Q. “It looks like my 21-month-old son would benefit from a surgical procedure. It would involve ½ hour of intravenous anesthesia, and would also involve him not being able to nurse the morning of the operation—he always nurses in the morning. How damaging is this likely to be for him? If we decide to go ahead with this, how can I prepare him for the procedure so it causes the least amount of trauma for him?”
Good for you for anticipating the difficulties of surgery, and asking for help preparing! There is a lot you can do to make the experience less frightening. If possible, begin your plan well ahead of the surgery date. Six weeks to two months is what I would suggest. Here are some of the steps you can take to minimize his fears, and to help him recover when it’s done.
Anesthesia signals a general alarm
First, let me say that the body has its own automatic “watch” system that runs a very sensitive assessment of physical threat, night and day. This inner monitor interprets any drug that alters the mind as a threat. So anesthesia, which suspends the body’s natural, protective reaction to pain and invasion, is interpreted as a danger by your child’s mind. He will be helpless during the procedure, and that experience of helplessness, along with his mind’s altered state, will be recorded, along with the surgery, like every other experience he has.
The customary anesthesia cocktail includes a drug that blocks the patient’s memory from recording the experience. This amnesia-inducing drug is not necessary, and in my experience, children recover better emotionally when it is not used. Your child will be well protected from pain without it. If it were my child, or myself, I would make a strong statement that I did not want it used.
Ask that the surgical team talk warmly to your child
Your child’s mind will be active and will record everything that happens during surgery. There are many studies that show that a patient’s recovery is faster when doctors speak warmly, positively and personally to the patient during surgery. So talk to the team ahead of time, and if you need to, give them a written example of how you want them to encourage him. “This is going to help you.” “We’re keeping you safe.” “You are going to heal very nicely.” “You’re such a strong, healthy boy.” “Everything’s OK. We’re almost done now.” Try to meet the nurses ahead of time. They may have more slack to reassure your son than the surgeon, who needs to focus to do a good job.
Prepare with lots of play, and as many surgical props as you can find
Some hospitals and surgery centers have programs designed to help children become familiar with the operating room, the recovery room, and the hospital rooms they’ll be in before a surgery takes place. If there’s not such a program, see if you can get permission to let him see, or better, explore as much of the environment he’ll be in as possible. Opening drawers, finding cotton balls, sitting on the table, riding up and down on it, turning lights off and on will allow him to be in charge in that environment, and to have an interesting, connected time with you there.
If you’ve jumped on the bed with your Mommy and Daddy wearing masks and having funny caps over their hair, and you’ve pulled them off in a game of peek-a-boo over and over, you’re going to be far less intimidated when the big day comes.
So find a doctor’s kit at the toy store, and buy or borrow masks, little hats, smocks, a stethoscope, and a syringe (without the needle). He’ll find all kinds of playful uses for them, and so will you.
Tell him what’s going to happen ahead of time
Children need to know about impending medical procedures. At 2, your son may or may not fully understand what you say, but assume that he understands everything. Tell him several times, and demonstrate to him what will happen.
“Son, the doctor is going to X,Y and Z. Here’s the part of your body he’s going to help, right here. Want to see it in the mirror? He’s going to look at it, and he’s going to fix it so it works better for you. He has to cut you to help you, so they’ll put you to sleep first so it doesn’t hurt. He’s going to put a needle in your arm right here. It’s going to hurt a little, but just for a minute. When you wake up, I’m going to be there (or, a nurse will be there until she sees you’re doing fine, and then she’ll let me come.) I’m going to see you as soon as I can.” Lovingly tell him. Tell him it’s going to hurt some afterwards, but that you’ll help him when he’s hurting.
