Your child is about to undergo an operation.
Surgery, sedation, recovery… what does your child associate with these terms? How can you prepare him or her emotionally? And how can you cope better yourself? What vibes are you sending your child? What is the parents’ role, and how can you make it easier for yourself and your child?
Here are some things to look out for and tips to help you cope with the fears and unknowns:
The Child’s Fears
Your child may be full of worry and fear before surgery. And these fears can grow when you come to the hospital: meeting the medical team, masks and gowns, pain, anesthesia, lack of control and invasive procedures may all contribute to your child’s emotional state.
Many children are particularly scared of the pain involved. You can explain to them that there is a very special doctor, called an anesthetist, whose job it is to give the child special drugs that will help him or her sleep so deeply they won’t feel any pain during the operation. And when it’s over and the child wakes up (older children need that confidence to know they will indeed wake up), the special doctor is there again, to help reduce the pain.
Fear of the unknown is very scary, especially for children, and so it is important to give them clear and concrete explanations as far as possible.
Among younger children, common fears before surgery are concerned with being separated from their parents (or even being neglected by their parents.) That’s why it is sensible to explain to your child that when they wake up after the operation, you will be there by their side. Or they can choose a favorite doll or toy which will be waiting for them in the recovery room.
School-age children express greater fears about needles, knives and damage to their bodies. Therefore it is important to give them rational explanations and information so they can understand the surgery is intended to correct an existing problem and not cause new damage to the body.
It is vital to help the child feel relaxed and secure, while understanding his or her fears and accepting them as perfectly normal. There is no need to convince your child not to be afraid. Allow them to express their feelings and listen.
Encourage the child to ask questions and talk about whatever he or she wants to talk about, particularly concerning the operation. This allows other fears and anxieties to surface. If your child asks questions to which you don’t know the answer or how to answer, you can tell them you will ask the doctor/nurse together and so you become a ‘partner’ with them in this process.
The Parents’ Fears
A parent who is about to send his or her most precious ‘possession’ into the operating theater has strong and mixed feelings. Have they made the right decision? How will she wake up? How should I answer his questions? Many worries may accompany the parents and yet they must try not to transmit these fears to their child, who may interpret his or her parents’ fears as an expression of imminent danger.
Many parents may turn to psychological help, with the aim of helping them cope with the situation. This allows space for their emotional procedures, helps them understand what their child is going through, and gives them tools for reducing the stress and pressures surrounding the surgery. This of course not only helps them but means they are in a better position to help their child.
Productive Imagination
When you watch little children play, you can see the wealth of their imagination – castles, princesses, pirates, knights, etc. – although imagination can also ‘blossom’ into negative areas, and increase fears and anxieties before an operation. That’s why it is important to equip the child with simple, matter-of-fact explanations that do not allow too much room for their imagination to complete the picture.
The Child’s Feelings of Guilt
Children often believe their health problems and the surgery are actually a punishment for them being naughty. They won’t always admit this or even realize this is what they are thinking, but they will feel some guilt and believe they brought it upon themselves. Therefore it is wise to explain to the child that their situation has nothing to do with anything they may have done or not done, and that the operation is not a punishment but rather a way of solving an existing problem.
The Parents’ Feelings of Guilt
Some operations are the consequence of an ongoing illness that requires surgical intervention at some stage. Others are the result of a genetic problem, in which case parents may develop strong feelings of guilt that make it difficult for them – and by extension their child – to cope. They understand they are not guilty but the emotion arises anyway and so they should work on the relationship between emotions and thoughts (there are treatments that deal specifically with this area.)
Another common thought driving parents’ guilt is “Why them and not me?” This usually stems from the helplessness a parent feels watching their child suffering and in pain. It is frustrating and painful for the parents, and so they would prefer to suffer instead of their child. After all, all parents have either told their children – or at least thought it – that they will always look after them.
Emotional Preparation for Your Child’s Surgery
Receiving and Understanding Information
First, it is important to adapt the level of your explanations to the child’s level of understanding – in terms of language, conceptualization and the child’s abstract versus concrete comprehension. Using words, “as if” games, dolls or books, one can speak to the child in his or her language and explain the process they are about to go through.
