Pre-Admission Phone Call and Nurse Assessment

You will receive a phone call from a registered nurse approximately five to seven days before your child’s scheduled procedure. The nurse will review your child’s past medical and surgical history, medications, and allergies.  The nurse will also instruct you regarding the time you should plan to arrive, the approximate time of your child’s procedure, and what medications should be taken the day of surgery prior to arrival.  We gather as much information in advance in order to make the day of your child’s procedure less stressful. The call also aids our employees in being fully prepared to care for your child. If you would prefer to contact the nurse directly, please call 616-685-3983, Monday through Friday, from 8 am to 4 pm.

Pre-Admission Testing

Your child’s surgeon or anesthesiologist may want them to have lab work or tests performed before the day of surgery. Your child’s surgeon may also request that they see their primary care physician or cardiologist for a surgical clearance appointment. Please complete all tests or appointments at least one week before your child’s scheduled procedure. That way, we’ll have all the information we need before you and your child arrive.

Infant / Toddler (6 months – 3 years old)

Try to keep the baby’s normal routine the day before surgery. Make sure your baby and you are well rested. The period before surgery when an infant cannot eat or drink can be challenging. Rock, walk, or otherwise try to distract the baby during this time. If you are breastfeeding, your baby will usually be able to continue up to a few hours before surgery. You will receive instructions regarding how many hours prior to surgery you will have to stop. Since you may have to miss several breastfeeding sessions, you should plan to pump your breasts to maintain your milk supply and to relieve discomfort. In most cases, breast-feeding can resume when your baby awakes from anesthesia.

Infants and toddlers can sense a parent’s stress. The biggest fear for children in this age group is separation from parent. Bring familiar toys, stuffed animals, blankets, pacifiers, music, etc. the day of surgery. The day of surgery, hold him/her and stay calm.

Surgical education and preparation for toddlers should take place only one or two days in advance, if possible. Preparation too far in advance can increase the anxiety in a toddler.

Useful methods of preparing toddlers for surgery include:

• Reading books about surgery
• Role-playing with dolls or stuffed animals
• Use very simple explanations and words. For example, say, “the doctor is going to fix your ears.” Do not say, “The doctor is going to cut a hole inside your ear.”
• Let your toddler help choose the security objects that will be brought to the surgical center.

Preschool Children (3-5 years old)

Preschool children are unable to fully understand the word surgery. Reassure your child that you will be there with them. Common fears for this age group include: fear of being left alone, thinking he/she is having surgery because he/she is being punished, fear of needles and shots, fear of waking up during surgery, fear of damage to body parts, and fear of pain. Three to seven days before surgery is the ideal time to begin preparing a preschool age child for surgery. Be patient with your child. It would not be uncommon for a preschool child to resume previous behaviors. They may exhibit temper tantrums, bedwetting, or thumb sucking due to the stress of the surgery.

Useful method of preparing preschoolers for surgery include:

• Let children of this age take the lead with medical role-play. For example, taking a doll’s “pulse” or listening to its “breathing” with toy instruments.
• Reading books about surgery.
• Role-playing with dolls or stuffed animals
• Use very simple explanation and words. For example, say, “Yes, it will hurt, but it will go away quickly.” Do not refer to anesthesia as “being put to sleep”, or the preschooler may refer to a pet that has died and wonder if he/she will die too. A better choice would be, “A doctor will help you sleep during the operation, and he/she will wake you up when it is over.” Explain the benefits of the surgery in words your child will understand. As an example, “After the doctor fixes your ears, you will hear better and have less ear aches.”

School-Age Children (6-11 years old)

School-age children typically understand what surgery means. They may fear the experience and can benefit from education a week or two before surgery. Common fears for this age group include: fear of having a body part injured or destroyed, fear of being away from school and friends, fear of pain, fear of needles and shots, fear of dying during surgery, loss of control, and thinking he/she needs surgery because he/she is being punished.

School-age children are very aware of physical image and body changes. They are usually embarrassed during body examinations. It is important to give the children privacy when possible. Serious medical conversations should not take place in front of a school-age child. Include your child in conversations with the medical team members in the room to promote a sense of control.

