An operation is a big event for a child and often a bigger one for their parents. Children cope far better when they know what is going to happen, in words they understand, at a time that suits their age. This page brings together practical guidance and the resources we think are worth your time.

It is general information. The instructions specific to your child come from the hospital and from the anaesthetist looking after them on the day. Where the two differ, follow the hospital.

At a glance

Ages: We operate on children from age 2.
Where: The Avenue Hospital.
When: Younger children are usually booked on a fortnightly Tuesday morning list.
Anaesthetist: Young children are cared for by a paediatric anaesthetist.
Fasting: Follow your admission letter, not any website. Times depend on your child’s age and the time of the operation.
How long: Arrive 90 minutes before the scheduled start. Home one to three hours after the operation finishes.
Parents: One parent can come into theatre until your child is asleep.
Overnight stay: Not expected. These are planned day surgery operations.
Going home: Plan a quiet rest of the day at home with someone with your child. You will be given instructions about pain relief and looking after the wound before you leave.

Where and when your child’s operation happens

Children’s operations are done at The Avenue Hospital.

Younger children are usually booked on a fortnightly Tuesday morning list. This is deliberate. A morning list means a shorter fast, which matters a great deal to a small child, and it means your child is cared for by a paediatric anaesthetist.

If there is a reason a particular day would be easier for your family, ask. We will tell you what is possible.

All of these are planned, elective operations. Your child will go home the same day unless you are told otherwise.

When to tell your child

The Victorian Department of Health’s Better Health Channel sets out timing by age, and it is sound advice.

Around 2 to 3: Talk to them just before you go. Time is an abstract idea at this age and early warning mostly creates worry without understanding.

Around 3 to 5: One to two days ahead. That gives them time to play it out with a teddy or a doctor’s kit, which is how children this age process an idea.

Around 6 to 12: About a week ahead. They understand more and they need time to build their own coping strategies.

13 and over: Several weeks ahead. They will want to think about it, look things up, and ask questions in their own time. Being left out is worse than being told.

What to say

Words that help

• Use plain, familiar words rather than medical ones.
• Name the good reason.
• Describe the anaesthetic as a special sleep that is different from ordinary sleep: they will not feel anything, and they will wake up when it is finished.
• Say what will be the same. You will be there when they go to sleep, and you will be there when they wake up.
• Check they have understood by asking them to tell it back to you in their own words.

Words to avoid

• “Cut”, “open you up”, or “put you to sleep” in a way a child might connect with a pet being put down.
• Framing anything about the operation as a punishment, or as something that happened because of what they did.
• Promising it will not hurt at all. Promise instead that everyone’s job is to keep them comfortable and that you will tell them the truth.

SPANZA’s EPIC project has worked examples of exactly how to phrase this for different ages and different operations: How to talk to kids about their operation (https://epickids.org.au/how-to-talk-to-kids-about-their-operation/).

Fasting

Your child needs an empty stomach before an anaesthetic. Anaesthetic medicines make it harder to protect the airway, and stomach contents that get into the lungs can cause serious harm. This is why an operation is delayed or rescheduled when fasting instructions have not been followed.

Follow the instructions in your admission letter, and from your anaesthetist, and nothing else. Fasting times depend on your child’s age, the time of their operation and the hospital’s own policy.

That includes overriding what you read elsewhere. General hospital web pages are written for adult day surgery patients and often say something like “nothing to eat or drink after midnight.” That is not necessarily what applies to a child on a morning list. Your admission letter and your anaesthetist are the authority. If they say something different from any website, including this one, follow them.

Younger children are booked onto a morning list partly to keep the fast as short as possible.

Two points worth knowing:

• Fasting guidance for children has changed. Several Australian children’s hospitals now allow small sips of clear fluid much closer to the operation than the old rule allowed, because long thirsty fasts leave children miserable without adding safety.
• Some things are not clear fluids even though parents reasonably assume they are. Milk of any kind, jelly, and smoothies are treated as food, not drink.

If anything in your admission letter is unclear, or if your child has diabetes, takes regular medication, or is breastfed or formula fed, ring our office or your anaesthetist’s rooms before the day rather than guessing.

Needles, numbing cream and the drip

For many children this is the part they are most frightened of, and it is the part where preparation makes the biggest difference.

• Many children have a drip (a cannula) put into a vein. Young children have anaesthetic gas through a mask instead and have the drip put in once they are asleep. Your anaesthetist will discuss which is right for your child, and older children can sometimes choose.
• Numbing cream is usually put on the skin beforehand. It takes time to work, which is one reason admission times can seem early.
• You can hold your child rather than have them held down. Comfort positioning, where a child sits on a parent’s lap or chest, is safer for staff and far less distressing for the child.
• Distraction genuinely works. A device, a song, bubbles, or a conversation about something else entirely.
• Tell the anaesthetist beforehand if your child has had a difficult experience with needles. They can plan around it.

On the day

• You will be asked to arrive 90 minutes before the scheduled start time. That time is used for admission, checks, and getting numbing cream on early enough to work.
• Bring a comfort item. A teddy, a blanket, a familiar toy. This matters as much for a twelve year old as for a three year old, even if the twelve year old will not say so.
• Bring something for yourself. There is waiting.
• Dress your child in comfortable, easy clothes. Pyjamas are fine.
• One parent can come into the operating theatre and stay until your child is asleep.
• Staff will take your phone number so they can call you into recovery as your child wakes.
• Expect to leave one to three hours after the operation finishes, depending on the operation and on how your child recovers from the anaesthetic.

How your child goes to sleep, and what it looks like

This surprises parents who have not seen it before, so it is worth knowing in advance.

As the anaesthetic takes effect, children often go through a brief stage where they wriggle, their breathing sounds different, their eyes may roll, and they may snore or cough. This looks alarming. It is normal, your child is already anaesthetised, and they will not remember it.

