Parents' Guide to Pediatric Surgery

Welcome

Welcome to Cleveland Clinic Children’s. Thank you for trusting us with your child’s care. Each of us is committed to treating you and your child like members of our own family.

Having a child in surgery can be stressful. But you are not alone. Each of us is here for you. Every caregiver is focused on your child’s safety and well-being. We will do whatever we can for you and your child.

At the same time, we want you to take an active role in your child’s care. If you have any questions regarding your child’s surgery or information covered in this guide, please speak up. We’ll listen.

This guide will help you understand more about your child’s surgical experience. Hang on to it and read through it when you can. The information here can help you and your family have a better experience before, during and after your child’s surgery.

Our goal is to give every child the best outcome and experience. We appreciate your confidence.

Sincerely,

Tomislav Mihaljevic, MD
CEO, President and Morton L. Mandel CEO Chair
Cleveland Clinic

Preparing for the Procedure

In advance

• If your child develops an illness within two weeks of surgery, call your child’s surgeon. Ideally, children should not be sick before surgery.
• All children are required to have a history and physical exam within 30 days of surgery. Sometimes this exam is performed by the surgeon’s office. If it is not, your surgeon will ask you to have the history and physical completed by your child’s pediatrician or primary care doctor. Please bring a signed copy of the record with you on the day of surgery.
• Is your child diabetic? Diabetes medications should be discussed with your child’s endocrinologist before surgery. Call your child’s endocrinologist for instructions on the day of surgery.
• Does your child take anti-seizure or cardiac medications? Anti-seizure and cardiac medications are usually taken the day of surgery to keep therapeutic (healing) levels and to avoid delays in the schedule. Ask your child’s specialist for specific instructions.

The day before surgery

• If your child is sick with an upper respiratory infection, ear infection, cold, cough, sore throat, fever or any other illness, please call the surgery center to inform the staff. If your child is having surgery at main campus, please call the M20 surgery desk at 216.445.8697 and ask to speak with a nurse or anesthesiologist. If your child is having surgery at another surgery center, please call your surgeon’s office and ask to speak with a nurse.
• Make sure your child has had a thorough bath or shower the night before (or the morning of) surgery. Clean skin, hair, fingers and nails will help prevent infection.
• The exact time of your child’s surgery will be finalized the day before surgery.
• You will be contacted or told to call before 4 p.m. the day before the procedure to review pre-operative instructions and confirm your arrival time. If your child’s surgery is scheduled for Monday, this call will take place on Friday. If the day before your child’s surgery is a holiday, you will receive a call/need to call on the last business day before the holiday.

The day of surgery

• Dress your child in loose, comfortable clothing. Pack an extra set of clothes.
• Encourage your child to wear his or her eyeglasses (contact lenses must be removed before going to surgery) and remove any body piercings or jewelry.
• Bring your insurance card or medical card.
• If instructed, please bring a copy of the completed medical history and physical exam with you on the day of surgery.
• Bring a list of your child’s medications, including vitamins and any over-the-counter medication. Be prepared to review the names of medications and dosages with the nurse.
• Children are encouraged to bring their favorite stuffed animal and items (books, handheld video games, etc.) to keep them occupied.
• Bring bottles, sippy cups and diapers as needed.

We recommend that siblings stay at home. You should plan to spend most of the day at the hospital.

Where to park

MAIN CAMPUS: 2070 E. 90th Street, Cleveland, OH 44195, Phone: 216.444.2200

Please park at the Surgical Center parking garage #4 at East 89th St. and Carnegie. Valet parking is available at the main entrance on E. 93rd and Euclid.

If your child will be spending several days at Cleveland Clinic Children’s or coming back for frequent appointments, you can buy discounted parking passes at the Valet Desk in the J Building (near main entrance) on the first floor.

HILLCREST HOSPITAL: 6780 Mayfield Road, Mayfield Heights, OH 44124, Phone: 440.312.4500

There are surface parking spaces and a free parking garage located adjacent to the hospital. Handicapped parking is available on the first floor of the parking garage and at surface lot locations around the hospital. Valet parking is available for a fee at the main entrance, Monday- Friday, 5:30 a.m.-9 p.m., except holidays.

