people trauma, etc etc. There is a subspec of 'paediatric anaesthesia' in the big tertiary centres where people specialise in doing specialist paediatric surgical procedures (things like congenital cardiac surgery, neonatal surgery, cleft repairs and whatnot) or complex children having more typical procedures - those anaesthetists will have a different skillset and also have the back-up of paed icu etc on site.
Even at your bog standard DGH every anaesthetist will be able to safely look after a child (we have to be able to to cover on-call when you've got no idea what might turn up during a shift). Please don't panic that you're going to have some incompetent amateur having a bash at it just for giggles! Anaesthesia for dental/ENT/general/ophth/ortho surgery are well within the skillset of even the most average of anaesthetists.

My son needed foot surgery aged 3. He was fine until we went in. We had practiced counting when the mask goes on. I had told him he'd be told to count to ten, but he probably wouldn't get to three. We got to 35 as he held his breath so long! After that it was fine.

After gently highjacking the OPs thread I just wanted to say how kind and helpful anesthetists are on here. There was another thread recently about C sections under GA and they couldn't have been more supportive.

I feel we are in very good hands. Thank you

@Greybeardy
Is it maybe just a Heath Board policy that children should be treated at the Children's Hospital?

I'm going off a rushed comment from an A&E nurse. Almost 5 years ago but it feels like yesterday, LO and a finger injury, that had a plastic surgeon put back together.

Tiny babies go under general anaesthetics all the time, let alone four-year-olds. Obviously any parent worries about this kind of thing, but it's really not a big deal at all.

I had a general anaesthetic when I was younger than your child. It was no big deal at all. My friend's son had heart surgery as a two-year-old and another had a kidney operation when he was only a few months old. Your child's operation won't take very long and it will be much less traumatic for them than having to have it done under a local. It's all going to be fine - try not to worry!

It's bread and butter for our daycase unit. He'll be absolutely fine.

It may have been the need for a plastic surgeon that was the limiting factor rather than/as well as anaesthestic factors. There's generally quite a few factors involved in the decision where the best place for someone to be treated is and for a child age and size will come into it as well as what the required surgery is and whether the child has any coexisting medical conditions. All UK consultants will have been trained in paediatric anaesthesia but those who work in specialist centres doing more complex work with children will have done more and will have the necessary experience to deal with tiny children, those with underlying medical conditions and those having complex surgery. But it's the whole team that matters,not just the anaesthetist, so the surgical paediatric and nursing staff as well as the anaesthetic team. You need a critical mass of patients of any particular type for clinical teams to be able to maintain the necessary skills so a lot of straightforward paediatric surgery can be done perfectly well in general hospitals but sometimes it is preferable for particular children to be in a specialist children's hospital.

Not sure what the set-up in that hospital was (guessing possibly not England, so perhaps things are different wherever it is). As per PP though, it's not just the need for anaesthetic that determines where the best place for an operation is. Not every hospital has plastic surgery for example, so it may have been that anyone needing plastics gets shipped out. There needs to be adequate paediatric ward capacity & paediatrician cover too. Sometimes a child with medical problems might need transferring out for even routine surgery if that condition could be a problem perioperatively that would be difficult to manage at the original hospital.

My DS had one at 4 for a hernia. He was fine but became delirious when emerging from the GA. It's apparently common but no one told me this could happen. It didn't last long though and we were home the same day.

@AgeingDoc and @Greybeardy
Thanks that makes a whole lot of sense. It was Scotland on outskirts of Glasgow. DS was 3 and had finger caught in a door, the tip was hanging off.

When we got in the car I opted for the local general hospital, who did what they could before sending us on our way.

An update on this... and hoping for some advice.

We made it through Xmas and new year. Not remembering all that I've posted precisely, forgive any repeat info...

We were told it could be a six month wait on the NHS, for the GA / removal of teeth. And so we looked at the private route. Even this is a one month wait (from today).

We've just, this evening, had to take DD to A&E due to the pain and discomfort. It's the first time she's ever had to go to A&E and so we are not the type to rush there whenever she's poorly.

We were told to simply up the pain killer dosage... and that was that.

We are now all up at 2am with her in pain.

I cannot fathom how we find ourselves in this situation. Our daughter is in pain. She will now be missing school (weeks of it at this rate). NHS wait could be half a year and even private is a month. A&E can't do anything, which I understand.

What do we do? I've never been so genuinely confused.

Any advice appreciated...

I'd go back to your dentist in the first instance, to check that there isn't an abcess or something like that. If there is, antibiotics may help relieve the pain. Your dentist may be able to speak to the hospital dental service and ask them to expedite matters given your DD's pain, but I'm afraid that can't be guaranteed. Unfortunately there are a lot of children in the same boat as NHS dental services are overwhelmed. 6-12 month waits are common I'm afraid. The teams will be working flat out but the demand is just so high. But there is no harm in asking, and there may be something else going on that the dentist can help with in the meantime so I'd give your own dentist a call in the morning and let them know what's happening,

We now have antibiotics. But another twist... the dentist wrote two different amounts for the dose. One record states '3 x 250mg daily' and another states '3 x 5ml daily'.

I've called them and they say it's the same
thing ... but doing online conversions... that is not the case!

What to do?

What are the antibiotics and what is the strength of them? I.e. X mg per X ml?

DS was prem and had surgery when under one.

I was put under 4 times between 2 and 5. Then again at 6 for dental work. It was fine. Kids tend to recover quickly from it. The bit I hated was having the numbing cream on the backs of my hands so I wouldn't feel the cannula. Apparently I was somewhat difficult about it and made my anesthetist crawl into the Wendy house with me for a pretend cup of tea before I let him put the cannula in.