The Fearful Child
Some children, either from past experience or from general lack
of understanding, are terrified to come to the operating room. When I see a child
break into tears, if the child is old enough to talk with, I will stop whatever is
happening at the moment, sit on the bed next to the child, and ask what exactly is
concerning the child. Sometimes there is no response. In this situation I ask such
children if they are afraid to go to sleep, afraid of feeling their operation, or
afraid of pain afterward. Generally they are able to verbalize their concern, but
even with no response at this point I reiterate that "the sleep from anesthesia is
different from sleep at home. . . . At home, if mom or dad shook you, you would
wake up. . . . In the operating room, no matter what we do you will not feel it,
you will not remember it, and then at the end I will take the medicine away, you
will breathe it all back out again, and then you will wake up and return to your
family." This explanation usually ends the tears. Sometimes the tears occur because
they want a parent
present for induction, even some of the older children. This request is easy to
grant, and it will also usually end the tears. If on the other hand, a specific
event in the past is causing concern, it is important to investigate to see whether
something was misunderstood or whether something can be carried out differently to
avoid the issue. Finally, some children cannot be consoled and it is not possible
to find the source of their concern. It is these children who will benefit from
a heavy premedication such as the combined oral midazolam, ketamine, and atropine
described earlier.
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