Useful methods of preparing school-age children for surgery include:

• Reading books about surgery
• Expressing emotions through drawing and play
• This age group may not ask questions if they think they are supposed to know. Make sure your child knows why they are having surgery, using words he/she can understand. Have your child explain what is going to happen related to the surgery. School-aged children sometimes listen carefully but often do not understand everything that was said. Explain the benefits of surgery in terms your child can understand. For example, “After your arm has healed, you will be able to play baseball again.” Use words such as sore instead of pain, or poke instead of shot to ease anxiety.
• Encourage your child’s friends to visit at home, by phone, or by computer during the recovery period.
• Emphasize that surgery is not a punishment, and that your child has not done anything wrong.
• Tell your child that it is all right if they cry of if they are afraid. Encourage him/her to ask questions of the medical team.
• Give your child compliments and hugs. Hold their hand during tests and procedures.
• If your child will miss more than a day of school, try to pick up homework so they do not get behind.

Teenagers (12-18 years old)

Although teenagers understand the reason for a surgery, they may not admit to the anxiety that they are experiencing. Encourage the teen to ask questions and talk with you about their concerns. Teenagers want to be active participants in decisions regarding the care they receive. Common fears for the age group include: fear of having a body part damaged or changed in appearance, fear of being away from school and friends, fear of surgery and its risks, fear of pain, fear of dying during surgery, fear of the unknown, fear of what others will think about them having surgery, and loss of control.

Useful methods of preparing teens for surgery include:

• • Encourage your teen to learn about the surgery by reading books and using the Internet.
  • Encourage your child’s friends to visit at home, by phone, or by computer during the recovery period.
  • If your child will miss more than a day of school, try to pick up homework so they do not get behind.
  • Encourage your teen to bring comfort items from home, such as music players or hand-held gaming devices.
  • Tell your child that it is all right if they cry or if they are afraid. Encourage him/her to ask questions of the medical team.
  • Do not keep secrets from your child. Teens may become very angry if they suspect that you are keeping secrets. They need to understand what is happening to their body.
  • Remember that privacy regarding body, feelings, and thoughts is very important to a teen. Please respect their privacy. Please be aware that any female that is of childbearing age and/or menstruating will be required to have a pregnancy test prior to surgery.

Sibling Care

In order for you to focus on the needs of your child having surgery, we highly recommend that you do not bring siblings under the age of 12. When a sibling needs to have a surgical procedure, siblings may experience a wide range of emotions. The sibling may be angry over the change in routines, or jealous if their sister or brother temporarily is not required to follow family rules (such as TV time or foods eaten). The child may feel guilty about being angry toward the ill sibling, or they may believe that they somehow caused the condition leading to the surgery. A sick sibling’s behavior, appearance, or level of attention from family, friends, or neighbors may be embarrassing. The sibling may feel sad and lonely if they are spending more time alone or away from parents. The child may feel afraid that the sibling undergoing surgery will not return, or will die, or that they or their parents will have the same medical problem in the future.

A sibling may express their feelings either verbally or through behavioral and physical changes. The behavioral changes may include reverting to outgrown behaviors (bedwetting, thumb sucking, etc.), seeking more attention, acting out, poor school performance, or ignoring the sibling needing surgery.

Strategies for family coping include attempting to maintain normal routines, reserving quality time for all of your children, finding quiet times to talk with the children about the impending surgery and their feelings, informing teachers of the impending surgery, and encouraging expression of feelings and stress through play, journaling, or art.

Children and Pain

Children as young as three can verbalize pain intensity. When the child cannot express the intensity of pain clearly, monitor for signs of pain. Signs of pain include agitated body movements, crying, rapid heartbeat, sweating, and irritability. Pay attention to what a child is doing, what they are saying, and how the child’s body is reacting. Compare your child’s behavior to their normal behavior when you are assessing pain intensity and considering administration of pain medication or other comfort measure as instructed by the surgeon (ice, heat, etc.). Always ask the surgeon about the typical range of pain for your child’s specific surgery.

