Before and after your procedure (children 16 and under)

Before the procedure

Arrival time

If your appointment is in the morning please arrive by 7:15am. If it is in the afternoon please arrive at 12:15pm. Please note this is not the time of the operation, this is the admission time to the ward. The theatre team will see all the patients and then decide the order of the list. Please be prepared to stay in the hospital for the majority of the day in case of delays.

Fasting (nil by mouth)

7:15am arrivals

Your child must not eat or drink after the following times:

No food, milk or juice after 2:30am
Breast milk only until 4:30am
Water only until 6:30am

12 noon arrivals

Your child must not eat or drink after the following times:

No food, milk or juice after 7:30am
Breast milk only until 9:30am
Water only until 11:30am

When your child arrives on to the ward, they will be greeted by the receptionist to verify your details and check you in to the ward—you'll then be asked to take a seat and wait for a member of staff to see you.

On the day of the procedure

Preoperative assessment

Your child’s anaesthetist will discuss with you the types of anaesthetic that can be used, and the benefits and risks of the preferences.

The nursing team will see you to:

Do your child’s observations
Check your child’s allergy status
Complete your admission paperwork
Weigh your child
Give your child a hospital wristband

The surgical team will ask you, as your child’s guardian, to sign the consent form.

After you have seen all the various teams, your child will be asked to get changed into a hospital gown.

Play specialist

The Health Play Specialists will prepare your child for their procedure by:

Explaining the process of attending day surgery and showing pictures of the areas they will go to
See and play with some of the medical equipment
Describing what to expect when they go to sleep and when they wake up
Providing extra support if your child has complex/ special educational needs and disabilities.

After the operation the Play Specialist will come to see you and your child and give resources to distract and occupy them whilst waiting to be discharged.

Preparation will allow your child to explore medication equipment and ask questions in a safe environment which in turn can help lower fear and anxiety.

Please ask a member of the team if you would like Play Specialist input before or after your child has their operation.

What to expect

You and your child can watch this demo about what to expect before the operation.

Premedication

Some children/young adults might require premedication before their procedure. The anaesthetist will discuss this with you on the day of surgery. Premedication is a term for drugs which are given before an anaesthetic to help your child to relax. They may make your child more drowsy after the operation.

Theatre list

Operation times are staggered, so you will be asked to wait until your child is called to theatre. A number of factors, including disability, age and medical history, are taken into consideration when deciding the order of the theatre list.

Anaesthetic room

When the theatre team are ready, you and your child will go to the anaesthetic room. A nurse, an anaesthetist and an anaesthetic nurse will be present, along with other staff such as an operating department practitioner, medical student(s) etc.

General anaesthetic

There are two ways of starting a general anaesthetic—breathing an anaesthetic gas or having medication through a cannula (a plastic straw in the back of the hand that goes into the vein). Depending on the circumstances, it might be possible for you to choose which to have.

The cannula will stay in after the operation is finished and will be taken out just before you leave the hospital. This is so we can give your child more medications if needed.

After your child has been put to sleep, for your child’s safety you will be asked to wait in the waiting room until the surgery is complete. No photos or video recording devices are allowed to be used in the anaesthetic room and you will not be allowed to stay and watch the procedure.

Monitoring patients in the operating theatre

The team will closely monitor your child throughout the operation—this includes oxygen levels (saturations), heart rate, breathing rate and other vitals, to ensure your child is kept safe at all times.

Recovery

After the operation, your child will be transferred to the child friendly recovery area. The time necessary for recovery is unique to every child and your child’s safety is our priority. One parent will be called to stay with the child shortly after they arrive from the operating theatre. In this area we keep your child safe, making sure they are not in pain or feeling nauseous (which sometimes can be a side effect of general anaesthesia).

The surgeon will come to explain how the procedure went and details of the aftercare. Our nursing staff will answer your questions at any time.

While your child is in the recovery area, nurses will closely monitor them as they start to wake up. They will monitor your child’s vital signs and, once they are safe, your child will be transferred to the ward.

When will your child wake up?

The length of time a child spends in recovery depends on the type of surgery they’ve had, the response to surgery and anaesthesia, and any medical conditions. It is important to remember that each child wakes up differently.

Postoperative information

Your child will be monitored on Saturn Ward after recovery. Postoperative recovery time is usually one hour if your child fulfils the nurse-led discharge criteria. However, this can vary and is dependent on your child’s condition and the procedure they have had. Here are some examples of procedures and the typical length of stay postoperatively:

Tonsillectomy: 6 hours
Adenoidectomy: 2 hours
Rectal biopsies: 2–4 hours

Some pain or discomfort is to be expected following most procedures. Pain relief (analgesia) will be discussed with you for your child. This can include paracetamol, ibuprofen, morphine, for example. Please note, if your child has morphine, they will need to be monitored for 2–4 hours.

Some children may have a sore throat after surgery, but this should settle down shortly after surgery.

Depending on the procedure your child has had and/or if your child has pre-existing medical conditions, they may need to be reviewed by an anaesthetist and/or a surgeon after surgery.

Your child may need to eat and drink after surgery and may need to pass urine.

Your child will receive a discharge letter once they are ready to go home and this may be accompanied with some medication to take home (TTOs), which will be explained to you.

After the procedure

General wound care

To ensure optimal healing of your child’s wound, we advise that you:

Ensure the wound site is kept clean and dry for 5–7 days—after this time, your child can wash as normal
Do not let your child pick at their wound—allow any scabs to detach naturally from the skin, as pulling them off may re-open the wound

Before discharge, you will be informed by your doctor whether or not you need to come back for your child to have their sutures (stitches) removed.

When to seek medical attention

If the wound re-opens
Any sign of infection:

Redness, pain or heat around the wound site
Discharge, oozing or an offensive smell from wound
Swelling around wound site
A temperature of 38°C or above, with or without the above symptoms

Please note: Minimal bleeding is normal, however, if the dressings are soaking through you should seek medical attention.

ENT aftercare

If your child has had an ear, nose and throat (ENT) procedure, please note the following:

Following grommet insertion, it is normal to notice a small amount of blood from your child’s ear on the morning after the operation
Your child may have a sore throat, ear pain, bad breath, voice changes and/or white patches in their throat after their surgery—these symptoms can last for up to two weeks after their tonsils or adenoids have been removed
It is important that your child is given regular pain relief—typically paracetamol and ibuprofen for the first week after the operation and other medications prescribed by the doctor
Eating and drinking is very important after surgery as it will help to clean and heal the throat—encourage your child to drink plenty of fluids throughout the day for the first few days following surgery. There are no restrictions on what your child can eat—your child may prefer to eat softer foods, but it is also fine for them to eat hard foods, such as toast or cereals.
If your child is bleeding following a tonsillectomy, take them to your nearest A&E
If your child has had their adenoids removed, do not let them sniff or blow their nose for two weeks
Your child’s surgeon will give you a guide on how long your child should be off school

When to seek medical attention after an ENT procedure:

Rash or bleeding from the nose or mouth, or in your child’s vomit
Frequent swallowing (this may indicate bleeding)
Vomiting more than four times within the first 24 hours after the surgery
Not tolerating fluids
Temperature of 38°C or more

Dental aftercare

Once your child’s tooth has been removed, there will be a hole in the jawbone—blood clots will form initially before healing completely
Your child will have been given a local anaesthetic during the procedure to minimise pain during and after the operation—this is given into the gum where the tooth is removed to cause temporary numbness to the area inside the mouth
Blood-stained saliva is normal for the first 24 hours after tooth extraction
Pain, discomfort and swelling to cheeks, jaw and neck are common during the first week after dental surgery—paracetamol and ibuprofen can help to provide relief, you will need to buy this from your local pharmacy
A soft diet is encouraged for the first 48 hours after surgery and the following avoided for the first 24 hours:

