Preparing Your Child for Surgery

Hearing that your child needs an operation can feel unsettling, even when the procedure is routine and straightforward. It's completely normal to worry, and your child is likely to pick up on the fact that something is different — children are remarkably attuned to their parents' emotions. The good news is that with a little preparation, most children cope far better than their parents expect, and many even come away from the experience feeling proud of how brave they were.

I've put this page together to walk you through what to expect, to give you some practical tips for preparing your child emotionally, and to explain what will happen on the day of surgery. Please read through it at your own pace, and don't hesitate to get in touch if anything feels unclear.

In the days leading up to surgery

The biggest gift you can give your child before an operation is calm, honest preparation. Children cope best when they know roughly what to expect and feel that the adults around them are relaxed about it.

A few general principles that tend to help:

Be honest, but age-appropriate. Avoid surprises on the day. Even very young children benefit from a simple explanation tailored to what they're having done, for example:

  • For tonsils or adenoids: "We're going to the hospital so the doctor can take out the sore lumps at the back of your throat that keep making you poorly. You'll have a special sleep, and when you wake up your throat will feel a bit sore for a few days, but it will be all fixed."

  • For grommets: "The doctor is going to put tiny little tubes in your ears to help them stop feeling blocked, so you can hear properly. You'll have a special sleep and it will be all done before you know it."

  • For nasal or other ear surgery: "The doctor is going to help fix your [nose / ear] so it feels better. You'll have a special sleep and won't feel anything while it happens."

Avoid words like "cut" or "put you to sleep" (this can be confusing for children who have had a pet put to sleep) — instead, try "the doctor will mend it" and "you'll have a special sleep that the anaesthetist gives you."

Don't tell them too early. For younger children (under 5 or 6), a day or two's notice is usually enough. Older children often like more time to process and ask questions. You know your child best.

Answer questions honestly. If they ask whether something will hurt, it's better to say, "Your throat (or ear, or nose) might feel a bit sore for a few days, but we have lots of medicine to make it feel better" than to promise it won't hurt at all. Children trust parents who tell them the truth.

Play it out. Younger children often process big experiences through play. Playing "hospital" with teddies, dolls, a toy doctor's kit or a stethoscope can really help. Let your child shine a torch in teddy's ears, or "take out teddy's poorly tonsils," and explain the steps as you go.

Pack a comfort item. A favourite teddy, blanket, or small toy can come into the anaesthetic room and will be there when your child wakes up. Older children might want their own pyjamas, a book, a tablet with headphones, or a colouring pad for the ward.

Think ahead about soft foods. If your child is having a tonsillectomy or adenoidectomy, it's worth stocking up in advance on soft, cool, child-friendly foods — ice lollies, yoghurts, jelly, ice cream, mashed potato, scrambled eggs, pasta with a mild sauce, and plenty of cold drinks. Eating and drinking normally is one of the most important parts of recovery, and having appealing options at home really helps.

Look after yourself too. If you can arrive feeling rested and calm, your child will feel it. Try to avoid discussing worries in front of them in the days beforehand.

Books that can help

Reading a story together is one of the gentlest ways to introduce the idea of a hospital visit. Here are some lovely ones to look out for.

Particularly recommended — the "Getting Ready for My..." series

This series by Dr Fei Zheng-Ward, a consultant anaesthetist, is wonderfully suited to the operations I most commonly perform. Each book is interactive, beautifully illustrated, and gently walks children through exactly what to expect before, during, and after their surgery. Written by an anaesthetist with over 15 years of experience, the information is accurate, age-appropriate, and reassuring.

Other lovely books for children going into hospital:

  • Topsy and Tim Go to Hospital by Jean and Gareth Adamson — a classic, reassuring UK favourite for ages 3–7.

  • Maisy Goes to Hospital by Lucy Cousins — gentle and simple, ideal for toddlers and preschoolers.

  • Peppa Pig: Peppa Goes to the Hospital — familiar characters make the idea less frightening for young Peppa fans.

  • Going to the Hospital (Usborne First Experiences) by Anne Civardi — clear, friendly illustrations showing each step.

  • I Don't Want to Go to Hospital by Tony Ross — a funny, relatable story for ages 2–6. (Royalties go to Alder Hey Children's Hospital.)

  • Dot by Julia Donaldson and Sarah Ogilvie — a heart-warming rhyming story about a hospital therapy dog, perfect for sharing with children aged 2+.

  • Jim's Lion by Russell Hoban — a more thoughtful, beautifully illustrated book for slightly older children who may be anxious about having an anaesthetic.

Helpful online resources

Two videos I recommend

These two short videos are wonderful for showing children (and parents) what to expect:

Watching together and pausing to chat about anything that comes up is often more helpful than watching in silence.

Fasting — what can my child eat and drink?

Fasting before an anaesthetic is important because it reduces the (already very small) risk of stomach contents coming up during the anaesthetic. However, we also don't want children to fast any longer than necessary — a hungry, thirsty child is a miserable child, and prolonged fasting can actually make recovery harder.

You will be given specific instructions by the pre-assessment team and by the hospital, and you should follow those exactly. As a general guide, current UK paediatric practice is:

  • No solid food, formula milk, or cow's milk for 6 hours before surgery.

  • No breast milk for 4 hours before surgery.

  • Clear fluids are encouraged up to 1 hour before surgery (this includes water or very dilute squash — no milk, no fizzy drinks, and nothing with bits in it).

Please do encourage your child to keep sipping clear fluids right up until the cut-off time. Arriving well-hydrated makes everything more comfortable, especially if a cannula is needed.

