When Your Child Needs Orthopedic Surgery

Two ways of doing orthopedic surgery

The procedure may be done in 2 ways: open or arthroscopic. The method used will depend on how extensive the surgery may be. Your healthcare provider will talk with you about your child’s surgery and the method that will be used:

• Open surgery. This is the traditional method of doing surgery. It's usually done through 1 cut (incision). This incision is large enough for the surgeon to have a direct view of the area to be operated on.

• Arthroscopic surgery (also called arthroscopy). This is done through several smaller incisions. A tube (arthroscope) with a tiny video camera and a light is inserted through 1 incision. This gives the surgeon a clear view of the area being operated on. Tiny surgical tools are then put through other small incisions to do the surgery.

Helping your child get ready

The idea of having surgery can be scary. You can help your child have a more positive experience during surgery by preparing them in advance. How you do this depends on your child’s needs. Many children’s hospitals have a child-life specialist who can help you and your child get ready. Here are some tips:

• Explain the surgery to your child in brief and simple terms. Younger children have shorter attention spans, so do this shortly before the surgery. Older children can be given more time to understand the surgery in advance. 

• Point out the body part that will be operated on.

• Explain to your child that they'll be “asleep” during surgery. Reassure your child that they won’t feel the surgery being done.

• Allow your child to ask questions.

• Use play when appropriate. This can mean role-playing with a child’s favorite toy or object. It may help older children to see drawings of what will be done during surgery.

• Help your child pick their “comfort object” to bring to the hospital. This can be any small item, such as a toy, stuffed animal, or blanket. Your child will be able to keep it until surgery starts.

The weeks before surgery

You'll be given specific instructions to help your child get ready for surgery. Carefully follow any instructions given to you by your child’s surgeon. Below are 2 instructions that are common to most surgeries:

1. Tell your child’s healthcare provider what medicines your child takes. This includes over-the-counter medicines, prescription medicines, vitamins, herbs, and supplements. Your child may need to stop taking certain kinds of medicines before the surgery. This will help to prevent bleeding and other problems during and after the surgery.

2. Follow any directions your child is given for not eating or drinking before surgery.

The day of surgery

Here's what to expect right before surgery: 

• Get to the hospital on time. You'll be asked to fill out certain forms.

• Your child will be given a gown to change into.

• A provider called an anesthesiologist or nurse anesthetist will meet with you. They'll discuss the medicines that will help your child sleep through the surgery. Be sure to ask any questions you have.

• You may be asked by several people to confirm which part of the body is being operated on. This is routine and is for your child’s safety. The body part may also be marked with a pen.

• Your child will be given an IV (intravenous) line. This gives your child fluids and medicines. Depending on the age of your child, the IV line may be put into the arm or the hand. The IV may be started after your child is asleep.

During the surgery

Here's what to expect during surgery: 

• Your child will be given general anesthesia. This is medicine that allows your child to comfortably sleep during the surgery.

• A soft tube called a catheter may be placed into your child’s bladder. This helps drain urine during and right after the surgery.

• The surgeon will do the surgery using the method that's been discussed with you.

Recovering in the hospital

Here's what to expect after surgery: 

• After surgery, your child will be taken to the PACU (postanesthesia care unit). There, specially trained healthcare providers will closely keep track of your child waking up from surgery. Certain monitors will be attached to your child to watch over breathing, blood pressure, and pulse.

• Your child will be given pain medicine as needed to stay comfortable.

• The urinary catheter will likely be removed shortly after surgery. The IV line might stay in place for a few days, depending on the type of surgery and if your child is staying the in hospital.

• In some cases, surgery is done with your child as an outpatient. This means your child goes home the same day. In other cases, your child may need to stay 1 or more days in the hospital. If your child stays overnight, they will be moved to a regular hospital room. Ask if you can stay with your child.

Recovering at home

Here's what to expect at home after surgery: 

• Give your child prescribed medicines as instructed. Pain control after surgery is important to help with healing. So give pain medicines if needed as prescribed.

• Schedule a follow-up visit with the surgeon after surgery.

• Being active helps your child heal. But too much activity can harm healing incisions. Follow any activity instructions your child is given.

• If your child needs physical therapy during recovery, this may be started soon after surgery.

• Follow any other instructions you're given for your child’s recovery.

Call your child’s healthcare provider 

Contact the healthcare provider or get medical care right away if your child has any of the following after surgery:

• Fever (see Fever and children below)

• Chills

• A seizure

• Chest pain

• Upset stomach (nausea) or vomiting

• More pain or swelling at an incision site

• Unexpected fluid leaking from an incision

• Increased redness around an incision

• Bleeding from an incision

• Breathing problems

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

• Rectal. For children younger than 3 years, a rectal temperature is the most accurate.

• Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The healthcare provider may want to confirm with a rectal temperature.

• Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

• Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

• Mouth (oral). Don’t use a thermometer in your child’s mouth until they are at least 4 years old.

Use the rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell them which type you used.

Below are guidelines to know if your young child has a fever. Your child’s healthcare provider may give you different numbers for your child. Follow your provider’s specific instructions.

Fever readings for a baby under 3 months old:

• First, ask your child’s healthcare provider how you should take the temperature.

• Rectal or forehead: 100.4°F (38°C) or higher

• Armpit: 99°F (37.2°C) or higher

Fever readings for a child age 3 months to 36 months (3 years):

• Rectal, forehead, or ear: 102°F (38.9°C) or higher

• Armpit: 101°F (38.3°C) or higher

Call the healthcare provider in these cases:

• Repeated temperature of 104°F (40°C) or higher in a child of any age

• Fever of 100.4° (38°C) or higher in baby younger than 3 months

• Fever that lasts more than 24 hours in a child under age 2

• Fever that lasts for 3 days in a child age 2 or older

If your child has a cast or splint

Call your child’s healthcare provider right away if:

• The casted or splinted body part tingles or feels numb.

• The cast or splint feels too tight or too loose.

• A rash develops under the cast or splint.

• Fingers or toes swell, feel very cold, or turn blue or gray.

• The cast or splint cracks or has rough edges that hurt.

• The cast or splint gets wet.