Sub-topics

On the way home
Pain
Pain relief
Eating and drinking
Nightmares
Resuming full activity
Swimming
Back to School

On the way home

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If your child is prone to car or motion sickness, he or she is more likely to vomit during the journey from hospital to home. The chance of vomiting is further increased if the child has already had something to drink or eat and if a dose of potent pain reliever has been given.

Drugs are available that are very effective in reducing the chance of nausea and vomiting. These drugs are called anti-emetics and may have been given by the anaesthetist while your child was still anaesthetised.

Continued vomiting, particularly by an infant or a small child, requires urgent attention. The excess loss of fluid with lack of intake can rapidly lead to dehydration and severe illness. If you are concerned, contact your anaesthetist or surgeon immediately.

Pain

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Children feel pain just as adults do. Similarly, they deserve the same attention to control of pain. In general, children tell things as they are. If it hurts, they say so. They also show other signs in keeping with the severity of the pain - for example, whimpering or crying. Small infants may be difficult to assess as far as pain management is concerned. Crying may be an indication of either pain or hunger, or both. Infants can often be pacified by feeding and they will then sleep peacefully. If they remain unhappy despite having had their normal feed, it is likely that they are in pain. Grimacing and drawing up of the legs may be additional signs.

Pain relief

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The most commonly used pain reliever in children is paracetamol (acetaminophen). This drug may be given as a tablet, a suppository, or a liquid (which comes in different flavours). Suppositories are easy to use in small infants and a plastic freezer bag may be used as a substitute for a glove when placing the suppository in the rectum.

Most children will have been given their first dose of paracetamol (acetaminophen) at the time of surgery and so they may not need any more for a few hours. Your child may have received a general anaesthetic plus a local anaesthetic without any other pain reliever. If so, then the first dose of paracetamol (acetaminophen) should be given before the local anaesthetic wears off. You will be told when to do this, as well as which drug and how much.

Stronger analgesics (pain relievers) may be required, especially in the first 24 hours after surgery. Codeine is commonly used and is usually given by mouth. Side effects include constipation and nausea, but these are uncommon with a small number of doses.

Anti-inflammatory analgesic drugs may be used, although not all are approved for use in children. Your anaesthetist will provide details about doses.

Mixtures of drugs may be beneficial, reducing the likelihood of side effects. Preparations that combine paracetamol (acetaminophen) with codeine are common and some also contain other additives, including mild sedatives.

Aspirin should not be used in children under the age of twelve years. This is because a rare, usually fatal inflammation of the brain, called Reye’s syndrome, can result when children take aspirin.

Eating and drinking

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The simple answer to the question of ‘when can my child eat or drink’ is ‘when your child feels like it’. Your child should not be forced to drink something and may not want to drink until after arriving home after day-stay surgery.

Your child should start with sips of water, progressing to ginger ale and cordial, and then to milk. The same applies to eating - begin with easily digested food, such as jelly and bread and butter, although some children like to start with ice cream. It is not unusual, however, for children to want something more substantial; some have been known to enthusiastically consume a hamburger three hours after a tonsillectomy.

Nightmares

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Sleep disturbance, including nightmares, is frequently described after hospitalisation, surgery and anaesthesia. The less stressful the hospitalisation, the less likely sleep will be disturbed. Things that may reduce the chance of a sleep disturbance include:

• good preparation beforehand (see Preparation for Your Anaesthetic)
• a harmonious family
• the child being accustomed to other carers, such as a babysitter, rather than being overprotected
• parents who are calm, as children can sense parental anxiety
• the presence of one or both parents as much as possible throughout the hospital stay
• sympathetic medical and hospital staff
• needles not being used
• good pain control
• a short stay in the hospital.

Resuming full activity

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The answer to the question ‘when can my child resume full activity’ is again simple: ‘When he or she feels like it’. If the operation requires a period of modified activity, your child’s surgeon will advise you of this. In general, there are no particular guidelines and you will be surprised at how quickly your child returns to a normal state of activity.

Swimming

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There may be a surgical reason to recommend against swimming - for example, grommets (tubes) in the ears or a large surgical wound. If not, then swimming should be considered as a part of full activity.

Back to school

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Unless there is a surgical reason for delay, your child may return to school as soon as he or she regains full and normal activity. It is wise to inform the teaching staff of the operation. The teachers will then be aware if any untoward reactions do occur, but should otherwise treat your child normally.