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All children need special attention when preparing for anaesthesia and surgery. The effects of hospitalisation on your child will be related to age; length of stay; parental factors; and your child’s previous experiences of hospital or medical care. These in turn affect how long it will take you to prepare your child and also what information your child should be given.

The most important message is: Always be truthful when telling children what is going to happen to them at the hospital.

The first time in hospital

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The first hospital experience is the most important one and influences all subsequent visits. It is therefore extremely important to try and make it as pleasant an experience as possible.

Length of stay

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The expected length of the hospital stay also determines the extent of psychological preparation. An overnight stay has a different effect from a day visit to the hospital. Children undergoing operations that might require weeks of hospitalisation need careful preparation.

Parental anxiety

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Hospitalisation has less effect on children who are accustomed to parental substitutes and who have been subjected to less protective parenting. Children can also sense parental anxiety, and show similar signs of anxiety and stress, which may not appear until the actual start of the anaesthetic.

What to tell your child

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The most important feature of preparing your child for anaesthesia and surgery is honesty. Children expect to be told the truth and will lose confidence in anyone who gives them misleading information. An example is when a parent tells a child that he or she is going to hospital for a ‘visit,’ or worse still when a parent does not tell the child that he or she is going to hospital, let alone having an operation.

The greatest fear children have in relation to hospitalisation is ‘needles’. The prospect of having a needle or injection must be discussed openly. Parents and guardians must never use the threat of a needle by a doctor or nurse as a punishment.

Many things have changed in anaesthetic practice, including the giving of premedication by injection. This is now uncommon – especially for children. If some form of premedication is needed, then it is more often given in the form of a tablet or liquid. Also, when injections do need to be given, local anaesthetic cream is commonly applied beforehand, making the process much less painful. As a parent or guardian you are entitled to ask whether or not these options are available for your child from your anaesthetist and hospital.

As well as talking with your child, there are other things that you can do to help with psychological preparation. You should take an active part in any preparation, such as reading books, watching videos, and visiting a preadmission clinic or the hospital with your child. (See: What you can do to help.)

Different ages

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How your child will react to hospitalisation will depend on his or her age. This, in turn, will determine the length of preparation.

Six months to four years

Small children are psychologically most vulnerable and do not understand the necessity for treatment. They recognise threatening situations but are unable to comprehend explanations or reassurances. Preparation will take from a few hours to a day.

Four to six years

These children are more accepting of explanation and reassurance and need to be prepared a few days ahead.

Six to ten years

These children are less likely to have a problem with separation, but there are more fears of anaesthesia, surgery and pain. They may have fantasies of mutilation, but are amenable to reassurance, although they may become irritable or impatient. Their preparation may take a week or so.

Adolescents

Adolescents fear loss of control and dying. They resent restricted activity and lack of privacy, and are more likely to have underlying emotional problems. As a parent you should recognise that preparing your teenager should take at least a week.