Make sure you get listening time for your feelings
It strikes up big feelings for loving moms and dads to have their child undergo surgery! And your feelings will be broadcast instantly and nonverbally to your child, who looks to your face and your voice for signals about whether he’s safe. So find a friend or other good listener to shed your feelings about this, so you are able to be confident and warm while you give him this information. If you’re quite frightened, get several listening sessions. It may be that you’ve had difficult medical things happen to you or to a loved one, and no one has listened completely to your story, or your feelings. It will help him tremendously to have you offloading your own emotional charge, so he has your most confident self to anchor him before, and after.
Wean him from his morning feeding
Because your son nurses in the morning, and is dependent on that feeding for his sense of well-being, that’s a good place to start. You don’t want him frantic for your breast as he’s wheeled into surgery.
So, take a month or two to wean him from his morning nursing. He will have lots of feelings about this, but it’s my guess that the benefits from weaning him, with love and support, from that one feeding will show up in many areas of his life. I know many children whose speech has blossomed, or whose interest in people outside the family has soared, or whose ability to play independently has increased, during the process of weaning.
You’ll want to tell him the night before that in the morning, he can have a cup of milk, or a bottle, and that you’ll hold him just as close as ever, but it’s going to be different. Then, in the morning, hold him close, pour your love toward him, offer him a cup of milk, and offer your warmth and reassurance as he has whatever feelings come up. The feelings will probably be quite passionate and hard to absorb. But what’s happening is that he’s offloading feelings that nursing keeps in place in his emotional memory. If he didn’t have stored feelings of dependence or desperation, he would be just fine with being cuddled and given milk in a cup. He would receive your love, minus nursing, and get all he needed for connection with you.
Staylisten for as long as he needs to cry with you. Keep offering yourself, and that cup of milk. Let him reject the milk. Let him be very disappointed in you. Your love is all he needs. Your love is good and nourishing, without a nursing. He can’t receive it while he’s working off those passionate feelings, but it will all fall into place when he’s finished telling you how he feels.
You can nurse him one day, and offer the cup only the next, so that weaning goes at a slower pace, if you like. You probably will need someone to listen to you cry about not nursing him. We mothers feel like we must be the cause of our children’s grief, and that weaning is a betrayal of our children’s trust, but actually, weaning around the age of 2 allows a child to realize his own capabilities, and to take in your love in a variety of ways, rather than depending heavily on just one very specific way.
Help him with his feelings about separation from you
It will also help greatly if he has worked through the feelings he has about being with other people rather than you. Most two-year-olds have many hours of crying they need to do before they feel safe and secure with grownups other than their parents. It would be good to get the work under way. Our article, Healing the Hurt of Separation will help you navigate this emotional project. Games like peek-a-boo and hide and seek will help him laugh about the lighter side of comings and goings; Staylistening while you propose to leave him with another good, warm, safe person will allow him to discover the safety and love that others offer, that he can’t sense as long as he has feelings of “I’m not ever safe without my Mommy and Daddy!”
When surgery is over, listen, listen, listen
These measures can help, but surgery is going to leave some big feelings, and pain, for your child to work through. Crying about pain actually seems to speed the healing process, and I’ve seen it reduce the body’s inflammatory response to injury. I highly recommend being with your child, holding him close, but not distracting him from his feelings about what has happened to his body. Let him feel sad, scared, insulted. Let him notice the pain.
A child’s mind can handle all that, make sense of it, and recover a sense of confidence best if you allow the child to fully face and feel what happened, while guarding his safety and loving him mightily. It’s like helping a woman through labor. The process hurts, and isn’t one we’d ever really choose, but it’s got to happen, and being present, being hopeful and offering attention and support is what keeps a woman conscious that she’s loved, and that she’s doing what is needed.
This is an opportunity to love powerfully
This may seem like a lot to tackle, but each step will bring its own rewards, its own games and laughter. Each step will bring moments when your child feels overwhelmed and upset. You then have the chance to deliver a powerful dose of your love and listening.. It’s just what we all want to do—to be there for our children when times are hard. To care. To love powerfully. This is an opportunity to be the kind of parent you’ve always wanted to be. And your child will come through, thanks to your planning, your attention, and your love.