Preparing for your child's operation It is generally a good idea to tell your child about the operation at a level appropriate for his or her age. Preschool children may find playacting helpful. If you do not prepare your child for the operation they will find it much more stressful. If your child is over 13, I recommend you let them see this entire website. The adult section may be more relevant. They are welcome to email me with questions.

Before the operation Most children do not need any specific preparation. It is important that you fill in the preassessment questionnaire and contact me in advance if you answer yes to any question in bold.

On the day of operation Your child must have an empty stomach at the time of anaesthesia but it is equally important not to starve children for too long. You should have been given a time of surgery by your surgeon. If not, assume the operation will start TWO hours after your arrival time. Your child must have no food for SIX hours before surgery. Food includes milk and fruit juice. Breast milk is OK until FOUR hours before surgery, and fluids (water, squash, soft drinks) until TWO hours before surgery. Please try to give your child food and drink until these times.It is particularly important to encourage him or her to drink on getting up if you are coming in for a morning operation.

Consent Any patient over 16 must sign their own consent form. From 14 to 16 the child should sign his or her consent if they can understand the operation. Under 14, a parent will normally be asked to sign but a child can sign as well.

On arrival Arriving in hospital can be unsettling for young children as their routine will be disrupted and they will see many strange people. Your child will be able to play once on the nursing floor and soon get used to his or her room. The nurses will take some measurements such as temperature and blood pressure and will put some local anaesthetic cream on the back of both hands. The surgeon will come and sign the consent form with you. I will visit, take a history and examine your child.

We normally operate on children at the beginning of the operating list, with the youngest child first. This may need to be altered according to the individual requirements of each patient. It is also vital to alllow enough time for the local anaesthetic cream to work before we start. I realise that many parents are anxious (I am a parent too!) but please try to let things happen in their own good time. Children rapidly pick up fear in their parents and this makes the experience far less pleasant.

Going to theatre This is perhaps the most important part of the operation. You and your child will go with a nurse to the anaesthetic room where we start the anaesthetic. I need the child to be calm and relaxed. It is very important that only ONE parent comes to the anaesthetic room. More than one parent overcrowds the anaesthetic room, producing an unsafe environment, and it is more difficult for me to get a rapport with your child. Other members of the family should stay in the room. Children will not be alarmed to leave their room with one parent but they can rapidly become frightened if both parents come to the theatre and one is then turned away.

Mothers who are pregnant, or may be pregnant, should let me know on admission as entering theatres either before or after your child's operation will expose you to pollutant anaesthetic gases. This has been associated with problems related to pregnancy in the past, and although later studies have failed to support this, I am happy to discuss this with you.

After some further checks, I will start the anaesthetic. An intravenous injection using the area of the hand made numb by the cream is the nicest and safest way. In practice very few children mind this. An inhalational induction (breathing gas) is sometimes used for very small children, but it is prolonged and less pleasant for older children. Once your child is unconscious you will be asked to go back to the room.

After the operation I will arrange for the recovery nurses to ask the floor nurses to bring you down to the recovery room as your child is regaining consciousness. Sometimes we do this a little earlier and sometimes later for various medical reasons. You can then take your child back to the room with the nurse.

Please try to let your child rest and sleep. Picking them up, unless they are distressed, increases their perception of discomfort. A dark and quiet room until they wake naturally is the best environment. Children bounce back much more rapidly than adults. When your child wakes up we normally start them on some clear fluids and then food. After operations on the throat such as tonsillectomy, cold is a brilliant anaesthetic, so ice cream and cold fluids will be encouraged. However, after dental treatment there may be temperature sensitivity so we avoid hot or cold drinks.

We avoid injections for pain relief. I will have given your child painkillers and I may have injected local anaesthetic to manage pain. Your child will be given pain killers I will have prescribed as necessary.

Going home If your child is going home the same day, we like to see them drinking and walking (depending on age) before they leave. They must be pain free and the wound, if any, must be dry. The nurses will check this. Please go straight home and stay with your child. Children may sleep after an operation but may not sleep at night time. Such disruptions to their time clock will resolve spontaneously. Do not worry. Equally, do not worry if your child does not want to eat for 24 hours provided he or she is drinking.

Toddlers especially can be unsteady on their feet for the rest of the day. All children must stay indoors and kept away from stairs, fires and the kitchen in case they stumble. Bikes are not safe. Please ensure you have a supply of whatever painkillers you normally use before the day of surgery. My preference is normally paracetamol (eg Calpol) and ibuprofen (Nurofen).