FAIRVIEW HOSPITAL: 18101 Lorain Avenue, Cleveland, OH 44111, Phone: 216.476.7000

Valet service is available for a fee at the main entrance. Self-parking is available for a fee in the adjacent parking garage.

How to Prepare your Child for Surgery

Meeting with a Child Life Specialist

We know that surgery can be a stressful time for parents and children. The staff at Cleveland Clinic Children’s is here to help parents prepare their children for surgery and to provide resources if you (the parent) need help talking with your child.

Child Life Specialists are healthcare professionals who are trained to help children and their families cope with surgery, illness and hospitalization. These professionals are trained in fields such as child life, child development, education and psychology. They help patients understand their medical experiences in a manner and at a level they can understand. Research has shown that when children understand what is happening to them, they cope more effectively and experience less stress. If you’d like to speak with a Child Life Specialist for advice on how to prepare your child, please call. We’re here to help.

The surgical area is staffed with a Child Life Specialist who will make every effort to see your child before surgery. If you would like to meet with a Child Life Specialist in the pre-operative area before your child’s surgery, please tell the nurse.

Child Life Phone Numbers

Main Campus: 216.445.6454

Fairview Hospital: 216.476.7216

Hillcrest Hospital: 440.312.0154

Tips to prepare your child

Infants

• Children can sense anxiety. Find as much information as you can about the surgery. This will help you to be prepared and remain more relaxed on the day of surgery.
• Bring familiar objects that will comfort your baby (favorite blanket, pacifier, and musical toy), as well as his/her favorite bottle or sippy cup.

Toddlers (1-3)

• Begin to talk about the surgery 1-3 days beforehand.
• Allow your child to choose a comfort item from home to bring (stuffed animal, blanket, toys, etc.).

Preschoolers (4-5)

• Begin to talk about having surgery 3-5 days beforehand. Your child may start asking questions about what to expect.
• Preschool-aged children sometimes believe their surgery is a punishment and need reassurance.
• Use simple, child-friendly explanations of how their body will be fixed.
• Playing doctor and reading books about having surgery or going to the hospital are great ways to help preschoolers understand.

School-age (6-12)

• Begin talking about surgery at least a week ahead of time.
• Talk openly and honestly to your child about the procedure using simple, easy-to-understand words (for instance: “IV catheter” is a small straw to give your body a drink of water; “anesthesia” is a medicine to help you fall asleep so that you do not feel anything during your surgery, etc.). Prepare your child for things he/she might see or feel (stitches or bandages).

Adolescents (13 and older)

• Begin to talk about the surgery a few weeks before; explain why he/she needs surgery and encourage him/her to ask questions. Most teens benefit from having some control of their situation; allow your child to take part in decision-making.
• Teens may be worried about how they will look after surgery. Be sure to discuss what your child should expect about his/her appearance after the surgery.
• Your child may be worried about waking up during surgery or not waking up at all. Reassure your teen that he/she will be asleep for the entire surgery and will wake up when the surgery is complete.
• Respect your teenager’s need for privacy.

Important safety information for teenage patients:

• Alcohol, smoking, and recreational drugs are not safe within 24 hours of having anesthesia. Please talk with the anesthesiologist if you have any questions.
• Patients cannot drink alcohol or drive for 24 hours after having anesthesia. Do not drive while you’re taking prescription pain medicines.

Schedule a tour

Tours are available for children who are scheduled to undergo anesthesia or surgery. Children will have the opportunity to learn about the hospital experience, from admitting to discharge. They can also meet the nurses who will care for them on the day of surgery. If you’d like to schedule a tour, please call the Child Life Department and leave a message.

Internet resources

For additional information, we encourage families to visit the Child Life website at Clevelandclinicchildrens.org/childlife. The website includes the “Going to Surgery” coloring book and video “What to Expect When Your Child Is Having Surgery.”

Instructions for Eating & Drinking Before Surgery

General Guidelines

To prevent serious problems during surgery, your child’s stomach must be completely empty when surgery begins. The surgeon’s office will give you specific instructions on when your child should stop eating and drinking. This information will be based on your child’s type of surgery, age, and health.

If these important safety guidelines are not followed, your child’s surgery may be delayed or cancelled.

