Surgery

What is surgery?

Surgery is a procedure used to diagnose or treat a health problem. Doctors may take out or fix parts of the body during surgery. Surgery is also called an operation. 

Some surgeries are short. Others may take longer. After surgery, your child will need time to rest and heal before returning to normal activities.  

Types of surgery

Types of surgery can be described by: 

• When the surgery is needed 
  • Elective surgery is planned ahead of time. It includes things like tonsillectomy, adenoidectomy, or adenotonsillectomy or cochlear implants for hearing loss. 
  • Urgent surgery is a procedure that needs to be done soon but does not need to happen immediately, such as setting a broken bone or treating hydrocephalus. 
  • Emergency surgery is done right away to treat a life-threatening problem. It includes things like severe bleeding or a blocked airway. 
• Where the surgery is done 
  • Inpatient surgery: Your child stays in the hospital 1 or more nights after inpatient surgery. 
  • Outpatient Surgery: Your child can go home shortly after outpatient surgery. This is also called same-day surgery. 
• Why the surgery is needed 
  • Diagnostic surgery is done to find out what is wrong. This is done by looking inside the body or taking a sample for testing. A biopsy is a type of diagnostic surgery.   
  • Curative surgery is done to treat or fix a health problem, such as removing a tumor or repairing a damaged organ. Curative surgery is often done to remove kidney tumors. 
  • Supportive surgery helps improve comfort or function but does not cure the underlying disease. It is used for things like placing feeding tubes for nutrition support. 
• How the surgery is done 
  • Minimally invasive surgery or laparoscopic surgery uses tiny cuts. This type of surgery often means a faster recovery and a shorter hospital stay. 
  • Open surgery uses larger cuts. This type of surgery often means a slower recovery and a longer hospital stay. 

Your child’s care team will explain which type of surgery they need. They will also talk with you about what to expect before, during, and after surgery.

Benefits of surgery

Surgery can help your child in many ways. It can: 

• Diagnose a problem or disease: Surgery can be used to look inside the body or take a tissue sample so it can be tested in the lab. 
• Treat health problems: Surgery can treat an illness or disease and fix injuries. It can also be used to remove all or part of a tumor or body part. 
• Stop future health problems or improve function: Some surgeries can stop problems from getting worse or help parts of the body work better. 
• Support comfort or quality of life: Surgery can make your child more comfortable by reducing pain or treating symptoms. 
• Help stage a disease: Surgery can help doctors see how far a disease, like cancer, has spread. 
• Implant a medical device: Surgery may be used to place a medical device, such as a port or feeding tube, that helps your child’s body work better or deliver treatment. 

Pediatric Surgery

Pediatric surgeons are specially trained to perform surgeries on children, from newborns to young adults. They understand children’s unique physical and emotional needs. Many surgeons focus on specific areas of care, such as: 

• General pediatric surgery: Includes procedures that treat a wide range of problems in different parts of the body 
• Pediatric oncology surgery: Focuses on removing tumors or treating cancer-related conditions 
• Pediatric orthopedic surgery: Treats bone and joint problems  
• Pediatric neurosurgery: Addresses conditions like brain and spinal cord tumors or injury

It is okay to ask for a second opinion if you have questions about your child’s surgery or want to explore other options. This means you reach out to a different doctor and care team. A second opinion can help you feel confident about the diagnosis and treatment plan. Your child’s care team can help you find another specialist if needed. 

Before surgery

Being ready for surgery can help the process go smoothly. It can also make recovery easier. Things you can do before surgery include: 

Follow pre-surgery instructions

Your child’s doctor will give you specific instructions to follow before surgery. This may include: 

• Fasting guidelines: Your child may need to stop eating or drinking at a certain time before surgery. Not eating or drinking before a test is called fasting. You might also hear it called NPO, which is short for a Latin phrase that means “nothing by mouth." This helps make sure their stomach is empty and keeps your child safe.  
• Medicines: You may need to stop or change certain medicines before surgery. Be sure to bring a list of your child’s medicines and note when they were last given. 

Pack for the hospital

Take with you any paperwork you may need, like medical records or health insurance information.  

Bring items to help your child feel comfortable, such as:  

• A toy, blanket, or book 
• Comfortable clothes for after the procedure 

What to bring to the hospital will depend on factors such as your child’s age, type of surgery, and length of hospital stay. 

Talk to your child 

Explain the surgery to your child in a way they can understand. Use words and phrases that are right for their age. Make sure they know that their care team is there to help make them feel better and keep them safe and comfortable.  

Meet the care team 

You and your child will meet some of the surgical team members. They will explain the surgery your child will have, answer your questions, and make sure your child is ready. 

Many hospitals offer child life specialists to help children understand and cope with surgery. These specialists can help you and your child manage stress and anxiety. 

What to expect during surgery

Before surgery begins, your child will put on a hospital gown. The care team will check their vital signs, such as heart rate, breathing, and blood pressure, to make sure they are ready for the procedure. Depending on the surgery, your child may be given medicine to help them relax and feel calm.  

You will have a chance to say goodbye and reassure your child before they go into the operating room. The care team will stay with them the entire time to keep them safe and comfortable. 

Anesthesia  

Right before the surgery, your child will be given anesthesia. Anesthesia helps prevent pain and discomfort. Three main types of anesthesia are used during surgery: 

• General anesthesia causes a complete loss of consciousness, often described as a "deep sleep." Your child will not feel pain during surgery. It may be given through a mask, breathing tube, or IV.   
• Regional anesthesia blocks pain in a larger area of the body by affecting specific nerves. It is given as an injection or through a small tube near the nerves. Examples include epidural anesthesia. 
• Local anesthesia numbs a small, specific area of the body, such as the skin, before treating a cut. It may be given as a shot, ointment, or spray.   

