As I had mentioned in my last post, things have been a bit hectic and busy in our household the past few weeks.
Eight weeks ago, one of our little guys had a scheduled surgery on one of his “dude parts”. Even though it was considered a routine outpatient procedure, the thought of your child going under general anesthesia will always be nerve wrecking to parents.
While the surgery was a success and we were home within four hours of checking into the hospital, the post-op was not what I expected it would be.
Doctors and nurses would probably prefer it if their patients woke up from the anesthesia once in recovery or while they are being taken into the recovery unit, and for children, ideally once they are in the presence of their parents. My little guy woke up in the O.R., shortly after the procedure was over and had to be carried over to the recovery room by the anesthesiologist before they called us from the waiting room. He was inconsolable at first, but once his vitals returned to normal and he had calmed down, we were good to go.
Once we were home he was in good spirits, and his pain seemed to be mild to moderate at worst. However, the day after his surgery his behavior changed and we had no clue what was going on.
After a trip to the pediatrician’s office and in consultation with a pediatric anesthesiologist, what we’ve learned is that some children, particularly young children around the ages of 2-5, can experience what is referred to as “Emergence Delirium” (EM) following surgery when general anesthesia is administered. While EM can last a few minutes to a few hours or even a couple of days, we found that it affected our son’s behavior for weeks after the procedure. It was as if he had been traumatized by the whole experience and was afraid to go to sleep.
Most of what he did to soothe himself to sleep prior to having the surgery, he all of a sudden refused to do. For example, the day after the surgery he stopped sucking on his two fingers, and if he involuntarily went to suck his fingers, he would quickly lower his hand as if he was reminded of the surgery.
He went from being my best sleeper to waking up multiple times at night, agitated and disoriented, as if he was having a terrible nightmare- unable to be consoled for longer periods of time. During the day he showed signs of increased separation anxiety and would cry and hide when we started on his nap or bedtime routines. He started refusing his naps and because he wasn’t sleeping well, he was also not eating much and was extremely fussy during the day.
There are many factors that could help explain why some kids go through this. Some research studies have shown that the type of medication used in anesthesia can play a factor; while others cite that sometimes the amount of time it takes for a child to wake up after the surgery and the pain level felt by the child can lead to EM. Other studies even indicated that the temperament of the child, and even the anxiety levels of parents and parents’ behavior leading up to the surgery can all potentially play a part.
Ultimately no one really seems to know exactly why this happens, nor does it seem it can be predicted in patients prior to surgery. And while I understand why surgeons and pediatric anesthesiologists wouldn’t want to explain this to anxious and nervous parents prior to the surgery, it would have helped to have had some information included in the discharge instructions prior to leaving the hospital.
After the doctors ruled out that there was nothing wrong, what we did (and continue to do) to help him get back to his normal behavior, was to practice lots of patience, provide him with extra comfort, and talk to him a lot to reassure him that we weren’t going to leave him, that he wasn’t going to have surgery anymore and that he was all better now. We also had to “sleep train” him all over again, which was not easy and entailed lots of reassurance during the night and helping him find new ways to self-soothe himself back to sleep. While it was tempting to just pick him up from his crib and bring him to bed and cuddle him back to sleep, the reality was that we needed to try to get him to go back to a sustainable routine and not develop bad habits.
Even though many of us assume that children under the age of two don’t understand much, we found that talking to him and trying to explain what had happened seemed to help him get over this phase.
It’s now been two months since his surgery and while his sleep patterns have improved, they are still not back to the way they used to be. My feeling is that it won’t go back to being exactly as it was before.
While I hope to never have to go through this again, nor do I wish this on any parent, I hope some of you reading this will find this helpful should you ever be in a similar situation.
h p://dune.une.edu/na_capstones/4Mason, Linda, M.D., “Pitfalls of Pediatric Anesthesia” (2015). Loma Linda University.