Explain to your child where they will feel pain after the procedure, and how long they can expect it to last. Tell them that the nurse will ask them how much pain he/she is experiencing. A zero to ten scale or a smiling to frowning face scale (typically ages 3-8) may be used. Zero means no pain, and ten means the worst pain they can imagine. Encourage your child to tell you when they are experiencing pain, and if pain medications do not seem to be helping.

There are many ways to help your child cope with pain. Be honest with your child about what will hurt and how long they may have pain, using simple terms. Encourage your child to express their feelings and to ask questions. Give your child permission to cry and to be upset. The following are suggested strategies for coping with pain:

• Holding or rocking
• Comforting – speaking softly, singing, stroking a hand, bringing a favorite toy or blanket
• Distraction – books, magic wands, music, movies
• Relaxation – listening to music or relaxing by slowly and gradually tightening and loosening the muscles from head to toe
• Play
• Guided Imagery – closing the eyes and thinking about a happy place or time, talking about a favorite television show or vacation, making up a story
• Deep breathing – Ask your child to take a big, deep breath through the nose and then to release it slowly through the mouth. While breathing out, imagine letting go of pain, negative feelings, and fear. Pinwheels, bubbles, and straws can be helpful tools to assist your child with deep breathing.

Eating/Drinking

Your child may not have anything to eat or drink after midnight the night before their scheduled procedure, unless given direction by your physician or our phone nurse. This includes no food, liquids of any kind, candy, mints, or gum. Your child may brush their teeth but must not swallow water. Failure to follow these instructions may result in temporary cancellation of the surgery. Despite parent’s best efforts, occasionally a child may break these rules when they are not closely supervised. Should this occur, for the safety of your child, please inform the surgical center staff as soon as possible once the Southwest Surgical Center has opened for the day. If you are told that your child may have clear liquids at any point in the surgical preparation, these include:

• Water

• Apple, cranberry, and grape juice

• Jell-O without toppings or added fruit

• Popsicles

• Clear pop / soda (Sprite, 7-Up, Ginger Ale)

• Sports Drinks or Gatorade

If your child has a cold, sore throat, fever, cough, or other illness one to two days prior to surgery, please contact your child’s surgeon.

Try to get your child to sleep on time the night before surgery so that they are well-rested.

Medications

Please consult your child’s surgeon or the pre-op phone nurse concerning instructions on the use of any prescription or over-the-counter medications and vitamins / supplements prior to your child’s surgery, as some of these may be required to be held prior to surgery or on the day of surgery. It is essential that we are aware of all your child’s medications or supplements including those taken on an as needed basis. Having your child’s full medication list available when you speak with the phone nurse is helpful. If your child has an inhaler, please bring it with you on the day of surgery. Otherwise, do not bring your child’s actual medications with you unless you are instructed to do so.

Personal Preparation

• Your child should bathe or shower the evening before or the morning of surgery. Do not apply oils or powders. Children should arrive with little or no make-up (especially eye make-up) or fingernail polish. Hair clips and barrettes with metal should not be worn. Plastic hair clips and rubber bands for longer hair are fine.

• Your child should wear loose, comfortable clothing or pajamas. No onesies, sleepers, or one piece outfits.

• Please bring a favorite bottle or “sippy” cup for your child with milk or formula from home and a favorite stuffed animal, toy, or blanket.

• We encourage you to bring books, games, or an activity to pass the time or to distract your child. A DVD player and movies are available for use.

• Contact lenses and glasses for your child may need to be removed. Please bring storage cases.

• Do not bring any of your child’s medications with you, unless instructed otherwise by the phone nurse. Medications that are typically requested to be brought along include inhalers and insulin pumps.
• At least one parent / legal guardian should bring a driver’s license or picture ID, as well as a valid insurance card. If you are a legal guardian, a copy of the guardianship papers are also required in order for you to legally sign the required consent forms. If you require eyeglasses for reading, please bring them with you, as you will be asked to review a number of documents during your stay.
• One parent / legal guardian must accompany and stay with a patient under 18 years of age during the entirety of their stay.
• Siblings should not be brought along to the surgical center.