If your child accidentally eats or drinks outside the allowed window, please let us know straight away — it's much better to tell us than to stay quiet, as we can usually adjust the plan.

The ward at the John Radcliffe Hospital

Your child will be looked after on the dedicated children's ward at the John Radcliffe Hospital in Oxford. It's a bright, welcoming, children-only environment with a large play area, play specialists, friendly nursing staff who are all trained in caring for children, and plenty to keep little (and not-so-little) ones occupied before and after surgery. Parents are very much part of the team on the ward, and parents are welcome to stay with their child throughout the day.

How the operating list works

Children's operating lists are usually run youngest first. This is because younger children find fasting hardest, and we want to minimise the time they go without food and drink. Occasionally, for clinical reasons — for example, a child who has eaten by mistake, or a more complex case that needs to be done earlier — the order of the list may change. If your child's slot moves, the nursing team will let you know as soon as possible. Please try not to worry if there's a wait; it's usually simply because the operation before has taken a little longer than planned.

Meeting the anaesthetist

On the morning of surgery, you and your child will meet the anaesthetist who will be looking after them. I work with a team of highly experienced consultant anaesthetists who specialise in caring for children — you are in very safe hands. They will introduce themselves, ask some questions about your child's general health, answer any questions you have, and talk through the anaesthetic plan with you in detail.

Types of anaesthetic

There are a few different ways an anaesthetic can be given, and the anaesthetist will discuss which is most appropriate for your child on the day. In brief:

  • Gas (inhalational) induction — your child breathes a sweet-smelling gas through a soft mask until they drift off to sleep. This is often used for younger children who don't like needles.

  • Intravenous induction — a small cannula (a thin plastic tube) is placed in the back of the hand or arm, and the anaesthetic medicine is given through it. Numbing cream (often called "magic cream") is applied well in advance so the cannula is as comfortable as possible. Older children often prefer this method.

  • Local anaesthetic — this is sometimes given in addition to the general anaesthetic (for example, infiltrated around the tonsil bed during a tonsillectomy) to keep your child very comfortable after the operation. It is given once your child is already asleep.

The anaesthetist will choose the best approach with you and your child, and will explain it all in a way that feels right for their age.

What about a pre-med?

A pre-med is a medicine given before going to theatre to help relax a child who is particularly anxious. It can be very helpful for some children, but it's worth knowing a few things:

  • Most children don't need one. With good preparation, a familiar teddy, and the reassurance of a parent at their side, the vast majority of children manage very well without.

  • It takes time to work — usually around 20–45 minutes — so it can delay going to theatre.

  • There can be side effects. Some children become drowsy and wobbly, and occasionally children can become a little disinhibited or upset as the medicine takes effect. Recovery can sometimes take a bit longer too.

If your child is very anxious, the anaesthetist will talk you through whether a pre-med is the right choice on the day, and weigh up the pros and cons with you. It's very much a shared decision.

Going to the anaesthetic room

One parent is welcome to come with your child to the anaesthetic room, hold their hand, and stay with them until they are asleep. This is often the part parents worry about most, but the team will look after you too, and most parents find it reassuring to be there.

Once your child is asleep, a member of the team will walk you back to the ward. This is sometimes the moment parents find most emotional, but it happens quickly, and it's a very positive sign — it means your child is safely anaesthetised and the operation is beginning.

While you wait

Operations often take less time than parents expect, but the wait can feel long. The ward has a parents' area with tea and coffee. Please do step out briefly if you need to — the nursing staff will always know how to reach you.

In recovery and back on the ward

When the operation is finished, your child is taken to the recovery area, where specialist nurses look after them as they wake up. As soon as they are stirring, a member of the team will come and collect you so that you can be there while they wake up properly. Most children are a bit groggy and sometimes a little teary at first — this is completely normal and settles quickly once they see you. You'll then head back to the ward together, where your child will be encouraged to have something to drink (and later something to eat) and can rest and recover.

A special note about tonsillectomy

If your child is having their tonsils removed, we ask you to plan for a longer stay on the ward after surgery — usually at least 4 to 6 hours post-operatively. This is because the small risk of bleeding is highest in the first few hours after a tonsillectomy, and we want your child safely observed by experienced nurses during that window before they go home. Encouraging your child to eat and drink normally on the ward — even though their throat feels sore — is actually one of the most important parts of recovery, as it helps the tonsil beds heal well. It's a good idea to bring snacks, drinks, chargers, books, or a tablet to help pass the time comfortably.

Before you go home

I will come and see you and your child on the ward after the operation to let you know how everything went, check in, and answer any questions before discharge. You'll also be given written post-operative instructions and information on what to look out for at home.

Medication to take home

Post-operative medication will be prescribed before discharge. Occasionally there's a short wait while the pharmacy prepares and dispenses it, so please don't be alarmed if this adds a bit of time to your discharge.

It is very helpful to have paracetamol and ibuprofen (both in liquid or tablet form, appropriate for your child's age and weight) at home ready before the day of surgery, as long as your child has no allergies or contraindications to these. Taken together, regularly and at the right doses, they are the mainstay of pain relief after most children's ENT operations — particularly tonsillectomy — and make the first few days much more comfortable. If your child has any medical conditions or allergies that might affect this, please do check with me or your GP first.

A final reassuring thought

Children are remarkably resilient. What can feel like a huge event to us as parents often turns out to be a very manageable day for them, especially when they feel prepared, informed, and loved. You'll be alongside them every step of the way, and so will an experienced, kind, and highly skilled team.

If there is anything at all you're unsure about — however small — please do get in touch before the day of surgery. There's no such thing as a silly question, and it's always better to have everything clear in your mind beforehand.