How To Talk to Kids about Upcoming Medical Procedures
Why?
Research has shown that when a child is given developmentally appropriate information about an upcoming medical procedure, he copes better. Surgery without proper emotional preparation can traumatize a child. Often, the child has heard you speaking about the surgery and therefore already has fears and misunderstandings. Talking about it allows you to address his fears. Children who are not prepared often regress in the weeks and months following surgery. Talking about surgery takes the shame away and lets your child know that it is okay to talk about it. It gives your child an opportunity to express her feelings.
Who can help?
Child life specialists are trained professionals who work in most hospitals. Contact the hospital where the surgery is scheduled, and find out if a child life specialist is available to meet with you and your child prior to the day of surgery. If you live far away from the hospital or you do not think going to the hospital before the day of surgery works best for your child, the child life specialist can give you information on how much to tell your child and what to say.
Another option is websites. Many hospitals have websites that have information on different age groups—what words to use, how much information to give, when to talk to your child, etc. Some hospital websites even have virtual tours that you can take with your child.
Lastly, parents and/or people who have had the same surgery may be able to give you tips and pointers. Just be aware that your child may not need to know every detail of that person’s experience.
When?
When you talk to your child will depend on several factors such as your child’s age and disposition.
A Child’s Age
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Infant or Toddler: Your child is in the here and now; tell him the day before surgery, the morning of surgery, and as things are happening.
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Preschooler: Three to five days in advance, tell your child so he or she has time to prepare emotionally and talk to you about surgery.
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School Aged: Tell your child at least one or two weeks ahead of time so he or she has time to prepare.
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Teenager: Ideally, your teenager should be involved in the decision to have surgery.
Your Child’s Disposition
Ask yourself the following questions. Does your child get anxious when you tell her about appointments ahead of time? Is she the type of child who wants to know every detail, or does she prefer not to have much information in advance? What has your child heard about surgery? Was she there when you scheduled the surgery? Did your child overhear you talking to friends or family about it? Has your child asked you about surgery? This is a big indicator that your child is looking for answers. Follow her lead.
The most important thing to remember is that preparation is a process, not a one-time session! Be honest. This does not mean that you need to tell your child every detail (or your every fear) about surgery. But you need to give honest answers to the tough questions like “Will it hurt?” or “Why do I have this?” Follow your child’s cues. If it looks like your child is overwhelmed with the information, wrap up your conversation and come back to it later.
You can’t fix everything; it is okay for your child to be upset or angry, to cry, etc. This is your child’s body that you are discussing. When possible, include him or her in the medical decisions. Find out as much information as you can so you can answer your child’s questions.
Try to gather information about what your child will experience with all five of his senses: What will he see, hear, taste, feel, and smell? If you don’t know the answer, say, “I don’t know, but I will find out for you.”
It’s not just the words you say, it’s how you say them. Your child will pick up on your body language cues. Your child will adopt your attitude about surgery. If you are coping well and feel confident, how do you think your child will be?
How?
Birth to 2 Years
Your young child picks up on your emotions. She may not understand all that you are saying, but she can tell when you are upset, angry, frustrated, etc. Talk to your child about your feelings, but do not overwhelm her. Take care of yourself. How are you feeling about surgery? Surround yourself with friends and family who understand and will listen to you. Ask to speak with a hospital social worker for support. (This applies to all ages!)
Use very simple terms when explaining to your child what is happening to her. Even young infants imitate doctors by putting the stethoscope around their necks; your child picks up more than you think!
The biggest fear for this age group is separation from parents. Reassure your child that you will be there. If possible, plan to have one parent or other close family member stay at the hospital with your child.
Be calm and patient, and maintain your family’s usual routine and rules. It is common for children this age to act out. Children look to rules and consistency to make them feel safe. If you start letting your child get away with everything, she will think, “Something must be really wrong.”
Let your child bring his favorite toys, books, blanket, etc. from home. This will give your child a sense of security and control over his surroundings.
Preschoolers
Children this age are such magical thinkers that your child may develop misunderstandings about why she needs surgery and what surgery will involve. Encourage your child to tell you what she thinks will happen. Do not laugh at or scold your child for her fears. Instead, tell her what will happen in simple terms.
Children have a fear of body mutilation. They often think that the doctor will cut off whatever is not working as it should. Unfortunately, sometimes surgery does involve cutting. Explain in simple terms what the doctor is doing and why. Talk to the medical team about what to expect when your child wakes up: what tubes, drains, bandages, etc. will your child see?
Your child may assume that he needs surgery because he did something wrong. Reassure your child that it is not his fault, and explain why your child needs surgery. Choose your words carefully. A child this age is typically very literal in thinking. Instead of saying, “They will put you to sleep” (which may remind your child of a favorite pet you put to sleep), say, “You will get medicine that will make you take a nap.”
Play with your child. Use a doctor’s kit, or read books about doctors and hospital visits. You child will communicate her fears and questions through play.
School Aged
A big fear among children of this age is that they will wake up during surgery. Reassure your child that there is a doctor (anesthesiologist) who is in charge of sleeping medicine and will be in the operating room the whole time. For a child who likes details, you can talk about all of the monitors that will tell the doctor how much sleep medicine your child’s body needs so that they will give him the right amount to make sure he stays asleep and does not feel anything the whole time.
Another big fear is that her body is not perfect and surgery will cause more scars and damage. Be sure to tell your child why she needs this surgery. Also, remind your child that no one’s body is perfect—we all look different. The doctors are trying to help to make sure that her body will work the best that it can.
Children this age are also afraid of being embarrassed. Tell your child that many children his age have had this surgery and felt the same way. Also, reassure your child that you will advocate for his privacy.
Your child may become angry or quiet as the surgery time approaches. This is normal. Encourage your child to talk about his feelings. Get your child to explain back to you what he thinks will happen. This gives you the opportunity to check his understanding and answer questions.
Friends are important to children this age. If it is okay with your child, include them by talking to them about the surgery (make sure their parents know what is going on). See if your child wants her friends to visit at the hospital, call, or send cards or gifts.
Teenagers
Most children want to be independent by this age. Surgery can make your child feel dependent on you, other relatives, hospital staff, and so forth. This can make your child frustrated and angry. Encourage your child to be part of all medical decisions (no matter how small they may seem to you). Give your child control by allowing him to take care of tubes, medications, etc
Being away from friends can be very stressful. Talk to your teen about how she wants to include or exclude her friends. Encourage friends to visit, write, and call.
Be truthful, or else your child will become angry and not trust you if she feels you are keeping secrets from her.
Encourage your child to talk about her feelings and her understanding of what is going on. You can also give your child a special book or journal to write or draw her feelings.
Make sure to respect your child’s privacy. Reassure your child that it is okay if he wants to talk to the doctor alone. He may have questions that he is too embarrassed to ask in front of you.
Help your child write down his questions to ask the doctor during appointments. Help your child research and connect with other people on the Web.
Your child may have strong feelings about surgery. It is normal for teens to feel very angry one moment and cry about surgery the next. Even at this age, familiar objects bring comfort. Encourage your child to bring her favorite book, movie, and music to the hospital.