Talking to Your Child About Surgery What you do and say to get your child ready for surgery can affect how he or she handles surgery.

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1 Guide t Surgery Getting ready fr surgery can be a stressful time fr yu and yur child. The surgens, nurse specialists and staff at Riley at IU Health understand this and wrk with yu t answer any questins yu may have. We want t make sure that yu and yur child feel cmfrtable and secure during yur stay with us. Our surgery team wants t ease any anxiety yu and yur child may be experiencing abut the surgery itself r the need fr anesthesia. Please let us knw if we can help yu in any way. Yur child s surgery will be perfrmed at either Riley Hspital fr Children at IU Health (Pre Pst Care Unit) r Riley Hspital fr Children at IU Health Nrth Hspital. A nurse will call yu befre yur child's surgery t tell yu at which lcatin the prcedure will be perfrmed. If yu need t cancel yur child's prcedure, please call yur child's dctr's ffice. Fr questins abut the surgery, please cntact the lcatin where the prcedure will take place. Cntact Riley Hspital fr Children at IU Health (Pre Pst Care Unit) Phne: Fax: Cntact Riley Hspital fr Children at IU Health Nrth Hspital Phne: Fax: Preparing fr Surgery Many preparatins are needed befre a surgical prcedure is perfrmed. We want yu and yur child t understand the surgical prcess. Yur child s dctr may request medical tests t ensure yur child s health and safety. The use f certain medicines may need t be adjusted. We als prvide parents with infrmatin abut practical cncerns, such as ldging, and the prper transprtatin fr a child after surgery. Surgery Preparatin Sessin We ffer a surgery preparatin sessin t discuss questins and cncerns with yu and yur child in persn befre the surgery. T schedule a surgery preparatin sessin at Riley Hspital fr Children at IU Health, please cmplete the Riley Surgery Prep frm. T schedule a surgery preparatin sessin at Riley Hspital fr Children at IU Health Nrth, please call Child Life at Talking t Yur Child Abut Surgery What yu d and say t get yur child ready fr surgery can affect hw he r she handles surgery. Fr babies: Bring familiar things frm hme (blankets, tys, stuffed animals, pacifiers, sippy cups, etc). We have sme tys, but having familiar things can make a big difference. Be patient and calm. Yur baby can sense if yu are anxius. It may upset him r her. Fr tddlers: Talk t yur child ne t tw days befre surgery.

2 Use simple wrds. Bring familiar things frm hme. Tell yur tddler that ging t the hspital is nt a punishment. Use a medical play kit t shw him r her things the dctr may use. Ask a Child Life specialist abut the kits. Fr preschlers: Talk t yur preschler three t five days befre surgery. Use simple wrds. Ask yur child fr his r her thughts and feelings abut surgery. Bring familiar things frm hme. Use a medical play kit t shw him r her things the dctr may use. Ask a Child Life specialist abut the kits. Fr schl-age children: Talk t yur child ne t tw weeks befre surgery. Be hnest and realistic. Ask yur child abut his r her fears and cncerns. Encurage yur child t talk abut hw he r she feels. Fr teens: Use crrect wrds. Give hnest infrmatin abut the surgery. Encurage yur teen t ask questins. Include yur teen in plans and decisins. Bld Wrk, Bld Dnatin and X-rays Bld wrk, bld dnatin and X-rays help ensure the best utcmes fr yur child during surgery. Bld wrk/x-rays. If the surgen has asked yur child t have bld wrk r X-rays dne befre surgery, the tests can be perfrmed at Riley at IU Health r yur lcal labratry. If tests are dne lcally, please be sure Riley at IU Health has the results befre the surgery. Results can be faxed t the numbers listed belw: Riley Hspital fr Children at IU Health Pre Pst Care Unit: Fax: Riley Hspital fr Children at IU Health Nrth Fax: It is always helpful t ask fr an additinal cpy f the results t bring with yu n the day f yur child's surgery. Bld dnatin. In sme cases, the dctr may decide that it is necessary t have bld available fr yur child's surgery. The surgen's ffice will crdinate a bld dnatin with the bld center that yu chse. Autlgus bld. Yur child may be able t dnate his r her wn bld depending n age and health histry. Yur child's dctr will let yu knw if yur child can d this. Bld can be stred fr up t 45 days and 90 days if it is frzen. It must be dnated at least ne week befre a scheduled surgery. Directed dnr bld. If yur child cannt dnate, then yu may decide t have selected peple dnate bld fr yur child. Yur child's dctr will let yu knw if this rileychildrens.rg/departments/pediatric-surgery