The care team will monitor your child’s breathing, heart rate, and comfort throughout the surgery. 

Updates during surgery

Once your child is asleep, the surgeon will perform the operation. A parent or guardian should plan to stay at the hospital during the procedure. You can wait in a special waiting area during the procedure. There may be coffee, water, or snacks available. Bring something to read or do, as waiting can take a while. If you leave the waiting area, let staff know how to reach you. 

During surgery, parents usually receive regular updates from the care team to help ease worries and keep them informed. These updates may include: 

• When the surgery starts 
• How the surgery is going and if everything is going as planned 
• If there are any changes or unexpected findings during the procedure 
• When the surgery is finished and your child is in the recovery area 
• When you can see your child after surgery 

Updates may be given in person, by phone, or by text, depending on the hospital or surgery center.  

Possible risks of surgery

Surgery is often needed to treat health problems and help your child feel better. But it does have some risks. Your child’s health care provider will talk with you about these risks. 

• Reactions to anesthesia: Anesthesia helps keep your child comfortable during surgery. While it is safe, some patients may have side effects like dizziness, nausea, and vomiting as they wake up. Rarely, serious problems like trouble breathing, allergic reactions, or malignant hyperthermia can happen. 
• Bleeding or infection: Surgery involves cutting into the body. This can lead to bleeding or infection at the surgical site. Your child’s care team will give you instructions for wound care. 
• Complications during surgery: In rare cases, complications such as unexpected bleeding or damage to nearby tissues and organs may occur.  
• Pain or discomfort: It is normal for your child to feel some pain or discomfort after surgery. Doctors will prescribe medicine for pain management and help your child feel more comfortable during recovery. 
• Slow recovery or additional procedures: Some children may take longer to heal. Some need follow-up procedures if the surgery does not fix the problem. 

After surgery

After surgery, your child will be moved to a recovery area. There, a care team will watch your child closely and make sure they are comfortable. They will monitor vital signs and help with pain relief as needed. 

• Outpatient surgery: If your child has outpatient surgery, they can go home once they are fully awake and stable. This means their heart rate, breathing, blood pressure, and temperature are within a normal range, and there are no immediate concerns about their health or safety.  
• Inpatient surgery: If your child has inpatient surgery, they will stay in the hospital overnight or longer. During this time, the care team will monitor their progress and provide any necessary treatments. 

Before you go home, your care team will explain how to manage pain, care for the surgical area, help your child heal, and what follow-up care might be needed.  

Pain management 

Pain management is an important part of recovery. The doctor will talk with you about managing pain with medicine. They may: 

• Prescribe medicine to help with pain 
• Recommend over-the-counter medicine to help with pain 

They will also talk with you about managing pain without medicine.

Follow-up care 

Your child’s doctor will schedule follow-up appointments to check their progress and make sure they are healing properly. During these visits, the doctor may: 

• Look at the surgical site to make sure it is healing 
• Remove stitches or dressings if needed 
• Talk with you about when your child can return to normal activities 

It is important to go to all follow-up appointments and follow the care team’s instructions. 

Travel after surgery 

If your child is going home after outpatient surgery, make sure to arrange for transportation. Your child may feel tired or dizzy, so they should not walk or travel alone. Bring a comfortable blanket or pillow for the ride home.  

Avoid long trips immediately after surgery unless your care team approves them. Your care team may give additional instructions for travel after anesthesia.  

Care at home

Once your child is home, they will need to rest and recover. Follow the care team’s instructions. Watch for fever and signs of infection, such as redness or swelling. You may need to: 

• Give prescribed medications for pain or infection prevention 
• Keep the surgical site clean and dry 
• Encourage your child to eat healthy foods and drink plenty of fluids to support healing 
• Limit physical activity until your child’s doctor says it is safe to resume normal activities 

Your child’s doctor will schedule follow-up appointments to check their progress and make sure they are healing properly. It is important to take your child to all of these appointments. 

When to call your care team

Watch your child as they recover. Call your care team right away if your child has: 

• Fever and signs of infection 
  • Redness, swelling, or warmth around the surgical site 
  • Drainage, pus, or foul-smelling fluid from the incision 
  • Fever (temperature of 100.4°F (38.0°C)
• Unusual pain or discomfort 
  • Severe or worsening pain that does not get better 
  • Pain that feels much worse than you would expect after surgery 
• Problems with breathing 
  • Trouble breathing 
  • Shortness of breath 
• Trouble swallowing, eating, or drinking 
• Other symptoms 
  • Vomiting, diarrhea, or signs of dehydration 
  • Unusual sleepiness or difficulty waking your child 
• Worries you have about the surgical site 
  • The incision opens or looks like it is not healing  
  • The area around the incision becomes hard, painful, or has a lump 
  • The site has a bad smell, pus, or redness that worsens 

If you are not sure whether a symptom is serious, contact your care team. 

Questions to ask your care team

• Why does my child need surgery? 
• Does the care team have experience with this type of surgery in children? 
• Will my child have minimally invasive surgery or open surgery? 
• Will the surgery be inpatient or outpatient? 
• What type of anesthesia will be given? 
• What are the risks or possible complications of this surgery? 
• What should we pack for the day of the surgery? 
• How long will the surgery take? 
• When can we go home after surgery? 
• How long will it take for my child to recover? 
• What problems should I watch for after surgery? 
• What follow-up care will my child need? 

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