Your are probably the best person to explain the surgery to your child and to reassure her. Information and reassurance are most meaningful when they come from you because she trusts you. Also, you will probably be most effective because you know your child better than anyone - what her unique style is and what creates or soothes her fears.
Where? Preparation may be done at home, where your child feels most comfortable. They are more at ease asking questions and expressing concerns in this safe environment. It is also possible for you to pick a quiet time and to include other family members in your discussions, as appropriate.
When? Allow your child enough time to think about the information you give and to ask questions, but not so much that your child has time to worry and become distressed. Professionals say that the younger the patient, the less advance warning you should give. For example, a preschooler might be told a few days in advance, while an older, elementary-school-age child might be told several weeks in advance.
Remember, however, that you know your child best. Weigh professional recommendations against your parental instincts when you decide on the optimal timing for your child.
How? Once again, you must rely on what you know about your child when deciding how to tell him about surgery. Here are some general guidelines.
Provide factual information in manageable doses. Make sure your discussion is age-appropriate. Don't use concepts or words beyond your child's understanding, and don't underestimate an older child.
Encourage your child to ask questions. It's important to anticipate questions, so have reasonably clear, concise explanations in mind (see Questions From Your Child). Above all, be honest. Your child's confidence and trust in you must be unshaken so he knows that he can rely on you during the stress of surgery and afterwards.
If you don't know an answer, say that you don't - and try to find out. If something will hurt, you must say so. Give as much information as you can about how things will feel, sound, and look.
Acknowledge feelings and concerns. What children think and fear about doctors, hospitals, and surgery is largely a by-product of what they've seen and heard on TV, in movies, from friends and family members, or from their own past experience. Your child has processed, interpreted, and fantasized about this information in her own way; feelings may include apprehension, fear, sadness, guilt, and anger. Your child will gain confidence just knowing that you understand her concerns and that you are there for support and encouragement.
There are many "props" that may be useful in talking about feelings and preparing for the surgical experience. A host of children's books are available to be read and discussed. Puppets and dolls can help act out the experience. Your child and family can participate in this medical play. Drawings and paintings may also help your child express what he is feeling about this new experience.
Offer reassurance. Children who are about to undergo surgery have a few consistent fears. Some of these common concerns are:
- Fear of separation from you and the protection you provide
- Fear of strangers, especially those wearing masks and mysterious outfits
- Fear of pain. Younger children often think the pain they experience is a punishment for something they have done wrong; reassure them. Explain to children that they won't feel anything during surgery, and talk about how pain is managed after they wake up
- Fear of the unknown, including the "sleep" of anesthesia
- Fear of surgery changing "who they are." Also fear of the surgery going beyond what has been discussed and planned
Address each of these issues directly in your preparations.
Help your child build confidence. Boost her ability to cope by reminding her of strategies that have been used before to get through other challenging or scary situations.
Give your child the opportunity to rehearse and play back the information you've given about having surgery. This allows you to see if your child has understood what you've said so far and if further information or reassurance is needed. It also allows him to practice and gain mastery over the situation.
Try to give your child choices wherever possible. Many things are determined by the surgical problem, but you can help her decide which books to read from the list, which finger to have stuck, and so on. Without these small choices, she may feel helpless. With them, she becomes an active participant and has some sense of control while minimizing anxiety.