Parental Presence in the OR: A Chat with Child Life and Pediatric Anesthesia

Parental presence in the operating room is often one of the first questions parents of children who are scheduled for a surgical procedure want answered. Take a seat, grab a cup a coffee and join Dr Barnett (NB) and Katie (KL) for a quick chat about what to expect from joining your child in the operating room as he/she falls asleep.

What is your role during my child’s procedure?

KL: As a child life specialist, my role is to support the psychosocial, emotional, and coping needs of children and families. My goal is to provide individualized interventions that may include therapeutic and medical play, age-appropriate preparation, procedural support, and family support to promote positive coping during stressful situations. I work with our children and families to help them positively cope and feel comfortable during anesthesia inductions. 

NB: I am a pediatric anesthesiologist, which means I went to medical school, completed a residency in general anesthesiology and then completed an additional year of training for providing anesthesia to children. My job is to make sure that your child is asleep, comfortable, and safe for the whole time that they are having their procedure.

 Can we go with our child to the operating room?

KL: Typically, I defer to the surgical/anesthesiology teams. At our institution we do have a program for parental presence which allows for one parent to be with their child until they fall asleep.

NB: Usually, one parent is allowed to accompany their child to the operating room for induction only. This is, however, institution/hospital specific. Some institutions do not have the ability to allow for parental presence so unfortunately in that instance, a parent/caregiver may not be able to go with their child.

Can more than one parent/care giver go with our child?

NB: Again, institutionally dependent. Most hospitals typically allow one parent or caregiver.

KL: One parent or caregiver can go back at our institution, and we recommend that the parent/caregiver who is most calm/comforting is the one to accompany their child.

Do we have to wear any special clothes to go into the operating room?

KL: Yes, we have our parents wear a paper suit over their own clothing, a facemask, a hairnet & shoe covers. You do not have to wear any special attire from home, all sterile materials are provided by the institution.

NB: Agree with Katie here, most institutions/hospitals have similar outfits for non-operating room visitors. These outfits help maintain sterility of the operating room environment to minimize infection risk.

How long can we stay with our child in the operating room?

KL: You are with your child while they are getting ready to fall asleep and while they fall asleep. This may be a few minutes to help prepare your child and start the falling asleep process.  

NB: A parent/caregiver who comes with us to the operating room is there for their child as they fall asleep. Once they have fallen asleep, typically we allow for kisses on cheek or forehead and then an operating room staff member will accompany you back to the waiting area.

Does the operating look like it does on TV shows?

NB: Kind of – there are bright lights, blue drapes, and lots of people in scrubs, masks & hats.

KL: Yes, you might see several pieces of medical equipment, not all of it is necessarily for your child. The operating room is like a garage and helps store various equipment to keep things clean & sterile.

Who else will be in the operating room?

KL: There may be the operating room nurse and surgical tech, the anesthesia team, and a few members of the surgical team. It may look like a lot of people, but they all have a job to keep your child safe during their procedure.

NB: Yes, that’s absolutely correct. The anesthesia team is typically made up of the anesthesia tech who is there to help us with our equipment and monitors, the anesthesiologist who is the medical doctor in charge and potentially either a certified nurse anesthetist (CRNA), and Anesthesia Assistant (AA), or an anesthesiology resident who is a medical doctor in anesthesia training.

What should I expect to see as my child falls asleep?

KL: You might see a few different things as your child falls asleep, and it looks a little different than falling asleep at home. Your child may be active as they fall asleep, so their body might wiggle, or their eyes may wiggle. They may make unusual breathing sounds. These are all normal responses as your child is falling asleep.

NB: Each child may react differently to falling asleep in the operating room. Some of their reaction depends on their baseline personality (ie level of anxiety) and/or whether or not they have received a premedication. If your child is going to sleep with a facemask, they may try to wiggle away from the smell (it STINKS!) and may need help to keep their body still, their eyes may roll backwards or look in opposite directions, and their breathing may sound noisier to you than usual. Some kids may do all these things, and some kids may do none of them, both reactions are normal. If your child goes to sleep with medicine through an IV, this happens very quickly and can be unnerving to watch. Sometimes kids will whine or cry as the medicine goes into the IV as it can be very irritating to veins.

What can I do to help my child fall asleep?

NB: Mainly just be there to comfort them as you normally would at home.

KL: Your job is to support your child by talking to them, snuggling with them, or redirecting them to a familiar or comfortable item to help them as they fall asleep. You may be able to sit with your child or hold them while they fall asleep since you are the most familiar person to them. Some kids by singing or reading a familiar book so don’t be afraid to sing while you’re in the operating room. If your child is stressed at the time of falling asleep you can talk them through the process and letting them know you are there and that they are safe while they are falling asleep.

Where do I go after my child is asleep?

KL: A staff member will walk you out of the operating room and back to the preoperative area and/or waiting room. You will be able to take off your awesome paper clothes and the staff member can help give you instructions about what to expect next or where to wait.

NB: Nothing to add here except that after you leave, your child will always have a member of the anesthesiology team there to make sure that they are safe, comfortable, and asleep while they are getting their procedure.

Will I receive updates during the procedure?

NB: Typically, for shorter procedures the first update you will receive is that your child is in the recovery room and for longer procedures an operating room staff member will usually call with short updates. Each institution is different, but rest assured, if something is wrong or unusual you will be informed. You will most likely see or hear from your surgeon before you get notified that your child is in the recovery room because it takes a bit of time to wake up and transfer to the recovery room bed. 

KL: Agree with above!

What should I do to prepare myself to go to the operating room?

KL: Ask your staff about what to expect in the room or where you can stand in the room. You know your child best so make sure to bring items that are familiar/comforting to them. You can also ask for other items (some hospitals have playrooms or toys for this very reason) that you think could be helpful. Remember to take big deep breaths and try to have fun while supporting your child. Parental presence is not for every parent/caregiver – so please don’t feel pressure or guilty if you choose not to participate.

NB: It may be helpful to call ahead and ask about the institutional policies so that you aren’t surprised or disappointed if you’re unable to join your child while they fall asleep. I really want to emphasize that parental presence is to help alleviate any anxiety for your child and that the most helpful parent/caregiver is the calmest choice. And I totally agree with Katie on parental presence not being for everyone, and that’s okay!

Well, we hope that this has been helpful and that all basic questions were answered from our different perspectives. A lot of institutions have pamphlets or websites with information with their support for surgery – don’t hesitate to ask before coming for your child’s procedure!