Surgery is the last thing most new parents expect to encounter during their baby’s first year, yet many do. Anthony and Kimberly Pope’s seven-year-old son Braylon had surgery at four days old for intestinal blockage. Robert and Jessica Cordova took son Wesley in for hernia surgery at seven weeks old. Colin Smith and Emma Lantz’s son Arlo, now three, had fundoplication surgery for reflux at five months old, along with seven other surgical procedures during his first year of life.
Over 115,000 children under three have surgery each year, and infant surgeries are surprisingly common, whether for hernias, found in 3 to 10 per cent of newborns, incorrectly positioned or twisted intestines, or abnormalities in the esophagus, diaphragm, abdominal wall, or lungs.
“Elective outpatient procedures like circumcision and frenectomy (removing a too-thick band of tissue under the tongue or upper lip) are considered surgery, too,” says Wendy Sue Swanson, M.D., executive director of digital health for Seattle Children’s Hospital. These procedures are generally quick and don’t require hospitalization, but still carry risk for complication, like bleeding and infection.
Workup: Getting ready for surgery
Learning your new baby needs surgery - sometimes, right away - is a jolt. So when the doctor says “surgery,” what’s a new parent’s first step?
“Always ask if there are alternatives to surgery, and whether ‘watchful waiting’ is possible,” advises Swanson. In some cases, a physician may recommend postponing surgery until a baby’s lungs are more mature, after six months old.
But waiting isn’t possible or preferable in all situations. Some conditions, like pyloric stenosis (blockage between the stomach and small intestine) require swift medical intervention, and some elective procedures, like frenectomy, may go more smoothly with a younger infant.
Bottom line: Before setting a date for surgery, make sure you understand the urgency and timeline associated with your child’s diagnosis.
And now is the time to ask about pain management: Will a paediatric anaesthesiologist handle the surgery? How will baby’s pain be managed after the surgery? Will pain control begin in the operating room or will baby receive medication prior to surgery?
“For a baby, it’s a good idea to have a plan in place for pain control at the very beginning,” advises Swanson. While you’re at it, ask if you’ll be able to bring comfort items like a pacifier, special toy, or blanket to the hospital.
Finally, before the big day arrives, make sure you understand the instructions for pre-surgery prep. In the 24 hours leading up to surgery, you may be asked to bathe your little one, and not to feed (including milk by breast or bottle) after a certain time.
These instructions may seem trivial (will a tiny nip of milk hurt?), but they’re anything but - food or drink too close to surgery can pose a choking risk and may necessitate a rescheduled surgery, meaning back to square one.
Nerves of steel: Getting through the big day
For a hospital procedure, it’s likely that you’ll meet your child’s surgical team for the first time on the day of surgery - overwhelming, to say the least. Here’s where your notebook comes in handy.
In most cases, parents get just a few minutes to speak with a child’s surgeon and anaesthesiologist before the procedure. Jotting down questions and responses helps keep your head clear and vital information handy.
At the hospital, ask about any support you think you may need - or even support you think you won’t need.
“Ask for hospital resources,” says Kimberly Pope. “Lactation support, hospital tour.” You may need them and not know it.”
Some parents are surprised to learn that they can’t accompany their baby - the tiny bundle they’ve been cradling since birth - into the operating room. “An operating room is a highly controlled environment,” says Swanson. “Squeezing another person into the room could disrupt carefully-designed systems and distract a surgeon precisely when extreme focus is needed,” she says.
Post-op: Recovery done right
Before heading home (hooray!), you’ll likely chat with your child’s surgeon for a post-op debrief. Ask if everything went as anticipated, or if anything unexpected cropped up. Make sure to gather a list of needed prescriptions (ask the nurse to fax or call the Rx to your pharmacy so you can grab it on your way home), home care instructions, and follow-up appointments before departing.
“After surgery, parents need clear instructions about dos and don’ts,” says Tamar Mirensky, M.D., paediatric surgeon at the Kravis Children’s Hospital at Mount Sinai. When is it safe for a child to return to day care or be submerged in the bathtub? When is it safe to use a stroller or a baby carrier?
The good news: paediatric surgery is getting better all the time. “Like much of medicine, paediatric surgery is a progressive field with a strong interest in minimally invasive approaches, reduced hospitalizations, and faster time to recovery,” says Mirensky. And ultimately, parents and surgeons share the same top concern: the safety and well-being of an utterly irreplaceable child.
Malia is an award-winning health and parenting journalist, and mom of three. Her latest book is Sleep Tight, Every Night: Helping Toddlers and Preschoolers Sleep Well Without Tears, Tricks, or Tirades.
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