Children having surgery
A visit to hospital can cause anxious feelings for anyone, but especially for tamariki (children). There are things you can do to help you and your tamaiti (child) prepare for surgery.
When tamariki come to hospital for surgery
Meet some of the team who will look after you when your tamariki come to hospital for surgery. Find out what to expect.
Have you ever been to hospital before?
You may need to go to the hospital for some treatments, like an operation to get your tonsils out or a special x-ray called a scan.
Sometimes, if that happens, you will have to be put into a special medical sleep called an anaesthetic. We'll explain more of this a little later.
It might be a bit scary coming to this place you don't know and meeting lots of new people who work here.
We're going to show you today what you can expect during your stay at the hospital.
We'll also meet some of the people who might be looking after you.
You may be able to come to the hospital on the same day as your treatment. You will have to go to the theatre reception to be checked in. Look out for signs for reception.
If you live far away from the hospital, you might have to stay the night before in our special children's ward.
In this ward, there will be a nurse who looks after you and many other children who are in hospital for all sorts of reasons.
If you go into this ward, you might even have a visit from the play specialist, who will show you some fun activities and help you understand what happens in a hospital.
If you are having the special medical sleep, the anaesthetic, you will be told not to eat anything for at least 6 hours and not to drink anything for an hour beforehand. This is important, so your tummy is empty, as the anaesthetic can affect how your tummy works.
In reception, the lovely receptionist will get your file and check that all your information is correct, like your name, address and birthday.
You will sit in the waiting room until a nurse calls you to do some checks.
There is a small playroom in the waiting room with a few toys, where you can play and where you might meet other children who are also waiting for treatment.
If you prefer, you can sit in the bigger waiting room with the adults.
It's a good idea to bring something you enjoy doing with you, like a game, a movie to watch or a book to read.
A nurse will take you into another small room where they will check some observations, like your heart rate, temperature and weight.
It's important to know how much you weigh because some of the medicine you might need is measured out depending on your weight.
If you've come into the children's ward the day before you're having an operation or a scan, which we sometimes call a 'procedure', an attendant will take you to the specific area where you will meet the team who will look after you while you have your special medical sleep. Your ward nurse and your adult can come along too.
You will also be seen by the surgeon and the anaesthetist. These are specially trained doctors who know how to care for you. The surgeon, the doctor who will be doing your operation, will talk to you and your adult and explain what they'll be doing.
They may draw an arrow on you to show where the operation will be. If you have any questions about any of that, they're always happy to answer them.
The anaesthetist, the doctor who will give you medicine for the special medical sleep, will also have a chat with you and explain what you can expect. They will ask you and your adult many questions and may listen to your chest and look in your mouth.
If you are feeling a little nervous, you can always talk to them about it. They may give you some calming medicine to help with the butterflies in your tummy. The anaesthetic room is just next door to the theatre. You will meet the anaesthetic technician who helps the anaesthetist and the theateer nurses who help the surgeon and organise the theatre.
This team of people will check your special ID bracelet that goes around your wrist and ask some more questions. All of this is to ensure that you'll be kept safe while you're in the theatre.
The room where you have your operation is called the operating room or theatre. Some children like to walk into the theatre themselves, while others prefer to be carried in by their adult.
The best part is you get to choose! You can bring your favourite toy to come sleep with you. You can also choose whether you want to hop onto the theatre table or whether you'd prefer to sit on your adult's lap while going off to sleep.
Your mum, dad, or caregiver can be with you the whole time until you fall asleep.
There are different ways that the anaesthetist can help you go into your special medical sleep, and they'll explain this to you. One option might be breathing in some gas through a nice-smelling mask.
You may be able to choose a special smell to put onto your mask — chocolate, strawberry, watermelon, or even marshmallows!
The other option you could choose to go into your special medical sleep is by a tiny straw called a cannula. This tiny straw will be put into your hand into a place called the vein with a very tiny needle.
Before the needle is used, we have a magic numbing cream that we put on your skin and keep it there with a sticker for quite a long time. This magic numbing cream means you'll hardly feel anything when the canula is put in your hand.
If you are having a mask with gas to have your special medical sleep, you might start feeling a little floaty as you get sleepier. This is common, and you'll soon feel very tired and eventually fall asleep.
If you are having a cannula to have your special medical sleep, sometimes this medicine can feel really cold as it goes in.
You may hear the anaesthetist tell you a funny story, or maybe you'll even get to play a game. You'll find that you get sleepy very quickly because of the speedy medicine that's put into the cannula. You might not even have time to count to 10.
The anaesthetist may put some pieces of equipment on you; these are called monitoring. They will help the anaesthetist look after you the whole time you're in your special medical sleep.
When you're in your special medical sleep and having your procedure, the anaesthetist will give you more medicine that they know will be helpful. They'll be looking after you and keeping you safe the whole time that you're asleep. Their aim is for you to wake up feeling good.
Once your procedure is finished, the anaesthetist will wake you up. You'll be taken to a different place called the wake up room or recovery.
In recovery, a nurse will look after you for a while. You may feel a bit dizzy or a bit tired as you wake up. You'll be in a new room, so things may look a little different.