3 can be dne. This bld must be dnated at least a week befre the surgery date. These special bld dnatins can be difficult. Yu must call the bld center three days after a scheduled dnatin t check if the bld was accepted. It may be necessary t ask fr mre dnrs during this prcess. Tell the surgen and the nurse wh calls the day befre surgery if yu have bld available. Dnatins can be scheduled with the Indiana Bld Center. Call r t schedule dnatins r ask questins. What Yu Need t Knw Befre Surgery Nail plish, cntact lenses, tampns and all jewelry, including bdy piercings, must be remved befre surgery. If yur child takes certain medicines, sme f them may need t be halted r the dsage adjusted prir t surgery. Be sure t talk t the dctr abut all medicines yur child takes. Insulin. If yur child takes insulin, cnsult his r her diabetes dctr befre the surgery t determine what adjustments need t be made t his r her medicatins. Supplements. If yur child is taking any supplements, such as herbs, discntinue their use fr tw weeks befre any surgery. Maps, Parking and Accmmdatins We want t make it as easy as pssible fr yu t navigate ur campuses and get where yu need t be befre and after surgery. Riley Hspital fr Children at IU Health Parking. On the day f surgery, please park in the Simn Family Twer. Stp at the infrmatin desk, and they will direct yu t registratin. Registratin will prvide a parking pass t parents. Visitrs can park in the Riley Outpatient Center fr a fee. Fd ptins. Parents will need t prvide their wn meals. There is a cafeteria, a deli, the Red Wagn Café and ther dining ptins. Ask the receptinist in the family surgery lunge fr a list f hspital dining and delivery ptins. Overnight ldging. Yu will be prvided with a hspital and campus map. We have als cmpiled a list f resurces fr vernight ldging that prvides addresses and phne numbers fr lcal htels. Many f these have special rates fr patients f Riley at IU Health. If yu are having prblems finding a place t stay, please call Scial Wrk at Rnald McDnald Huse. Riley at IU Health als hsts a Rnald McDnald Huse n campus. Fr mre infrmatin, please call Riley Hspital fr Children at IU Health Nrth Parking. Surface parking is available. Fd ptins. There is a cafeteria as well as the Cffee Bar and Atri. Campus map. Yu shuld have received an with a map and directin infrmatin. Please nte: Car seats. If yur child is under the age f 8 r weighs less than 80 punds, yu will need an apprpriate car seat t take him r her hme. If yur child is expected t have casts after surgery, yu may need a special seat. The surgen's ffice can make arrangements fr this befre the day f surgery. Driving. Children wh are ld enugh t drive and have been given a general anesthetic r sedatin cannt drive a mtr vehicle fr a minimum f 24 hurs after anesthetic. A licensed driver must accmpany them t the hspital and drive them hme. rileychildrens.rg/departments/pediatric-surgery

4 Underging Anesthesia Mst surgeries require lcal r general anesthesia. This means yur child will likely be asleep when the dctr perfrms a needed prcedure. Parents and lder children are ften cncerned abut hw anesthesia is used and what happens in the surgical suite. We answer cmmn questins abut anesthesia belw: Wh will anesthetize my child? At Riley at IU Health, all patients underging anesthesia are cared fr by a dctr wh specializes in pediatric anesthesia. Our assciatin with the Indiana University Schl f Medicine means that ur pediatric anesthesilgists are cmmitted t the highest levels f medical care, research and educatin. Our anesthesia team ften includes resident dctrs training under the full supervisin f staff pediatric anesthesilgists, which gives yur child the benefit f care by several individuals dedicated t his r her needs. If yu have any questins abut the pediatric anesthesilgy team, please ask the nurse wh will cntact yu the day befre surgery. What may my child eat r drink n the day f surgery? Anesthesia is safer tday than ever befre. One reasn fr this is ur better understanding f the risks assciated with eating and drinking befre anesthesia. Yu will be given very specific instructins abut what yur child may eat and drink befre surgery as well as the times when the eating and drinking must stp. These instructins are designed t reduce the risk f serius respiratry