Kids and Surgery

By Christine Gorman

Surgery is scary enough for adults. but imagine what goes through the mind of a three-year-old when he sees a doctor or nurse all suited up and wearing a surgical mask: "It's a monster! It's got big eyes and no mouth! It's taking me away from Mommy and Daddy." No wonder half of all children from the ages of 2 to 10 show evidence of distress--from bed-wetting to nightmares--for at least two weeks after their operation. Some of them remain traumatized even six months later.

It doesn't have to be this way. Many children will respond to straightforward explanations about their need for surgery. And there is growing evidence that giving some children, particularly those under age 5, a sedative before an operation helps minimize the anxiety later on. That seems only logical, and yet less than 20% of children in parts of the U.S. are given a sedative--a calming drug that is distinct from anesthesia--before surgery, in contrast to 75% of adults. The push to change the way youngsters are prepped got a big boost this spring when Dr. Zeev Kain of Yale reported that in the first week after an operation, children given the liquid form of midazolam (the most commonly used preoperative sedative) experience 25% to 50% fewer nightmares and other disturbances than those given a placebo.

Often, children think they have done something wrong and surgery is their punishment. So it's important to reassure them that you aren't angry with them and that they didn't do anything to "deserve" their treatment.

It's also important to tell children the truth. A surprising number of parents, perhaps trying to control their own anxiety, tell their kid they're going to McDonald's, then take them to the hospital instead. Another big no-no is that tired old phrase "This won't hurt a bit." You didn't believe it when you were a kid, so why should they?

Let your children know there are medications to lessen their pain (nothing can make it go away completely) and that they need to let an adult know when it hurts so that the pain can be treated.

Most children's hospitals offer an operating-room tour before surgery to demystify the process. Some programs even have child specialists act out the operation on a doll or stuffed animal, demonstrating how the anesthesia mask fits over the face or where the EKG "stickers" are attached to the chest. It can be a good idea to play operating room at home as well. (You can get doctor's kits from most toy retailers.) But don't force this or any other information on your child if he or she doesn't seem receptive.

Remember that even straightforward explanations can be confusing. The child specialists at Cook Children's Medical Center in Fort Worth, Texas, for example, take pains to explain to their young charges that even though they are put to sleep during an operation, it's not the usual kind of sleep, so they don't need to worry about waking up in the middle of the operation.

Before any surgical procedure, it's vital to give doctors a complete medical history, including all drugs and herbal remedies your child takes and any known allergies. A little preparation can avert mishaps and speed your child's recovery.

For more on how to prepare your child for surgery, visit time.com/personal You can e-mail Christine at gorman@time.com