The nurse can give you extra medicine through the cannula if you need it.
As soon as the nurse is happy, your adult will be called in to be with you. You may even be allowed an ice block.
You may not be able to go home on the same day as your procedure. Sometimes it's important for you to stay in hospital to be looked after for a day or even a few days. You'll be cared for on the children's ward. Your adult will be able to stay with you overnight.
If you're going home on the same day as your procedure, you'll be moved to the postoperative area. You may also be given something to eat if you feel hungry.
Another nurse will be looking after you there until you're ready to go home.
We look forward to welcoming you to our hospital if you ever need to come here. Remember, you can ask any questions you want to, and we're here to look after you.
[Children speaking]
I remember getting in quite late and getting put to sleep. Then when I woke up, I realised that I had to get some cream on with a needle in my hand.
But what I realised was that the needle was actually for a tube to get in, and that was actually for my operation.
At first, I was worried about having a tube go in my arm, but when I had some numbing cream on my arm I felt a bit better.
So there was no breakfast time for me because before my operation I wasn't allowed to have breakfast.
I couldn't eat anything before but after I could have an ice block.
When I was getting down to the theatre, I met some really nice people on the way that would help me get down to the theatre.
I liked getting rolled around the hospital on a chair that could go up and down with a remote.
Yes, I met the doctors, nurses, and I met some other nice people too
And they were telling jokes as I drifted off to sleep.
When I woke up, it was a teeny bit sore, and then I pressed the buzzer, and the nurses came to give me some medicine.
Mum was there, and all the doctors and nurses cared for me and made me feel better. You could bring a toy or something to play with and keep you company, and maybe a book to read.
So then, I went to the playroom, which was quite nice because I met some new people. There were a lot of toys, and a lot of options.
You're allowed to feel scared, but it'll be okay. There's going to be lots of people to look after you and you are going to be fine.
Preparing your tamaiti (child) for surgery
To provide the best care for your tamaiti, your anaesthetist needs some information. When the surgery is booked you will be asked to complete a health questionnaire on behalf of your tamaiti. The information is used to determine whether they need to be assessed before the day of their surgery. If they do, they may be assessed in a clinic or from where you are over the phone or using telehealth (video).
Sometimes your anaesthetist will arrange tests or a treatment your tamaiti needs before their surgery.
If your tamaiti is taking certain medicines, you will get special medicines instructions for the day of surgery. These will be written down for you.
Health supplements or herbal remedies that do not need a prescription can interfere with medicines, anaesthetics and blood clotting. Do not let your tamaiti use these for 2 weeks before surgery.
Talking to your tamaiti about surgery
Tamariki and rangatahi look to their parents and caregivers for support when they are having a procedure. Knowing how to help can be difficult but there are good resources on how to talk to your tamaiti about their surgery and helpful videos to watch.
Preparing your child for hospital — KidsHealth (external link)
If they are unwell before surgery
If your tamaiti becomes unwell in the weeks before their surgery, call the phone number in your surgery booking letter.
The surgical team usually prefers tamariki to be clear of an upper respiratory infection (cold or flu) for 3 weeks before surgery. Some tamariki have frequent infections so compromises can be made — phone the number on your booking letter for advice.
On the day of surgery
At the hospital
It is a good idea to bring anything from home that may make your tamaiti more comfortable, such as a toy, blanket or an electronic device. There is often a playroom in the waiting area.
Your anaesthetist will meet you and your tamaiti before their operation to:
- review all your child’s information
- discuss the pain relief options
- talk about the risks and benefits of these.
They will decide with you which option would be best for your tamaiti.
Tamariki are sometimes asked to change into theatre clothes — often they can stay in their own pyjamas. Your tamaiti may be given a 'pre-med' before coming to the operating theatre. This is medicine to relax them, if they are anxious. There are various options your anaesthetist will discuss with you, but they are usually given by mouth or the nose.
If your tamaiti is happy watching an electronic device or movie, they can continue this up until they have their anaesthetic.
In the operating theatre
You will be met by the theatre team who do a final check of everything and ask you to confirm some details. There will be 7 to 10 people in the team, including nurses, surgeons, anaesthetists and technicians. They are all there to look after your tamaiti.
Being with your tamaiti in the operating theatre
If your tamaiti is older than 9 months, a family member may be allowed into the theatre with them until they are asleep. Children benefit most from a calm support person.
If you are very anxious about doing this, a nurse can go with them to theatre instead — you do not have to go. When they are waking up in the recovery room, a family member will be called to be with them.
If your tamaiti is younger than 9 months, they will not have developed 'separation anxiety' yet, and there is no benefit of having a parent with them as they go off to sleep. Tamariki go to sleep quickly with an anaesthetic at this age, and we prefer to have all of our attention on them.
Going off to sleep with anaesthesia
There are 2 ways of going off to sleep with anaesthesia.
Intravenous (IV) induction
A nurse will put numbing cream on your child's skin (over a vein) 45 minutes or more before theatre. We then put a small IV tube into the vein to give some anaesthetic — your tamaiti will quickly go off to sleep after it is given. They will become quite heavy in your arms and we will help you move them to the bed.