prblems. The instructins must be fllwed carefully. If fr sme reasn they are nt fllwed, please tell us right away s that adjustments can be made t help prtect yur child frm harm. What type f anesthetic will my child receive? The gals f general anesthesia include pain relief, unawareness ("anesthetic sleep"), acceptable vital signs during surgery (including bld pressure, heart rate and xygen) and a cmfrtable wake-up perid. A cmbinatin f medicines and techniques may be used t meet these gals. A dctr will discuss the anesthetic plan fr yur child with yu. The anesthetic plan is develped frm factrs including yur child's health histry, current cnditin and surgical needs. Yur child's anesthesilgist may prescribe a preperative medicatin fr yur child t reduce his r her level f anxiety. This will help t decrease the memry f beginning the anesthetic. Depending n the surgical prcedure, the anesthesilgist may als discuss appraches t managing reginal and acute pain fllwing surgery. When may I see my child after anesthesia? We realize this is a stressful time fr yu and yur family. Our gal is t reunite yu with yur child as sn as pssible. Our main pririty, hwever, is the safe recvery f all f ur patients frm the effects f anesthesia. Therefre, we cannt guarantee that yu will be able t visit yur child in the recvery rm. The final decisin is based nt nly n yur child's cnditin but als n the cnditins f the children arund him r her. What can I expect while my child recvers frm anesthesia? While tday's anesthetics allw a smther, mre cmfrtable recvery than in the past, side effects are nt unusual. Nausea and/r vmiting can ccur either as a result f the anesthetic r the surgical prcedure. Anti-nausea medicines will be given if needed. Every effrt will be made t prvide cmfrt t yur child. Supplemental pain medicatin may be necessary. Even if yur child is cmfrtable, waking up in an unfamiliar envirnment may be upsetting. It is ccasinally helpful t prvide medicine t relieve anxiety in the recvery rm. Yur child may be very sleepy frm the anesthetic r ther medicatin. Althugh yur child will want t see yu, he r she will prbably want t sleep and nt feel like talking. rileychildrens.rg/departments/pediatric-surgery

5 Safety During Surgery We want yur child t have a safe surgery experience with gd results. T ensure yur child s safety, we always: Wash ur hands. We will clean ur hands befre and after tuching yur child. Ding this is the best way t stp the spread f infectin. Check yur child s name and armband. Many peple will ask yu r yur child t state his r her name and birth date. We will check this infrmatin n yur child's armband frequently. We d this t make sure we are ding the crrect prcedure n the right patient. Verify yur child s prcedure and mark the surgical site. We will ask yu t tell us what prcedure yu think yur child is having t make sure we are ding the crrect ne. One f the dctrs will mark the site if it invlves the right r left side. This will make sure the surgery is dne n the crrect side f the bdy. Perfrm a pregnancy test n all girls wh have started their perids. This may seem like an unusual request, especially fr yunger girls, but anesthesia medicines can have a bad effect n any unbrn baby, and we want t avid this. Give a sedative if indicated. If we think yur child may be anxius abut ging t the perating rm, we will give him r her a sedative called Versed by muth. This medicine can cause yur child t becme very drwsy and disriented. Once it is given, we will need yur help t keep yur child safe by hlding him r her up r having him r her lie n a stretcher. Give antibitics if indicated. Yur child may be given antibitics while he r she is in the perating rm. This will help prevent infectin. Mnitr yur child s temperature. Yur child's temperature will be mnitred during the peratin and in the recvery rm. This will help us catch any prblems early. Mnitr bld sugar if indicated. If yur child is a diabetic, we will check his r her bld sugar in the perating rm and the recvery rm. We will ask yu the result f his r her mrning check. rileychildrens.rg/departments/pediatric-surgery