Children of all ages cope better with surgery when they know what is going to happen and why they have to have the operation. Help your children appreciate this and make sure they feel they are in good hands and in a safe and secure environment in the hospital. It will help if you can arrange a little tour of the department and show your child the different staff uniforms and equipment they may see in and around the operation – tubes, infusions, gowns, etc. With children it is usually preferable to accompany explanations with pictures and demonstrations.
Don’t use threatening words or scary sentences like, “the doctor’s going to cut you up,” or “they’ll stitch up your stomach.” You can explain to them that the doctor will correct their problem and that many other children have had the same problem and all of them went to hospital to have it seen to and they’re all fine.
Sometimes children feel their parents are not telling them the whole truth or that their situation is far more serious than they have been led to believe. To create trust, do not deceive or mislead your child. Tell them as much truth as you think they need to know, and as much as their level of understanding can absorb.
You can use books to complement your explanations, particularly those written specifically to help young children prepare for surgery and sedation. Reading these books together with your child allows them to ask questions, express thoughts and make the whole experience a little less threatening. With even younger children, one can use dolls or teddy bears and simulate medical procedures on them.
Parents, remember that as well as your verbal messages, you are also transmitting non-verbal signs – intonation, tone, facial expressions, body language, etc., which can either help relax your child or add to their stress. For if you talk about calm but look stressed, your child will feel the stress and not the calm.
Techniques for Reducing Stress
Relaxation techniques and guided imagery are designed to help reduce tension and enable the patient to cope more effectively with stressful situations. Using these techniques, deep breathing and muscle relaxation, one learns to focus attention inwards, to calm the body and thus increase the feeling of control over that body.
Guided imagery enables the person to concentrate on positive images and pleasant pictures or memories, using them to process certain situations. Children of course have a very rich imagination and so guided imagery can help them embark on fascinating journeys and detach them from a reality that sometimes becomes too painful to bear, whether physical or emotional. Therefore, in preparation for surgery, a child – while holding Mommy’s or Daddy’s hand – can learn to imagine he or she is “freezing” the pain, warming the numb area, etc.
Changing Perceptions
From Victim to Hero
Situations of sickness often arouse feelings of compassion, despair, pain, etc. However, the child, who largely lives in the here and now, does not necessarily feel down and wants to laugh and be happy, despite his or her situation. Parents may think this is unnatural, because they are occupied with their child’s suffering and all the possible ramifications, but they should try and allow their child this kind of detachment.
Indeed, when we hear the roars of laughter coming from the Pediatric Department, particularly from those children in very bad physical shape, we remember that it’s all about attitude, and that adults can allow children to be happy even in the bad times.
Moreover, we can enhance the child’s strengths by empowering him or her to cope with this positive attitude, and transform them from victim to hero, both at home and in school as well.
Play, and as fast as possible
This sentence is parallel to “return to normal functioning” for an adult after surgery. For a child, games are the essence of joy, the channel of communication and expression and a way to unload aggression, stress, etc. You can bring their favorite games to the hospital and that will help them return to their old selves faster, in spite of any pain and recuperation they still have to go through.
Enlisting a Supportive Environment
Both at home and at school, a child should feel accepted and supported, physically and emotionally. The more a child feels he or she can receive a response to their needs – whether help in getting out of bed, someone to listen when they cry, a parent who can accept their expressions of anger and frustration, etc. – the more they will be able to find the strength to fully and speedily recover from their surgery.
When an operation requires lengthy hospitalization (either before or after), it is crucial to involve the school, arrange class/teacher visits, homework, etc., so the child experiences some form of continuity with his or her familiar world.
And lastly but by no means least: don’t forget the siblings! Naturally, the child suffering in hospital becomes the center of attention and all the worries at home, which often leaves brothers and sisters feeling “left out and alone”. Whether they are older or younger, it’s important to give them a role to play and to make sure they understand what’s going on. They are also worried about their brother or sister and no doubt have many mixed emotions too. Parents should make sure to keep an eye on them as well.