The most useful thing you can do at that moment is stay calm, because your child reads you.

Waking up

• Recovery nurses will call you in when your child is waking. Some children are already awake, some are still drowsy.
• Some children wake agitated or confused. This is common, it settles, and children do not usually remember it. A familiar toy helps. Medication can be given if needed.
• Feeling sick is common and treatable. Say something rather than waiting.
• Your child may have a sore throat or croaky voice for a few hours.
• When they can eat and drink is decided on the day by the anaesthetist and the surgical team.

Questions worth asking the anaesthetist

• What is the plan for how my child goes to sleep, mask or drip?
• Can my child choose?
• Can I stay until they are asleep?
• What is the plan for pain relief after the operation, and what do I give at home?
• My child has had a hard time with needles before. What can we do differently?
• When exactly does fasting start, and what can they drink and until when?

Frequently Asked Questions

Can I stay with my child while they go to sleep?
One parent can come into the operating theatre and stay until your child is asleep.

Will my child remember the operation?
No. Your child will have no memory of the operation itself. Most children also have no memory of the restless stage as the anaesthetic takes effect, or of any confusion while waking.

What if my child is unwell in the days before the operation?
Contact the practice rather than deciding yourself, and do not simply turn up and hope.

The decision is made together by you, Dr Tomlinson and the anaesthetist. The anaesthetist has the final say on whether a child is too unwell to be anaesthetised safely. Dr Tomlinson advises on whether the operation is time critical or can safely wait.

As a general guide:

• Not usually a reason to postpone on their own: sniffles, or a lingering cough that is settling after a viral illness. Children pick up viruses constantly, and waiting for a completely clear run can mean waiting a very long time.
• Reasons a planned operation will be postponed: fever, a wet or productive cough, or any breathing difficulty such as croup or an asthma flare. These meaningfully increase the risk of an anaesthetic, and a planned operation is not worth that risk.

Ring us. It costs you a phone call and it can save you a wasted morning.

How long will we be at the hospital?
Plan on most of the morning. You will be asked to arrive 90 minutes before the scheduled start time, and you will usually leave between one and three hours after the operation finishes, depending on the operation itself and on how quickly your child recovers from the anaesthetic. Add the length of the operation in between. Do not book anything else into that day.

Will my child stay overnight?
No. These operations are planned as day surgery and your child goes home the same day. You would be told well in advance if anything different were planned for your child.

Can my child bring a toy?
Yes, and we encourage it. A familiar toy or blanket is genuinely useful, in the anaesthetic room and again in recovery.

My child is very frightened of needles. What should I do?
Tell us before the day rather than on the day. There are real options: numbing cream, going to sleep with a mask instead of a drip, comfort positioning so your child is held by you rather than restrained, and distraction. These work much better when they are planned.

Should I tell my child there might be a needle?
Yes. Children who are told the truth cope better, and children who discover they were misled find every future appointment harder. You can be honest and reassuring at the same time.

What if my child refuses on the day?
It happens, and staff have seen it many times. Tell the nurses and the anaesthetist rather than trying to manage it alone. There is usually more flexibility than parents expect.

If you have a question before the day

Most of what you need will already have been covered in your consultation, during the booking process, or in the emails you receive before surgery. Please check those first.

If your question has not been answered there, contact the practice by phone or email. We would much rather answer a question beforehand than have you worrying about it, or have the operation delayed on the day because something was unclear.

Resources we recommend

For parents

• EPIC: resources for parents and caregivers (https://epickids.org.au/parents-caregivers/), Australian, produced by a subcommittee of the Society for Paediatric Anaesthesia in New Zealand and Australia. Includes a downloadable game plan your child fills in and brings to hospital.
• ANZCA: Anaesthesia and children (https://www.anzca.edu.au/patient-information/about-anaesthesia/anaesthesia-and-children), patient information from the Australian and New Zealand College of Anaesthetists, with a short animated video and downloadable fact sheets.
• RCH: Preparing your child for surgery, general anaesthesia (https://www.rch.org.au/kidsinfo/fact_sheets/Preparing_your_child_for_surgery_general_anaesthesia/)
• RCH: Fasting for surgery (https://www.rch.org.au/kidsinfo/fact_sheets/Preparing_your_child_for_surgery_fasting/), explains why fasting matters and what counts as a clear fluid. The specific times given are RCH’s own.
• RCH: Your child’s hospital stay (https://www.rch.org.au/kidsinfo/fact_sheets/preparing_your_child_for_hospital/)
• Better Health Channel: Preparing a child for hospital (https://www.betterhealth.vic.gov.au/health/servicesandsupport/preparing-a-child-for-hospital), Victorian Department of Health. Short and practical, with the age-based timing guidance.
• Meg Foundation: Comfort Positions (https://www.megfoundationforpain.org/comfort-positions-a-guide-for-parents-and-healthcare-professionals/), a photo guide to holding your child safely and comfortably rather than restraining them.

For children

• Jilly’s Big Sleep (https://www.childrens.health.qld.gov.au/our-work/frankies-clubhouse/frankie-books/jillys-big-sleep), a picture story from Children’s Health Queensland about a child having a general anaesthetic. Free online. Best for roughly 3 to 8.
• RCH Be Positive: A child’s guide to hospital, Surgery (https://www.rch.org.au/be-positive/A_childs_guide_to_hospital/Surgery/), a short video following a real child through an operation. Captions in several languages.
• RCH Comfort Kids, for kids (https://www.rch.org.au/comfortkids/for_kids/), breathing exercises, coping activity sheets for 7 to 11 year olds, and a guide aimed at teenagers.
• EPIC: resources for children and young adults (https://epickids.org.au/children-young-adults/)