6 The Day Befre Surgery A nurse will call t give yu instructins ne r tw days befre the surgery date. This phne call will include imprtant infrmatin fr yu and yur child abut the fllwing: Diet instructins. It is very imprtant t fllw diet instructins exactly as they are given. If they are nt fllwed, the surgery may be delayed r cancelled. Eating r drinking t clse t the surgery increases the risk f vmiting stmach cntents int the lungs. This may cause pneumnia, lung damage r even death. If these instructins are nt fllwed, the surgery r prcedure will be cancelled. Clear liquids are limited t water, apple juice, Gatrade and Pedialyte; n Jell-O r Jell-O water. Arrival time. Yu will be asked t arrive earlier than yur child's scheduled surgery time. This allws us plenty f time t be sure that yu and yur child will be ready fr surgery. All patients will see a nurse, a surgen and an anesthesilgist prir t their prcedure. A Child Life specialist is available if yur child needs supprt t prepare fr surgery. Als, any pre-surgery tests that are needed may be dne at this time. The scheduled surgery time is nly an estimate and may change due t emergencies r prcedures lasting lnger r shrter than scheduled. Please tell the nurse if: Yur child has had tests dne utside f Riley at IU Health and if yu have a cpy f the results. Bld has been dnated fr the surgery. Yur child s dctr has given yur child special diet instructins r treatments. Yur child is ging t need special equipment at discharge, such as an apnea mnitr, car seat r crutches. Yur child is taking any medicines. This includes any ver-the-cunter medicines, herbs r as-needed medicines. The nurse will need t knw the name, the dsage rdered, hw ften the medicine is taken and when it was last given. Yur phne nurse will tell yu what medicines t take befre the prcedure. Yur child develps a cld, persistent cugh, flu symptms r fever. Please cntact yur child's dctr r the surgery team at Riley at IU Health befre cming t the hspital. Yur child has any allergies. Yur child has been expsed t a cntagius disease (measles, mumps, Chicken px) within the past three weeks. Please ntify the surgen and the nurse wh calls yu befre the prcedure. If yu wuld like t use ur utpatient pharmacy services t have yur child's prescriptins filled befre leaving the hspital. Yur child has any special sensry cncerns. If yu have nt received a phne call by 1 pm the day befre surgery is scheduled, please call the lcatin where yur child's surgery is scheduled t take place t learn when t arrive and abut imprtant diet restrictins and t ask questins abut yur child's health histry. Phne numbers. If yu d nt understand these instructins r have questins, please call the apprpriate surgery center at the numbers listed belw. Riley Hspital fr Children at IU Health Pre Pst Care Unit: Riley Hspital fr Children at IU Health Nrth: rileychildrens.rg/departments/pediatric-surgery

7 The Day f Surgery There are many things t remember n the day f yur child s surgery. Belw are sme guidelines t keep in mind: What t bring t the hspital. When yu cme t the hspital n the day f surgery, please bring: An extra set f lse fitting clthes. Any medical supplies yu use at hme, such as G-tube tubing and adapters, special frmulas, extra trachestmy tubes, special bttles r nipples, sippy cups r prescribed medicines in their riginal cntainers. A favrite ty r blanket. Children may bring a MP3, CD r DVD player with earphnes. Please be sure items are well marked with yur child's name. When yu arrive at the hspital. Yu will be assigned t a small rm where yu will need t wait until it is time fr yur child's surgery. The dctrs and nurses will meet with yu in yur rm. If yur daughter has started menses (is having perids), she will be asked t give a urine sample fr a pregnancy test. This is required by her anesthesilgist fr her safety while under anesthesia. When yur child is ready, a surgical nurse will cme ut t meet yu. The nurse will be wearing surgical scrubs and a paper hat. Yur child will either walk, be carried r ride in a wagn, in a wheelchair r n a stretcher t the perating rm. The rms have limited seating, and we ask that nly tw peple accmpany the patient. Yu shuld plan t be here mst f the day. We als ask yu nt t bring any ther children with yu. Safety. Safety is ne f ur main cncerns. Yu will verify the surgical prcedure and site befre the surgery. The dctr, patient r family member will mark the site if it invlves either left r right. Befre surgery. The anesthesilgist, yur child's nurse and a Child Life specialist will wrk with yu t help yur child be cmfrtable ging t surgery. The Child Life specialist will assess yur child's level f anxiety and understanding f the prcedure, address any fears r cncerns and help best prepare yur child fr surgery. If needed, yur child may be given a medicine t drink t