• No solid food 8 hours before surgery. This includes gum, hard candy, mints, and/or milk.
• Six hours before surgery: Infants and children can have baby formula or tube feeds. No thickeners or additives.
• Four hours before surgery: Infants and toddlers can breastfeed or have a bottle of breast milk.
• Two hours before surgery: Your child can have clear liquids (avoid red, purple, or blue colors). A clear liquid is any drink that you can see through (NO pulp) such as apple juice, water, white grape juice, (one) popsicle, Gatorade, and Jell-O without fruit. Please limit these liquids to no more than 8 ounces (or one cup).

If your infant is having surgery early in the morning, please wake him/her during the night to breastfeed or give clear liquids to drink (Pedialyte or apple juice). This will help your infant to feel more comfortable while waiting.

If you have any questions about eating or drinking before surgery or about anesthesia, please call the Surgery Center and ask to speak with a nurse or anesthesiologist.

Medications on the day of surgery: what to give, what not to give

If your child has to take medication on the day of surgery, please give it with a small sip of water or apple juice. If your child needs to take the medicine with apple sauce, you may give medicine with one (1) teaspoon, a minimum of 4 hours before surgery.

Please do not give your child Motrin, Ibuprofen, Advil, aspirin or any non-steroidal anti-inflammatory (NSAID) 5-7 days before your child’s surgery, unless the surgeon tells you to.

If you have any questions about the medications your child is taking, please call your child’s surgeon’s office for specific instructions the day before surgery

Day of Surgery

Arrival time and check-in

Please arrive promptly at the time you are given. The time you should arrive is not the scheduled surgery time – it is the time you should arrive at the main check in desk. We may ask you arrive up to two hours before your scheduled surgery time to allow for pre-operative assessment and time to meet with your surgeon and anesthesiologist. We try to follow our surgical schedule as closely as possible; however, unexpected delays may occur. We appreciate your patience.

When you arrive, please check in at the surgical desk. Some facilities have family pagers. If available, you will be given a pager, which is used to communicate with families during surgery. You will receive three text messages: one from the operating  room, one from the recovery room when your child’s surgery is finished, and another when you may visit your child.

When planning for your day of surgery, remember that the surgery itself takes up only part of the time you spend with us. You must include preparation and recovery in your plans, which together may take up most of the day.

Pre-operative assessment

When you are called to the Same Day Surgery room, you will be greeted by a nurse who will check your child’s temperature, heart rate and blood pressure, and review questions about his/her health. Your child will be given a hospital gown and an ID bracelet to wear. A team member from Anesthesia will ask many of the same questions. You will also see the surgeon, who will review the proposed surgical procedure(s). To make sure that you understand the procedure, you will be asked to sign an informed consent on behalf of your child (if you haven’t already signed one in the surgeon’s office).

While you are in the pre-op area, you may be asked the same questions several times. Do not be alarmed – this is our way of ensuring patient safety.

A urine sample (pregnancy test) is required for all females who are of menstruating age. If your child needs to urinate before being called to pre-op area, please notify the receptionist so that we can obtain the specimen.

Operating Room

Another part of our culture of safety is called the “time out,” which takes place in the operating room before surgery begins. During the “time out,” the surgical team will review the following:

• Correct patient identification
• Correct side, site marking
• Correct procedure
• Correct position on the operating room table
• Correct implants, special equipment (when applicable)

Anesthesia

The Anesthesia Care Team consists of a physician anesthesiologist plus an anesthesia resident/fellow or certified nurse anesthetist. They will continuously watch your child’s vital signs throughout the procedure. The type of anesthesia your child will receive is based on his/her surgical procedure and on your child’s health. This will be discussed in depth with the patient and family before the surgery.

Your child can be given anesthesia several ways. The two most common are the following:

1. For children younger than 10 years old (or who weigh less than 88 pounds) the doctor may place a soft, clear mask over the child’s mouth and nose, so the medicine is inhaled. This air will make the child sleepy and is not painful. An intravenous (IV) catheter (a very tiny, soft plastic straw) will be placed after the child is asleep, so that he/she is not awake for the “poke.”
2. Children 10 years and older (or who weigh more than 88 pounds) may receive anesthesia via an IV catheter. A doctor or nurse will put the catheter underneath the skin, into a vein. The medicine will be delivered through this catheter into your child’s body. Your child will fall asleep very quickly.