Gas induction
Using a face mask placed over your child's face, we usually introduce some 'laughing gas' to start with and then gradually add an anaesthetic gas. It smells a bit like felt tip pens.
The anaesthetic gas makes their brain a bit excited before it becomes sleepy, so it is normal for your tamaiti to wriggle, have unusual head or eye movements and have noisy breathing during this phase. Soon after, they will become still. It looks a little alarming if you are not expecting it, but it is quite normal.
While they are asleep
Your tamaiti will have an IV drip placed into a vein while they are asleep, for pain relief and anything else that is needed.
While they are anaesthetised, they will be connected throughout their operation to several monitors which watch their heart, blood pressure, oxygen levels and breathing. The anaesthetist stays with your tamaiti for the whole operation, checking they are asleep, comfortable and safe.
Anaesthesia and children — KidsHealth (external link)
After the operation
The surgeon may phone you once the operation has finished, to explain how things went. Sometimes they will meet with you later on instead.
The recovery room nurses will also phone you when your tamaiti is starting to wake up. Make sure your mobile phone is on and has enough battery.
Your tamaiti will wake up in the recovery room, with a nurse monitoring them. The IV drip will be wrapped with a bandage in younger children.
Pre-school age tamaiti commonly get something called 'emergence delirium' when they wake up from an anaesthetic — it means they are confused and disorientated. They may even be inconsolable for 10 or 20 minutes. This passes with time, and a familiar voice and a cuddle are usually all that is needed. Sometimes medicines will be given in theatre or recovery to calm the tamaiti down.
Pain relief for your tamaiti
Good pain relief is very important. Anaesthetists are skilled in treating pain in different ways. Your anaesthetist will decide with you what is most suitable for your tamaiti and the type of surgery planned. Pain relief can be given by various routes.
Sometimes your tamaiti will be given oral paracetamol before surgery. Most pain relief given after surgery (post-operative pain relief) is also given orally, unless your tamaiti has had surgery on their bowel.
Your tamaiti may be given intravenous (IV) pain relief while they are asleep. Post-operative pain relief may also be given this way, especially early on.
If your tamaiti is old enough, they may have a patient controlled analgesia (PCA) pump. This allows them to control their own pain relief. When they press the button, the pump delivers a set amount of pain relief medicine into their vein, usually it is morphine. The anaesthetist sets limits on the pump so they cannot give themselves too much (overdose). In younger children, the nursing staff will manage the pain pump.
Local anaesthetic is used to numb the site of surgery. It is injected while your tamaiti is asleep and it relieves pain for several hours afterwards.
Local anaesthetic is injected around a nerve supplying a region of the body. An ultrasound scan is used to guide the needle. It is very rare for an anaesthetist to damage nerves when placing a nerve block. This sort of local anaesthetic lasts for many hours.
This type of injection is to the tail bone — at the very bottom of the spine, below where the spinal cord is found. It creates numbness from the waist down.
Caudal injection is often used for painful surgery involving the groin or legs. It is done while your tamaiti is asleep. It numbs the pain nerves but also numbs other nerves, so your tamaiti will initially have weak legs and be uncoordinated when they next try to walk.
These effects all should get better by the next day. For very few tamariki, they can still be a bit clumsy on their legs the next morning. All effects should have gone after 2 days.
Caudal injections are generally very reliable and low risk.
This is similar to an epidural used for childbirth. It is commonly used for major hip surgery.
While your tamaiti is asleep we position them and place a needle in their back (into the epidural space, outside of where the spinal cord is). We then pass a very narrow plastic tube through the needle. We take the needle away and attach the plastic tube to their back to stop it moving. We can give local anaesthetic through this tube for a couple of days, to keep your tamaiti comfortable.
Risks with epidurals include failure, the tube coming out of place, headache, infection and nerve damage. Your anaesthetist will discuss these more with you.
Side effects, risks and complications with anaesthesia
Your anaesthetist will plan the safest anaesthetic for your tamaiti — they are specially trained for any problems that arise. Anaesthesia is safer now than ever before. It is thought to be one of the safest medical procedures.
Anaesthesia risks are greatest in the very young, but serious complications can occur in anyone, regardless of age or fitness.
One way of thinking about this is by thinking about travelling by car. There is always a risk of serious accident or death on the roads, but we mostly think it is a low enough risk that we drive anyway.
Everyone reacts to and tolerates anaesthesia differently. The risks to your tamaiti depend on their health and the type of operation they need. The anaesthetist will discuss these with you.
- sore or dry throat
- emergence delirium (being confused and disorientated)
- feeling sick (nausea) and throwing up (vomiting)
- headache.
Most of these side effects can be treated with medicines. Your tamaiti may have disrupted sleep patterns for a few days afterwards.
Injury to lips, teeth injury or both are possible, caused by placing or removing the breathing tube.
- serious allergy to a medicine
- serious breathing problems
- major nerve or brain damage
- awareness of surgery.
People often worry about the risk of being aware of their surgery during anaesthesia, but this is rare. When it does happen, it tends to be awareness of sounds only. In tamariki, it does not seem to be associated with subsequent psychological problems.