ideas on how to prepare DD (3) for operation

[rhetorician]

She is nearly 4, actually, very articulate and observant. She is having her tonsils and adenoids out on Weds (they will call us the day before if she gets bumped). What should we tell her in advance? She will be full of questions, I know. There is probably no point preparing her before we are certain that the operation will go ahead, either. Ideas? Thanks

Just tell the truth. I have refused to operate on children who have come for a "treat".

What dratsea said. DD has had several operations and we have always been honest with her. We have also explained the reasons behind the operation and the benefits of having it done.

Give her a simple matter of fact explanation of what will happen. Acknowledge she might feel anxious. You could role play with a doll/ teddy having his adenoids out, but don't make it too much of a big deal.

Oh I've no intention of lying to her - do people actually do that?

Yes some parents don't prepare their children, which is the worst thing they could do.

There are some downloadable leaflets online for children about having an operation.

I've just told her (we bought her a new dressing gown and pyjamas) - I asked her if she remembered seeing the doctor, and that he was going to do an operation. That she would be asleep for that part and would probably feel a bit sore afterwards, but that one of her mummies would be there the whole time (except when going to the loo) and there would be pink medicine to help her with being sore. We'll see what she asks next

The medicine may not be pink! We don't use Calpol as it's more expensive than the generic version. However if she's expecting that then you can take your own if she won't take anything else but make sure you give it to the nursing staff. Take any regular medication too.

It will be sore afterwards so stock up on calpol and nurofen. It's quite normal for it to get worse at home before it gets better too. Give regular pain relief for at least a week and encourage a normal diet. Eating and drinking is really important to prevent a bleed or infection. We don't say crunchy foods or ice cream these days, just whatever they want to have. Little and often is fine. I'm not sure if you're staying overnight, lots of hospitals do it as a day case spending on their criteria but pack pyjamas and a toothbrush anyway.

Depending, not spending!

I think she'll be in at least overnight as surgery is scheduled for the afternoon. Older daughter has weighed in helpfully with gleeful accounts of knives , but DD2 is modelling her new nightwear with great delight. Thanks for the tips. She will take whatever medicine they give her in hospital - the point at which she starts being picky about the colour will be the point at which she will be on the mend. Thank you all very much

I hope it goes well.

There's a Topsy and Tim go to hospital that my children were watching on iplayer yesterday. I only half saw it but it might be useful.

It's a shame you didn't post sooner as I can recommend these two books that I got for 4yo DD2 who had the same op back in July. The first one is about a general stay in hospital and the second is about a stay due to tonsillectomy. It's not exactly Booker prize winning stuff but it helped DD understand what was going to happen and why. this and this. Hope the op doesn't get postponed and that your DD has an event-free recovery.

www.gosh.nhs.uk/parents-and-visitors/advice-when-you-stay/preparing-treatment

www.bch.nhs.uk/story/whats-it/getting-ready/having-operation/talking-your-child-about-operation

Both of these give excellent advice that I used in helping prepare my daughter for her surgery.

Things I found most useful were:

Ideally before you declare that you're going to hospital play with dolls/teddies drs and nurses, get the teddies to do the same thugs she's likely to be asked, take temps under arm, take medicine, use a stethoscope, display affected area, lie still etc.

When you at doctoring teddy be sure to ask consent and explain what and why you are doing. Drs should always do this but often don't with small children.

Always finish with something like "and the dr says you can go home now" rather that all better as they may well still feel rough.

Notice period = 1 day for every year of their life.
When you teach this point encourage them to pack a suitcase ready with what they think they need, add things you think she needs. Pack and unpack, role play arriving and leaving. I used to say we are going to the pretend hospital and when it was time to pack the case for real my language changed.

At the hospital don't be afraid to ask the drs to explain again if she doesn't understand and really try to get their consent for examinations or procedures. I did this with my 2.5 year old much to the amazement of the staff.
If you do have to override lack of consent explain that you hear that she doesn't want to but you know that we need to let the drs do x to get better.

Sorry that so long, I spent a LOT of time researching this last year and am eternity living it on the ward.

It's worse for you than it is for then xxxxxxx

You have done the right thing by talking to her. Kids really don't do well with the surprise element. And I too have refused to anaesthetise children who didn't know what was going to happen.

They also pick up on parental body language so try to keep it calm even if you are internally panicking.

