Operation Baby: What to Expect When Your Little One Needs Surgery

Surgery is the last thing most new parents expect to encounter during their baby’s first year. Yet many do: Anthony and Kimberly Pope’s 7-year-old son, Braylon, of Renton, had surgery for pyloric stenosis (blockage between the stomach and small intestine) when he was 4 days old. Lakewood couple Robert and Jessica Cordova took their now 4-year-old son, Wesley, in for hernia surgery at 7 weeks old (3–10 percent of babies are born with hernias, and most require surgery). And Tacoma parents Colin Smith and Emma Lantz’s son Arlo, now 3, had fundoplication surgery for reflux at 5 months of age, along with seven other surgical procedures during his first year of life. 

Other reasons an infant could need surgery include intestinal malrotation, or incorrectly positioned intestines (experienced by around 1 in 500 babies); volvulus, a rare bowel blockage caused by intestinal twisting; and other abnormalities in the esophagus, diaphragm, abdominal wall or lung.

Elective outpatient procedures such as circumcision, currently performed on just over half of American male babies, and frenectomy (removing an overly thick band of tissue under the tongue or upper lip or other fold of tissue from another part of the body) are considered surgery, too, says Seattle Mama Doc blogger Wendy Sue Swanson, M.D., executive director of digital health for Seattle Children’s Hospital, adding that these come with similar risks and potential for complications, such as bleeding and risk for infection.

Although each surgical scenario is unique, they share a common theme: New parents don’t know what to expect. “The hardest parts [of son Arlo’s first surgery] were the little, seemingly insignificant unknowns,” Emma Lantz says. “I couldn’t picture the incision. Would there be gauze covering it? Right or left side? Why didn’t I ask? I felt so lost.”

Workup: Getting ready for surgery

Anesthesia, overnight hospital stays, pain management, breastfeeding and postsurgical care crowd the list of worries, while groggy new moms and dads are still making the transition to life-changing parenthood and to the small new person in their care.

So when the doctor says “surgery,” what’s a new parent’s first step? “Always ask if there are alternatives to surgery, and whether watchful waiting is possible,” Swanson says. In some cases, a physician may recommend postponing surgery until a baby’s lungs are more mature, after 6 months of age.

But waiting isn’t possible or preferable in all situations; some conditions, such as pyloric stenosis, require swift medical intervention, and some elective procedures, such as frenectomy, may go more smoothly with a younger infant. Bottom line: Before setting a date for surgery, make sure you understand the urgency and timeline associated with your child’s diagnosis. 

Now is the time to ask about pain management: Will a pediatric anesthesiologist handle the surgery? How will baby’s pain be managed after the surgery? Will pain control begin in the operating room, or will baby receive medication prior to surgery?

“For a baby, it’s a good idea to have a plan in place for pain control at the very beginning,” Swanson says. While you’re at it, ask if you’ll be able to bring comfort items, such as a pacifier, special toy or blanket, to the hospital.

Finally, before the big day arrives, make sure you understand the instructions for presurgery prep. In the 24 hours leading up to surgery, you may be asked to bathe your little one and to refrain from feeding him (including milk by breast or bottle) after a certain time. Although these instructions may seem trivial (will a tiny nip of milk hurt?), they’re anything but. For example, food or drink too close to surgery can pose a choking risk and may necessitate a rescheduled surgery: back to square one.

“Like much of medicine,
pediatric surgery is a progressive field with a strong interest in minimally invasive approaches, reduced hospitalizations and faster time to recovery.”

— Tamar Mirensky, M.D.  

Getting through the big day

For a hospital procedure, it’s likely that you’ll meet your child’s surgical team for the first time on the day of surgery — overwhelming, to say the least. Here’s where your notebook comes in handy. In most cases, parents get just a few minutes to speak with a child’s surgeon and anesthesiologist before the procedure. Jotting down questions and responses helps keep your head clear and vital information handy.

At the hospital, ask about any support you think you may need, or even support you think you won’t need. Braylon Pope’s sudden surgery at 4 days old meant mom Kimberly Pope’s breastfeeding got off to a rocky start: “I had to quickly learn to pump without instructions in the ER. The back of the pump box doesn’t tell you much!” Kimberly says. “Ask for hospital resources. Lactation support, hospital tour, follow-up home visit. You may need them and not know it.”

Some parents are surprised to learn that they can’t accompany their baby — the tiny bundle they’ve been cradling since birth — into the operating room. A 1989 study found positive results (including, notably, decreased parental anxiety) when parents of pediatric patients were allowed in the operating room during anesthesia induction. But in nearly all cases, parents won’t be bedside for the actual procedure.

“An operating room is a highly controlled environment, with a surgeon or two, an anesthesiologist or two, a tech and a scrub nurse,” Swanson says. Squeezing another person into the room could disrupt carefully designed systems in place to protect the tiny patient. And a parent’s presence could distract a surgeon precisely when extreme focus is needed, Swanson says.

Post-op: Recovery done right

If your child’s surgery will be followed by an overnight stay or several days of hospitalization, ask the nurses to help coordinate your child’s sleep schedule. “I asked the nurses to coordinate with me regarding [son Arlo’s] sleeping schedule. They tried to do the last check before his typical bedtime. We tried to maintain his routine as much as possible,” Emma Lantz says.

Before leaving the hospital, you’ll likely chat with your child’s surgeon for a post-op debriefing. Ask if everything went as anticipated, or if anything unexpected cropped up. Be sure to gather a list of needed prescriptions (ask the nurse to fax the prescription to your pharmacy, so you can grab it on your way home), home care instructions and follow-up appointments before departing. 

After surgery, parents need clear instructions about dos and don’ts, says Tamar Mirensky, M.D., pediatric surgeon at the Kravis Children’s Hospital at Mount Sinai in New York. When is it safe for a child to return to day care or be submerged in the bathtub? When is it safe to use a stroller or baby carrier?

The good news: Pediatric surgery is getting better all the time. “Like much of medicine,
pediatric surgery is a progressive field with a strong interest in minimally invasive approaches, reduced hospitalizations and faster time to recovery,” Mirensky says. And ultimately, parents and
surgeons share the same top concern: the safety and well-being of an utterly irreplaceable child.