About 2,000 children under the age of 16 have surgery every year at National University Hospital (NUH), and parents play a vital role in helping to prepare them for surgery.
In fact, doctors encourage parents to be present when doctors start to administer anaesthesia in children older than six months old, said Dr Neo Hong Jye, a consultant in the department of anaesthesia at NUH.
Parents can engage their children in simple play to distract them. In fact, their very presence alone can help to reassure the child.
At NUH, parents are often able to stay in the operating theatre with their children for about 10 minutes, until surgery is about to start.
One reason doctors want parents around is that they are increasingly using spinal blocks on children. These are medicines that numb parts of the body to block pain, but the patient is still conscious. They are given through shots in or around the spine.
Blocks are becoming more commonly used, as anaesthetists are becoming more concerned about the use of general anaesthesia medications and its effect in the young and developing brain, said Dr Neo.
But with blocks, the age and maturity of the children are also crucial, as doctors need their co-operation.
Interestingly, children below the age of three months can undergo spinal injections easily, as minimal co-operation from them is necessary. They often fall asleep with a pacifier during surgery, said Dr Neo.
But schoolgoing children often need to be sedated to calm them before and during the operation.
Still, with the right coaching, children over the age of 10 can take a regional injection easily with minimal sedation, said Dr Neo.
A regional block involves medication being injected near a cluster of nerves to numb only the area of the body that requires surgery.
Parents can help by encouraging their children and showing them the correct attitude to have towards procedures that can be uncomfortable, but necessary for their recovery, said Dr Neo.
If the parent is calm, it is likely that the child will be calm too.
Often, hospital employees see parents villainising medical staff and using injections as a threat, to get the children to behave, he added.
Of the 2,000 children who have surgery each year, 21 per cent to 23 per cent are under three years old, usually needing surgery to correct inborn abnormalities.
These can involve the urinary tract, hernia, intestines, bones and spine, heart and lungs, said Dr Neo.
The types of surgery that can be done with just regional anaesthesia include herniotomy (hernia repair) and surgery on the fingers, hands, forearm, toes, feet and legs.
The duration of the operation should not be more than two to three hours. Beyond this period, patients can get restless.
Some operations require general anaesthesia or sedation, for instance, procedures such as the insertion of tubes, X-rays and examination of the eyes, which might be daunting to a child, said Dr Neo.
General anaesthesia is also needed for cancer surgery.
No matter the type of anaesthesia used, children do much better with adequate and appropriate parental support. Parents can lower the anxiety level by keeping themselves calm and explaining to their children what is going to happen.
Those who arrive with adequate parental psychological preparation tend to cope and co-operate better than children taken to the hospital without being first prepared by their parents, said Dr Neo.
Side effects from anaesthesia are generally few, but may be unpleasant, as they involve nausea, vomiting, blockage of the airway and drug allergies.
While NUH has not done a trial on young children who have undergone general anaesthesia and regional anaesthesia, their doctors are waiting for results of other studies.
These will hopefully determine if different types of anaesthesia have different effects on the neuro-developmental behaviour of children.
This article was first published on October 27, 2015.
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