The final decision on whether your child has a “mask” or an IV is up to the anesthesiologist. Older children should be prepared to have an IV placed before going to surgery. We can provide numbing creams and other means of comfort and distraction to make this more tolerable. We will do everything possible to make this experience as comfortable as possible. Your child’s wellbeing and safety is always our main focus.

After Surgery

Your child will be brought to the Post-Anesthesia Care Unit (PACU, or recovery room) by the Anesthesia team. You will be paged or notified to report to the recovery room within a few minutes of your child’s arrival in the PACU. Because of the limited space, and for safety reasons, only two family members are allowed in the PACU.

Once your child arrives in the PACU, he/she will be closely watched and cared for by highly skilled nursing staff. If your child is sleeping in the recovery room when you arrive, please allow him/her to wake up naturally as if from a nap. If he/she is awake when you arrive, you will be encouraged to hold and comfort him/her. You must stay in the recovery room until your child is discharged to home or admitted to the hospital floor.

Recovery room

• Your child may have oxygen to help him/her breathe easier
• Your child may look pale or slightly swollen. This is normal and will go away.
• Your child may have an upset stomach and feel sick. This is a normal side effect of anesthesia. We will do everything we can to lessen this side effect.
• Your child may feel dizzy or lightheaded; it’s best to let him/her sleep in the recovery room until this feeling goes away.
• Your child may have a sore throat. Drinking cold liquids will help.
• Your child may shiver as if cold; we will apply heated blankets to keep him/her comfortable.
• Your child may complain of an itchy nose. This is a side effect of pain medicine and will go away in about an hour.
• Some children will appear awake even though they are not aware of what is going on around them (for a short period).

Post-operative pain

Your child’s doctors and nurses will do all they can to help your child be as comfortable as possible after surgery. After surgery, pain relief for your child will be provided in a variety of ways. Pain relief is a team approach in which you, the surgeon, the anesthesiologist and the nurses will decide what is best for your child. If the pain is minor, your child will need very little pain medicine. Other surgeries are more painful, and your child may need stronger medications in the hospital and at home. Follow your doctor’s advice for adequate pain relief; pain medicine can reduce anxiety and allow your child to heal faster. Parents understand their children better than anyone. A parent’s gentle touch, distraction and quiet play activities can be very reassuring to children.

Discharge to Home

Recovery time varies from patient to patient, depending on the type of procedure, the patient’s condition, and the anesthesia that was used. Before leaving the hospital, your child will need to be awake, breathing normally, and feel comfortable. Ask your nurse when your child may be safely discharged to home.

Discharge instructions

Your child’s discharge instructions will be reviewed by a doctor and nurse before going home. The instructions will include:

• Eating and drinking after surgery
• How to treat your child’s pain or discomfort
• Giving medicine
• Bandages and wound care
• Activity for first 24 hours
• Whom to call if you have questions

On the way home, we recommend that an adult sit beside young children in the car. Position your infant/child with his/her chin off the chest. During the ride home, check your child frequently to make sure he/she is breathing without difficulty. When your child is sleeping, you should be able to awaken him/her easily. Older children can become nauseated in the car on the way home; we will give you a bucket just in case your child vomits.

Patients cannot drink alcohol or drive for 24 hours after having anesthesia. Driving after combining alcohol with narcotic pain medicine is extremely dangerous. Pain medicine may cause you to become sleepy and make it unsafe for you to drive.

Prescriptions

While many medications can be purchased at any local pharmacy, some liquid pain medicines may only be available at Cleveland Clinic’s Surgical Center Pharmacy. We strongly encourage you to have your child’s prescriptions filled before leaving the hospital. Patients are often given one dose of pain medicine (by mouth) before going home.
We will give you instructions for safely giving your child his/her medication at home.

