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How do I prepare my 4-year-old for tonsils surgery?
Q: What is the best way to prepare an almost 4-year-old for having her tonsils and adenoids removed?
A: Removing the tonsils and adenoids, known as adenotonsillectomy, is common for young children and considered minor surgery. But surgery can feel like a very big deal for a 4-year-old. When children understand why they are having surgery and what will happen, they feel more relaxed and cooperate better. Taking the time to prepare your child can reduce her anxiety about the surgery and help speed her recovery. Here are some tips:

1. Explain the surgery at the level your child can understand. Explain what the problem is: lumps in your throat that are making you sick and tired a lot. The doctor will take out the lumps and then you will be healthier. If her tonsils are very large, have her open her mouth to look at them in the mirror. Try to avoid explanations that might scare her like, “They’ll cut you open and sew you up with a needle.” Explain that lots of kids have this and get fixed at the hospital.

2. Reassure your child about any misunderstandings and fears she might have.
  • Misunderstandings: Preschoolers may think that they caused this problem by something bad they did, and the operation is a punishment. Let your child know that she didn’t do anything wrong. Her body just grew that way, and the operation is just the way to fix the problem. Some children are afraid that the surgery will take out something they need, but you can reassure her that she doesn’t need her tonsils and adenoids anymore.
  • Fears: The two greatest surgery-related fears of preschoolers are that they will be separated from their parents and left all alone, and that they will have pain. Reassure your child that you’ll be there with her when she goes into surgery. Then a doctor will give her a special mask with medicine to breathe to make her sleepy so they can fix her, and she won’t feel anything. Tell her you’ll be there with her when she wakes up. Also reassure her that they’ll give her medicine so she won’t hurt. And then she’ll be able to eat lots of ice cream. Children 3 years or older who are otherwise healthy can usually leave the hospital the day of the surgery. Even when children need to stay overnight, most hospitals allow at least one parent to stay in the room. Encourage her to ask you questions and express any fears she might have. Answer her questions and reassure her. Also tell her that the doctors and nurses will answer her questions.

  • 3. Help your child “practice” beforehand. Read a children’s book about preparing for surgery. Buy a doctor’s kit and let her practice taking her stuffed animal’s temperature, listening to its heart and breathing, putting on a bandage, etc. Encourage her to ask the stuffed animal how it’s feeling and reassure her that it’s doing well.

    4.Visit the hospital together beforehand. This helps make the hospital feel familiar and friendly. Most hospitals offer pre-operative children’s programs, family orientations and hospital tours conducted by a specially trained nurse or child life specialist. Call as soon as possible to schedule a pre-operative tour, program or orientation. Preferably, this should take place a few days before the surgery.

    5. On the day of surgery, cuddle and reassure your child as much as possible. Encourage her to bring a favourite toy or blanket to the hospital if she would like. Try to stay calm yourself. A child-life specialist may help your child relax. If you’re with your child until she goes into surgery and in the recovery room when she wakes up, it’ll seem as if you never left. If she needs to stay overnight, try to sleep in the room with her. For prolonged stays, the child life specialists usually have activities to help children play and make them feel comfortable. If your child is having discomfort after surgery, follow the doctor’s instructions about pain relief and give your child plenty of attention.

    Remember that what you say to your child and how you say it—your tone of voice, facial expression and body language—are important to reassure her about the surgery.
Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician