When a child requires surgery, the strain on every member of the family can be tremendous. For Mr. And Ms. Castillo, that pressure was not only deeply emotional, but practical as well. Both their 5-year-old son and 3-year-old daughter were scheduled for dental surgery under general anaesthetic on the same morning, while their youngest son required supervision that nobody else in their family was available to give. Compounding that fear was the anxiety that any parent awaiting surgery for their children feels, a vulnerability that creates the value behind The Scarborough Hospital’s (TSH) paediatric pre-operative teaching program.
When Mr. And Ms. Castillo informed Wanda Bowen, one of four Child Life Specialists at TSH, about the need for supervision of their third child when they came to TSH for the paediatric pre-operative education (offered for surgical patients from ages 3-14 and their families, and for parents of children under the age of 3), Wanda gave them the relief they needed. “Whatever happens, we’ll work it out,” she said, before continuing her session to the parents and children assembled, not only answering their questions thoroughly but also giving everyone a complete walkthrough and tour of what would occur on the day of the operation.
Her expertise was evident in the way she used child-friendly communication, giving hands-on demonstrations and the spirit of play to help them comprehend things such as topical anaesthetic and the start of an intravenous, using terms such as ‘magic cream’ and ‘helper straw’ with accompanying props. For parents, she then turned to explaining how they can participate in making surgery as comfortable as possible for both their children and themselves.
When the tour reached the operating room, a great burden was lifted from all in realizing that, on the day of surgery, there may be anxiousness, but there will be no surprises. “It’s not just a tour,” says Wanda, “it’s an education.” Research indicates that it is better for the child to have an understanding of what is happening, and this extends to the parents, who are going through just as difficult a time. “We are here to support the parent in supporting the child.” In the operating room, the child is given the opportunity to sit on the table and experience the sights and sounds of the room, an orientation that can help them remain calm later on.
On the day of the operation, the Castillo family arrived to find that the Child Life Specialists were ready and committed to put into motion the pre-operative teaching they had done, giving the Castillo parents a familiarity that helped them focus completely on caring for their children going into surgery – surgery which TSH would not have the children face alone.
The Till I Sleep program is a core component of how paediatric surgery is done at TSH. It allows a parent to accompany their child to the operating room until anasthesia has fully taken effect, resulting in a hospital experience that can give great solace to both parent and child.
“At the same time,” said Dr. Shelina Dhanji, the dental surgeon operating on the Castillo’s son, Francisco, “there is no way the Till I Sleep program would be effective without the rest of the pre-operative teaching delivered by the Child Life Specialists. Parents are equally susceptible to being anxious on their child’s behalf if they haven’t seen everything beforehand, and it helps us a great deal to know that all of their questions have been answered.”
Patients and their families, then, are not alone in reaping the value of the pre-op program. It makes all of us feel better when the child goes to sleep calmly,” said Dr. Dhanji. “In my view, when a child goes to sleep anxious, they wake up anxious, and that can present problems.”
A moment after Francisco Castillo is helped onto the operating table, Dr. Robert Lamont, a TSH anaesthesiologist for the surgery, enters the room. After a friendly greeting to his young patient, he begins to administer what Francisco is now comfortably aware of through the education of Child Life Specialists, while thinking back to his own childhood. “When I was a kid, they didn’t tell you what was going on. Nowadays, the kids get to come for a tour, the Child Life staff do a great job of keeping them calm and happy, and their parents can understand what is going on, and be there for their children, too,” said Dr. Lamont.
Francisco, held closely in his mother’s arms, drifted peacefully off to sleep. His surgery was a success.
The Scarborough Hospital has provided the Till I Sleep program for over five years. More than 1300 children benefit from the pre-operative teaching program every year. For more information, please contact the TSH Child Life Office, General Campus at (416) 438-2911, Ext. 3414 or the TSH Child Life Office, Grace Campus at (416) 495-2701 Ext. 2805.