Beachwood Family Health and Surgery Center Pharmacy
26900 Cedar Road, Beachwood, OH 44122
Phone: 216.839.3000; Monday-Friday, 8am – 6pm

Cleveland Clinic Children’s Outpatient Pharmacy
R Building: Monday-Friday 9am – 5pm

Euclid Avenue Pharmacy
JJ Parking garage, 1st floor: Monday–Friday, 8am – 6pm; Saturdays, 9am – 3pm

Fairview Health Center Pharmacy
18099 Lorain Road, Cleveland, OH 44111
Phone: 216.476.7119; Monday-Friday, 8am – 6pm

Hillcrest Hospital Pharmacy
6770 Mayfield Road, Mayfield Heights, OH 44124
Phone: 440.605.1611; Monday-Friday, 9am – 5pm; Saturdays, 9am – 1pm

Twinsburg Family Health and Surgery Center Pharmacy
8701 Darrow Road, Twinsburg, OH 44087
Phone: 330.888.4000; Monday-Friday, 8am – 6pm

What to Expect at Home

Activity

Your child may be sleepy and need to relax for the rest of the day. He/she may be unsteady when walking or crawling and will need you or another adult to protect him/her from injury. An adult must be with the child at all times until he/she has returned to his/her usual state of coordination. Encourage quiet activities for the rest of the day (video games, reading, or watching television).

Eating and drinking

Do not force your child to eat or drink until he/she is ready. Encourage your child to drink clear liquids throughout the day. After your child is tolerating fluids well, you may begin to offer solid foods. Start with light foods such as soup, crackers, and dry cereal and slowly go back to a normal diet.

Managing your child’s discomfort or pain

It is normal for your child to have some discomfort, pain, or a low-grade fever (less than 101 degrees Fahrenheit). Here are some things we recommend:

• Follow your surgeon’s advice for treating pain and low-grade fevers.
• Parents can comfort their child better than anyone. Be sure to hold and reassure your child.
• Give your child cold liquids or popsicles for a sore throat.

Keep your child home from school or daycare after he/she is discharged to home. If your child is discharged late in the day, he/she may need to stay home from school or daycare the following day, depending on his/her alertness and coordination. If your child still needs pain medicine at home, do not send him/her to school or daycare.

When to call your child’s doctor after the surgery

Please call your child’s surgeon if your child has:

• Severe nausea or vomiting
• Unable to urinate within 6-8 hours after being at home
• Fever higher than 101 degrees Fahrenheit
• Signs of infection, including swelling, redness, a foul odor, drainage at the surgical site with prolonged fever
• Severe pain or the child is not consolable
• Excessive drainage/bleeding from the surgery site
• Cannot be awakened easily or remains very sleepy

Follow-up phone call

Within 1-2 days of your child’s surgery, a member of our nursing team will call you to check on how your child is doing, and answer any questions that you may have.

Surgical Site Infections

Common symptoms

A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. Most patients who have surgery do not develop an infection; however, infections develop in about 1 to 3 out of every 100 patients.

Some of the common symptoms of a surgical site infection are:

• Swelling, redness, and a foul odor around the area where your child had surgery
• Drainage of cloudy fluid from your surgical wound
• Fever (or prolonged fever)

To prevent surgical site infections, doctors, nurses, and other healthcare providers:

• Scrub their hands and arms up to their elbows with an antiseptic agent just before the surgery.
• Wear hair covers, masks, gowns, and gloves during the surgery to keep the surgery area clean.
• Immediately before surgery, use clippers to remove hair on the area where the surgery will take place (instead of a razor, which may cause skin irritation).
• Clean the skin with a special soap that kills germs.
• Give the patient antibiotics before surgery starts. In most cases, antibiotics are given within 60 minutes before the surgery starts and are continued for 24 hours after surgery.

Before your child’s surgery:

• Tell the doctor about other medical problems your child may have, such as allergies, diabetes, and obesity, that could affect surgery and treatment.
• Make sure your child has a thorough bath or shower the night before surgery. Clean skin, hair, fingers, and nails will help prevent the wound from becoming infected.
• Do not shave near the surgery site. Shaving with a razor can irritate the skin and make it easier to develop an infection.

At the time of your child’s surgery:

• Ask if your child will get antibiotics before surgery.

After your child’s surgery:

• No one should touch the surgical wound or dressings.
• Family and friends should clean their hands with soap and water or an alcohol-based hand rub before and after visiting. If you do not see them clean their hands, please ask them to do so.

What do I need to do when I take my child home from the hospital?

