Surgery Journey
Your Child's Operation: A Guide for Parents
Your Child's Operation
Operating on a child means caring for a family, not only a patient. Consent for the operation is given by a parent or legal guardian, and your child also deserves an honest explanation in words they can understand, and a real say in how the day goes. This guide covers preparation, children's fasting times, and pain relief dosed by weight. A calm parent helps create a calm child — we will look after you both.
Consent and Your Child's Say
- A parent or legal guardian gives legal consent for the operation.
- Your child's own agreement (assent) is sought at a level suited to their age: a toddler is told simply what will happen, an older child can see pictures and ask questions, and a teenager takes part in the discussion much like an adult.
- If a child clearly objects to a non-urgent procedure, tell the team — this is explored and addressed rather than overridden.
Preparing Your Child
- Use simple, honest words: “You will have a special sleep so you will not feel it happening, and a grown-up you trust can stay close until you are asleep.”
- Do not promise it will not hurt if it might.
- Bring a favorite toy, blanket, or comfort item from home.
- Many units offer picture books, videos, or a pre-visit to the ward; ask about them.
- In most units a parent can stay with the child until they are asleep, where it is safe to do so; ask your anesthesia team about their policy.
- Feeling scared is common and manageable — for children and for parents.
Fasting Times for Children
Children's fasting rules are shorter than adults' and should not simply be copied across. Long fasting causes distress, dehydration, and low blood sugar in children. European pediatric guidance allows the following for healthy children — always follow the exact times your own team gives you:
Clear fluids
- Until before anesthesia
- 1 hour
Breast milk
- Until before anesthesia
- 3 hours
Formula or a light meal
- Until before anesthesia
- 6 hours
Pain Relief: Dosed by Weight
- Children's paracetamol and ibuprofen doses are calculated from the child's weight (paracetamol typically 15 mg/kg per dose). Your discharge sheet will state the exact dose for your child — follow it exactly.
- Never give codeine or tramadol to a child under 12, for pain or for cough.
- Never give tramadol to anyone under 18 after tonsil or adenoid surgery.
- Do not use adult doses, or leftover medicines from another illness.
- Your child's current weight is recorded before surgery so that every medicine dose is accurate.
Before the Operation
- Tell the team about any cough, cold, or fever; a child who is unwell may need the operation postponed, on the anesthesia team's advice.
- Ask what to expect in the anesthesia room and recovery area.
- Prepare for how your child may look and behave on waking: groggy, tearful, or clingy is normal.
Waking Up and the First Days
Children often wake from anesthesia confused, tearful, or agitated for a short time. This usually settles within 20 to 30 minutes with a calm, familiar adult present. Offer small, frequent sips of a favorite drink, and encourage a return to normal activity, play, and school as your child's procedure advice recommends. Some children have disturbed sleep, clinginess, or new fears for some weeks afterward, especially if they were very anxious beforehand; this usually settles.
Warning Signs: When to Seek Help
Green
- What you notice
- Tearfulness, clinginess, or grogginess for a few hours; mild loss of appetite for a day
- What to do
- Expected. Comfort your child and follow the discharge advice
Amber
- What you notice
- Not drinking at all for several hours; a temperature of 38 °C or more; a wound that is red or leaking
- What to do
- Call the clinic or your doctor the same day
Red
- What you notice
- Difficulty breathing, blue lips, or excessive sleepiness that is hard to wake from; repeated vomiting, or signs of dehydration (no wet nappies or urine for 8 hours, dry mouth); severe or worsening pain despite the prescribed medicine
- What to do
- Go to the emergency department now
Questions Parents Ask
Can I stay with my child until they are asleep?
In most units, yes, where it is safe to do so. Ask your anesthesia team about their policy.
Will my child remember the pain?
Children generally do not remember pain from under general anesthesia. Good pain relief afterward is still important, and you will be given a clear plan.
Can I give my child the cough medicine with codeine that I have at home?
No. Codeine is not safe for children under 12, and must not be used after tonsil or adenoid surgery in anyone under 18. Use only the medicines on the plan you are given.
Why are fasting times shorter than the old 'nothing from midnight' advice?
Modern guidance allows most children clear fluids until 1 hour before anesthesia, which is kinder and safer than fasting overnight.
My child is very frightened. What can we do?
This is common and manageable. Bring a comfort toy, use simple honest words, and ask the team about preparation materials. The team will support both of you.
How much pain medicine should I give at home?
Exactly the dose on your discharge sheet, calculated for your child's weight. Do not use adult doses or leftover medicines.
My teenager wants to make their own decisions. Is that allowed?
Young people are involved in decisions about their own body as much as possible, alongside their parent or guardian, following local policy.
Full guide written by Dr. Tamer Elalfy