Foods that are very hot, cold, hard or sharp
Mouthwashes or spitting forcefully
Playing sport or exertive activity
Touching or sucking the wound

Take care to ensure your child does not bite or chew the cheek, lip or tongue
Oral hygiene is important, particularly for the first few weeks after the procedure—gentle tooth-brushing is recommended as soon as possible, and mouthwash should be used for children above 5 years from 24 hours after the procedure

When to seek medical attention after a dental procedure:

New or increased bleeding
Pain uncontrolled with regular pain relief
Increased swelling
Not eating or drinking
Temperature of 38°C or more

Orthopaedic/plastic aftercare

It is important that your child is given regular pain relief—paracetamol and ibuprofen in the first few days of surgery
Limb elevation can help to reduce pain and swelling
Your child will likely have a cast on—casts following surgery are typically not waterproof and will need to be kept dry
Your child can shower, provided you are able to seal water from getting to the cast, otherwise sponge baths to maintain hygiene are recommended

When to seek medical attention after an orthopaedic/plastic procedure:

Increasing pain and swelling to limb
Changes in sensation, strength or skin colour
Temperature of 38°C or more
If the cast comes off

FAQs

What are TED stockings?

TED (thromboembolus-deterrent) stockings, also known as compression stockings, are a type of anti-embolism stocking which promotes increased bloodflow velocity in the legs and helps prevent deep vein thrombosis (DVT).

A DVT can sometimes lead to a more serious condition called a pulmonary embolism, and wearing compression stockings reduces the risk of this happening.

TED stockings are typically applied to patients who are 16 or older, and it is mandatory, regardless of the procedure, unless they are having orthopaedic surgery on both legs. Sometimes TED stockings are applied to younger patients.

Pregnancy test/screening

All female patients and patients assigned female at birth aged 12–55, and those who have started menstruation younger than age 12, may need a pregnancy test. The doctor will discuss this with you.

Pregnancy testing allows us to provide you with appropriate information to make a decision on what to do next.

Pregnancy is just one factor in the decision to have an operation. If your child is pregnant, the team will discuss the implications of this with you. You will be able to decide together whether to go ahead with surgery, to consider another treatment, or to delay treatment.

It is still possible for your child to be pregnant while menstruating (having a period) in the early stages of pregnancy. This is why is it hospital policy is to test all female and patients assigned female at birth aged 12–55 to ensure we provide the best possible care.

Diet/food postoperatively

After surgery, sandwiches, water, apple juice, yoghurts and fruits are available to all patients unless it is contraindicated (not recommended).

For dental patients, apple juice is not advised—the patient is allowed to eat straight after surgery or when ready.
For ENT patients, any foods or drinks that red in colour are strictly not allowed. This enables the team to monitor for any blood that might appear in vomit.

Parking

There is a reduced parking fee of £10 on the day of your child’s surgery. The nursing team can assist you with this.

Combining procedures

If your child is on a waiting list for another procedure, it may be possible to combine these procedures. Please discuss this with both leading consultants before the planned date of surgery.

Can I bring my other children?

No—please do not bring other children to the hospital on the day of your child’s procedure. We do not have facilities to look after other children besides the patient. You will also need to concentrate on your child who is having surgery.

Can one of my other children be treated on the same day?

Unfortunately, not. Siblings must be scheduled for operations on different days. You will need to concentrate on one child at a time.

I have another question

Please contact the admissions team on 020 3315 3321 or 020 3315 8858.

The information in this leaflet was compiled by:

• Andrea Olayiwola (Senior Staff Nurse)
• Anabela DeBarros (Senior Staff Nurse)
• Kristian Pacquing (Trauma Coordinator)
• Markjames Gunton (Paediatric Practice Development Nurse)
• Vanessa Digie (Sister, Children’s A&E)

Contributors

Maya Sharda George Vasilopoulos

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