cause drwsiness befre surgery. It will als help make it easier when he r she is ready t g t the perating rm. This will be given abut 15 minutes befre the surgery. At this pint, yur child will need t lie dwn, stay in a wagn r n yur lap. We als ask yu t keep the rm calm and quiet. Family surgery lunge. When the surgical nurse takes yur child t surgery, he r she will let yu knw where yu need t wait. The family surgery lunge is als lcated n the secnd flr f Riley Hspital fr Children at IU Health. Please be sure t check in with the receptinist in the waiting area. The lunge ffers free Wi-Fi, s feel free t use yur cell phne r cmputer while yu wait. A Family Supprt Nurse will be making runds frequently between the perating rm, recvery rm and surgery waiting area t keep yu infrmed f yur child's surgery and prgress. Updates n yur child's prgress will be given every ne t tw hurs thrughut surgery and as yur child wakes up in the recvery rm. If yu leave the waiting area. After checking in, it is a gd time fr yu t get smething t eat r drink. We ask that yu d nt leave the hspital and that yu ntify the receptinist if yu are leaving the waiting area. Be sure t ntify the receptin desk r leave yur cell phne number with the receptinist. Make sure the hst r hstess knws where yu are ging and hw lng yu will be gne. This will help us if we need t find yu r if the surgen needs t talk t yu during surgery. rileychildrens.rg/departments/pediatric-surgery

8 Recvery Rm Guidelines In rder t make visitatin in the recvery rm as smth as pssible, we ask that yu fllw these guidelines: Only tw visitrs at a time. There is a limited amunt f space arund patients in the recvery rm. The nurses need t be able t mve freely arund the bed in rder t take care f yur child. N children under the age f 16 are allwed in the recvery rm. Yur child needs all f yur attentin while yu are visiting. There is als a lt f equipment and unfamiliar peple and nises, which might be scary fr a yunger child. Family Supprt Nurse. A Family Supprt Nurse is available in the daytime, Mnday thrugh Friday. The nurse will make runds n a frequent basis between the perating rm, recvery rm and surgery waiting area. He r she will be able t give yu infrmatin abut hw yur child's recvery is ging. Please d nt cme t the recvery rm until we call fr yu. When the surgen tells yu that yur child is ging t the recvery rm, it ften nly means that the prcedure itself is dne. Additinal time is needed fr the anesthesilgist t wake yur child up and fr the perating rm staff t get him r her ready t mve t the recvery rm. It will then take time t get yur child settled in. This can take an hur r mre after the surgen talks t yu. Admissin delay. Due t increases in ur patient ppulatin, there is a pssibility that yur child may be held in the recvery rm fr an extended time befre his r her admissin bed assignment becmes available. Ging Hme If yur child is staying vernight fllwing surgery, this is cnsidered an admissin, and yur child will g t a patient care unit when he r she leaves the recvery rm. If yur child is ging hme after surgery, he r she is an utpatient and will g back t the Riley at IU Health Pre Pst Care Unit. Hme care instructins. Befre yu leave fr hme, the pst-care nurse will g ver yur hme care instructin sheet and answer any questins. Please ask the nurse t prvide yu with an excuse fr wrk r schl if needed. Medicines. Prescriptins fr medicines may be filled thrugh ur utpatient pharmacy services. Fllw-up call. Sn after yur child's surgery, yu will receive a fllw-up telephne call frm a nurse. He r she will be happy t answer any questins yu may have fllwing surgery. Questins after surgery. Riley Hspital fr Children at IU Health has a surgery nurse available 24 hurs a day at , r yu may call the surgen's ffice during ffice hurs. If the ffice is nt pen, yu may call and ask fr the surgen's resident n call. If yur child is having surgery at Riley Hspital fr Children at IU Health Nrth, please call the surgen s ffice t ask fllw-up questins. Satisfactin survey. Yu will be given a satisfactin questinnaire t fill ut. Please be sure t fill ut yur survey. We appreciate yur feedback and use it t imprve ur services. Pstperative Cmplicatins Please call yur child s dctr if he r she: Has a fever greater than 101 degrees Fahrenheit Experiences persistent nausea r vmiting Has excessive bleeding r swelling Experiences difficulty breathing Has any ther unusual symptms rileychildrens.rg/departments/pediatric-surgery