The Royal College of Anaesthetists has some patient information for kids. The age appropriate stuff for 4 year olds is about Rees bear. Reading through it can help you ore her without worrying too much about saying the wrong thing. All that needs to be talked about is there.

Lots of hospitals now have videos on you tube showing what to expect - have a Google - if you can't find one there is one by Worcester called Sarah's journey (I don't work in Worcester or have any link with the people who made it) that I think covers most things.

On the day itself follow the fasting instructions you have been given -and if a drink of water/squash is suggested in the morning I would try to get her to take it - you only need to fast for clear fluids and being thirsty is horrible and not well tolerated by the kids IME. hunger they seem to cope better with.

Having some distraction stuff to kill time in hospital is also handy - so ipad/ new colouring book/ new book/ lego kit all work well - you know your own child best...

Also a small plea remember the staff want the best for your kid and do this multiple times a day eg. I generally find in my hands giving intravenous medicine to 4 year olds works best to get them off to sleep (unless they have had lots of negative blood taking/!drip attempts before) as I'm a whizz with a Where's Wally book and bad chat but if the parent tells their child on the ward they won't like it I'm being set up to fail before I've even started.

Don't second guess going home - we do lots of day case tonsils where I work!

Sorry ipad typo - fasting times for clear fluids (water/squash) is 2hours only hence my hospital encourages parents to give their kids a drink before 06:30 if they are coming in first thing and before 10:00 for those coming in at 11:00.

But check what you have been told as local practice varies!

Don't tell her that you'll be there throughout.

Ds has had grommets in, and they like them to wake up and check they're okay before you come back in. So they wake in a strange room (recovery) without you and it's an awful shock. I assumed I'd be in for him waking, and they didn't let me in. He leapt into the arms of the nearest nurse, looked at her, shrieked "you're not mummy" and kicked her.
Luckily she thought it was funny.

The next time I told him that I wouldn't be there, but when he woke he could ask for me and I'd come as quickly as I could as soon as I knew he was ready.

And make sure she's aware that she may well feel sore afterwards. Dm had a friend who told their ds that he'd go into the hospital to have it all better and it'd never hurt again. He went in feeling fine, and came out feeling very sore. he didn't speak to his parents for a fortnight as he felt they'd lied to him as the doctor made it worse not better.

gasman thanks so much - info says nothing at all after 10 for 11am admission, but clear fluids after that. She is clearly a bit worried about it, and keeps asking questions, but also seems glad to have a narrative about what is going to happen to hold onto. Consultant seemed to suggest 48 hours normal until discharge - we have older child, so logistically easier to have her at home, but we'll see. She knows she will be sore for a while afterwards - we made sure to tell her that part. Big sister told her that it would be a bit scary, but ok (big sis was in for few days for pneumonia) - which is probably useful too.

quick update for you kind ladies - we went in at 11, and she finally went down to theatre at 3, so poor child was starving! but staff very impressed with how calm and relaxed she was about the whole thing - anaesthetist said she wouldn't bother with pre-med because she was so chilled. All of your advice really helped - all she really wants to do is put on her new penguin pyjamas! She knows it will be sore afterwards, bless her

Hi,
Just been reading your post rhetorician & so glad to hear all went well for your daughter today. My son was meant to have same op today but we were sent home as he has a slight cough so they didn't want to proceed, which we were happy about, had a feeling they,d have concerns about going ahead with op. We should get another appt through for 3/4 weeks time. Very worried about it. Would very much, if you didnt mind, like to hear how your daughter gets on & how things go over the next few weeks..
Best wishes to you & hope your daughter has a speedy recovery.

brimmond thanks - sorry that you had to postpone, but as you say, probably for the best. How old is your son? DD2 was brilliant throughout, only slight hitch was getting her to eat enough for them to allow her home. Advice is to keep her indoors/at home for a week, and keep her topped up constantly on pain relief - pain will peak at about day 5. Really important to eat and especially drink plenty, probably not the time to be picky with them about diet! Surgeon said crisps are good!! So far she seems fine, although I am sure there'll be some conseuqences in terms of mood. Will keep you updated

That's great everything went well & very much appreciate your feedback. Yes had heard that unlike the advice you used to get, they try to encourage rougher food now, crisps, toast etc. Looks like we have a new date of 11th Nov for my son. At least we can enjoy his birthday before then, he will be 4 in 2wks time,
Take care & best wishes, Wendy x