• Before going home, a doctor or nurse should explain everything you need to know about taking care of your child’s wound. Ask questions before you leave the hospital if you do not understand how to care for the wound.
• Before you go home, make sure you know whom to contact if you have questions or problems.
• Wash your hands with soap and water before and after caring for your child’s wound.
• If any symptoms of an infection occur, such as fever or drainage, redness or pain at the surgery site, call your child’s doctor immediately.

Can surgical site infections be treated?

Yes. Most surgical site infections can be treated with antibiotics. The antibiotic your child receives depends on the bacteria (germs) causing the infection. Sometimes patients with surgical site infections also need another surgery to treat the infection.

Patient Resources

Cell phone usage

Cell phones and wireless computers are permitted in the public areas throughout the hospital. The devices are not to be used in the Intensive Care Units (ICUs). Free Wi-Fi is available on main campus.

Cleveland Clinic Hospitality Concierge

Whether your stay is brief or extended, Cleveland Clinic’s Hospitality Concierge is happy to help enhance your visit by matching Cleveland’s resources with your needs. Stop by the Concierge desk located in the main lobby of the Children’s Hospital (Building M), Desk M1-1, Monday-Friday, 8a.m. to 4:30 p.m. or by calling our Concierge at 216.636.9473.

Lactation (breastfeeding) support

Breastfeeding moms are encouraged to feed their children while at Cleveland Clinic. You may request a lactation consult by calling 216.445.7919.

Latex-Safe Hospital

Cleveland Clinic is a latex-safe hospital, which means that every reasonable effort has been made to remove latex materials to which people may be allergic, thus reducing direct exposure to patients and employees. Please remember that only Mylar balloons are permitted at Cleveland Clinic.

Ombudsman

Do you have a concern about your hospital visit? The staff in the Ombudsman Department is available to help resolve issues about services that cannot be solved through other channels. The office is located at S18 on the first floor of the S building, Monday through Friday, 8:00 a.m.-5:00 p.m.; email: ombudsman@ccf.org. You may also call 216.444.2544.

Smoking policy

Cleveland Clinic is committed to the health and well-being of our patients, visitors, and employees. Therefore, smoking is strictly prohibited anywhere on Cleveland Clinic’s campus.

Hand washing saves lives

Cleveland Clinic is committed to keeping you safe during your stay with us. One of our most important safety goals is to reduce the spread of infection in our hospital, a problem faced by every hospital in the nation. You and your child are an important part of our healthcare team and can help us reduce infection by speaking up. Please remember that it is okay to ask us, “Have you washed your hands?” Please do not hesitate to speak up or ask someone to speak up on your behalf. It is also important for all visitors to do as the caregivers do and “foam in, foam out” – clean your hands with the foam hand sanitizer as you enter and leave the room.

Important Phone Numbers

Hospitals

Cleveland Clinic Children’s
(Main campus, J1-9 check-in desk)
9500 Euclid Ave., Cleveland , OH 44195
Pediatric PACU, M20, Phone: 216.445.8697

Hillcrest Hospital
6780 Mayfield Road, Mayfield Heights, OH 44124
Surgical Center Pre/Post, Phone: 440.312.4694

Fairview Hospital
18101 Lorain Avenue, Cleveland, OH 44111
Phone: 216.476.7000

Cleveland Clinic Children’s Outpatient Center
8950 Euclid Avenue, Cleveland, OH 44106
Phone: 216.444.0317

Ambulatory Surgery Centers

Cleveland Clinic Beachwood Family Health & Surgery Center
26900 Cedar Road, Beachwood, OH 44122
Phone: 216.839.3542

Cleveland Clinic Twinsburg Family Health & Surgery Center
8701 Darrow Road, Twinsburg, OH 44127
Phone: 330.888.4241

Cleveland Clinic Strongsville Family Health & Surgery Center
16761 SouthPark Center, Strongsville, OH 44136
Phone: 440.878.3400

Cleveland Clinic Sports Health
Marymount Ambulatory Surgery Center:
5555 Transportation Blvd., Garfield Heights, OH 44125
Phone: 216.518.3200

Appointments

General Pediatrics & Specialties: 216.444.KIDS (5437)
Therapy & Rehabilitation: 216.636.KIDS (5437)