By: Justin L. Lockman, MD, MSEd, FAAP
When a child needs a medical procedure, it is normal for both parents and the child to feel nervous. Those worries can grow when anesthesia is involved, whether for surgery, medical imaging or other tests or procedures.
The good news is that modern anesthesia is very safe, and pediatric anesthesia teams are specially trained to keep children comfortable and protected every step of the way. Understanding what anesthesia is and how it works can help you feel more confident and prepare your child for a smooth, reassuring experience.
What is anesthesia?
Anesthesia uses a special class of medicines that allow scary or otherwise painful procedures to be performed without pain, anxiety, movement or memories of the procedure.
Types of anesthesia
General anesthesia will temporarily put your child deeply to sleep. Other forms of anesthesia may involve sedation ("twilight sleep") without completely stopping movement. The specific type of anesthesia given will depend on your child's health, the procedure being performed, and any special needs that your child has.
Your child's comfort and safety are very important. Before, during and after anesthesia, your child's heart rate, blood pressure, breathing, temperature and oxygen level in the blood will be watched closely. Your child will stay "asleep" until the anesthesiologist stops the medicine and allows them to wake up.
The anesthesia care team
Most anesthesia professionals work as a team. Anesthesiologists (doctors who are trained in anesthesia), residents (doctors who are learning to become anesthesiologists), certified registered nurse anesthetists (CRNAs), physician assistants, nurses and other trained staff may all be part of this team.
What is a pediatric anesthesiologist?
A
pediatric anesthesiologist is a doctor who has advanced training and experience to help ensure a safe and successful surgery, test or treatment for your child.
After completing full anesthesiology training, a pediatric anesthesiologist studies at least one additional year of specialized training in anesthesia for infants and children. Many children who need surgery have complex medical problems that affect many parts of the body. The pediatric anesthesiologist can evaluate these complex problems to plan a safe anesthetic for each individual child.
What will my child's doctor need to know before anesthesia is given?
Before having anesthesia, your child will need a physical examination. At this time, either your child's doctor or a member of the anesthesia care team will review
your child's current health and medical history. This may take place in the days before, or on the day of the planned surgery, test or other treatment requiring anesthesia. Being prepared with this information can make the process smoother.
It is important to tell the doctor about any of the following that apply to your child:
Allergies, including any allergies to food, drugs or latex (rubber).
All medicines your child is taking, including those prescribed by a doctor as well as herbal supplements, natural medicines and inhaled (breathed-in) medicines.
Any history of breathing problems, including
asthma, reactive airways disease, croup or wheezing. Also, be sure to include any history of snoring or apnea (periods when breath is held during sleep).
Recent illnesses (within the past month), especially bad colds or fevers.
Problems your child had as a newborn, such as preterm birth, breathing problems requiring medical care, staying in a neonatal intensive care unit or in the hospital longer than their birth mother stayed, or any known birth defects.
Heart problems, including holes between the heart chambers, valve problems, heart murmurs or
irregular heartbeats.
Any other medical problems your child has or has had, especially if they required a doctor visit or hospital stay.
Any history of previous anesthesia for a past surgery or procedure, and whether there were any known complications such as breathing problems, difficulty with airway management, delirium or confusion after waking up or severe nausea or vomiting after anesthesia.
Any
family history (both sides of the family) of problems/complications with anesthesia, especially anyone who had a high fever after anesthesia.
Family history of
bleeding problems or disorders.
Anyone in the home who smokes or vapes, whether inside or outside the home.
If your child has loose teeth. (Sometimes loose teeth must be removed during anesthesia for your child's safety.)
For girls who have had their first period (menstruation): the anesthesiologist may require a pregnancy test before starting anesthesia. Sometimes other blood tests or x-rays are needed before surgery, depending on your child's circumstances.
What are the risks of anesthesia for my child?
Anesthesia is very safe, but there are always risks with any medicine.
Minor side effects of anesthesia, such as a sore throat or lip injury from a breathing tube, nausea and vomiting or itchiness can be common.
Major complications from anesthesia are extremely rare in children, but can include breathing problems, heart problems, brain problems, life-threatening allergic reactions and more.
If you have any questions or concerns, talk with your anesthesiologist before starting the procedure.
What should I tell my child about anesthesia?
Children who understand what is happening will have a more positive hospital experience. Some tips:
- It is important to be honest with your child in order to maintain a trusting relationship. Using words that your child can understand (based on your child's age and level of maturity) is equally important. For example, for young children you might use "sore" instead of "pain" or "taking a nap" instead of "put under anesthesia."
- Timing matters, too. Talk about the hospital visit 5 to 6 days ahead for older children and 1 or 2 days ahead for toddlers. Children 3 to 12 years of age are often not ready to hear about the risks of surgery or anesthesia. They often understand enough to be scared and anxious, but not enough to be reassured. Your anesthesiologist may wish to tell you about risks when your child is not present.
- If your child becomes worried when you talk about anesthesia: Explain that it is completely normal to be scared, but that the anesthesia team will work hard to make your child feel safe and comfortable. You should know that your child will never be left alone even for a moment so that if anything unexpected occurs, the anesthesia team will try to fix it before it becomes a serious problem.
Importantly, you can help keep your child's fear and anxiety to a minimum by being calm and reassuring yourself. If you act scared or nervous, even young children can pick up on your emotions and will also be scared.
Some hospitals offer special programs that explain the anesthesia and surgery process in simple, child-friendly ways before the day of the procedure. Ask for printed or online resources that can help you and your child prepare.
What if my child gets sick just before the scheduled time?
Let the anesthesia care team and your child's doctor know right way if your child becomes ill within 4 weeks of the day scheduled for the procedure.
If your child develops a cold or other illness, the surgery, test or treatment may need to be postponed. Certain illnesses can raise the risk of complications during anesthesia, and delaying the procedure may be the safest choice.
In some cases, the procedure needs to go ahead despite an illness. In those cases, your anesthesiologist may modify the plan to keep your child as safe as possible. So, it is important to be sure to tell them about any recent illnesses.
If your child is exposed to
chickenpox (varicella) within 3 weeks of the procedure (even if they do not have symptoms), their procedure may be rescheduled because of the risk to other patients. Chickenpox can spread before skin spots or other symptoms develop.
Remember
Share any questions or concerns you may have with your child's pediatrician or their anesthesia care team.
More information
About Dr. Lockman Justin Lockman, MD, MSEd, FAAP, is a professor of clinical anesthesiology and critical care and professor of pediatrics at Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine. Dr. Lockman serves on executive committee for the American Academy of Pediatrics Section on Anesthesiology and Pain Medicine
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