Preparing for Your Child’s Surgery
We want your family’s experience at Johns Hopkins Children’s Center to be a positive one. The information and resources below will help you prepare children of all ages for what occurs before, during and after surgery.
What to Know Before Surgery
Child Life Specialists
A certified child life specialist can help you and your child prepare for the surgery experience through a phone call, video meeting and/or hospital tours. (Please note: Tours are only available for patients having surgery at the Bloomberg Children’s Center surgery unit).
A child life specialist may be available on the day of your child’s surgery to help explain what is happening, promote coping in the hospital and provide support to make the experience easier.
To speak to a child life specialist about your child’s upcoming procedure, please contact the Child Life Department at 410-955-6276 or [email protected].
Surgery Time Notification
Most families get a phone call on the last business day before the procedure. This call will explain when to arrive, the time of surgery and when your child should stop eating and drinking.
We know that this may be stressful, as it can be difficult to plan transportation, care for other children and other logistics. However, due to surgical emergencies and caring for critically ill patients, we are unable to provide surgery times sooner than the day before the procedure, in most cases.
Please reach out to your surgeon’s office if you have additional questions or concerns about scheduling.
Videos to Help Support Your Child Before Surgery
Preparing for Surgery at Johns Hopkins Children's Center
Children talk about what to expect when preparing for surgery at Johns Hopkins Children's Center
Supporting Your Child on Surgery Day
A video for parents and caregivers to learn about ways they can support their child who is having surgery or a procedure under anesthesia.
Hopkins Kids Talk About Anesthesia
Hopkins kids talk about anesthesia and relate their personal experiences.
Surgery Preparation Materials
NPO Guidelines Prior to Anesthesia
Use these helpful guidelines to prepare yourself and your child for their surgery.
Parent to Parent: Preparing and Coping with Your Child's Surgery
Use our helpful guide, made by parents for parents, to help you prepare for your child's surgery.
Children's Guide to Surgery Coloring Book
Our Guide to Surgery Coloring Book can help you prepare your child for the experience of coming to Johns Hopkins Children's Center for surgery.
For non-Hopkins Institutions, an unbranded coloring book is available for use at other institutions. For more information about purchasing the right to print the activity and coloring book, please download the request form.
How to Prepare for Your Child's Surgery
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Before Surgery Day
- A nurse will call your family the day before your child’s surgery (or the last weekday for surgeries scheduled on Mondays or the day after a national holiday) to inform you what time to arrive, and when to stop giving your infant breastmilk or formula. They can also inform you whether your child is scheduled to stay overnight at the hospital after surgery.
- What to Bring:
- Familiar comfort items (blanket, stuffed animal, pacifier, toys, etc)
- If your child is on a special formula, you may want to bring this with you (there are refrigerators at the hospital to store formula and breast milk).
- Comfortable clothes and personal items for caregivers, if your child is going to be spending the night in the hospital
How to Help your Infant on Surgery Day
- Your infant may be hungry because they are not able to eat anything before surgery.
- You may soothe your child by swaddling, shushing, and rocking them; there are play and comfort items available at the hospital to help soothe infants.
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Before Surgery Day
- A nurse will call your family the day before your child’s surgery (or the last weekday for surgeries scheduled on Mondays or the day after a national holiday) to inform you what time to arrive, and when to stop giving your child food and drink. They can also inform you whether your child is scheduled to stay overnight at the hospital after surgery.
- 1-2 days before the surgery, talk to your child about it using simple words. Explain what body part the doctor is going to fix.
- Your toddler may worry about surgery if told about it too soon, as toddlers do not have a strong understanding of the concept of time.
- What to Bring
- Familiar comfort items (blanket, stuffed animal, pacifier, etc) and/or toys from home. While there are toys in the hospital for your child to use, allowing your child to choose what to bring to the hospital can give them a sense of control.
- If your child is picky about snacks or has dietary restrictions, it may be helpful to bring something they like with you to the hospital
- Comfortable clothes and personal items for caregivers, if your child is going to be spending the night in the hospital
How to Help your Toddler on Surgery Day
- Keep food and drink out of sight. Your child may be hungry since they may not have anything to eat or drink before their surgery. Toddlers may be easily distracted with toys and activities as long as they do not see food or drink.
- Be patient. It is common for toddlers to become fussy or clingy surrounding a hospital experience. Try to provide comfort and support to your child while remaining consistent with your approaches to discipline.
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Before Surgery Day
- A nurse will call your family the day before your child’s surgery (or the last weekday for surgeries scheduled on Mondays or the day after a national holiday) to inform you what time to arrive, and when to stop giving your child food and drink. They can also inform you whether your child is scheduled to stay overnight at the hospital after surgery.
- A few days before the surgery, talk to your child about it using simple words. Explain what body part the doctor is going to fix, using words for body parts that your child is familiar with.
- It is important to give your child enough time to process the information, but not too much time to allow for fears and misconceptions to develop.
- Provide opportunities for your child to express their thoughts and feelings related to the surgery. You can do this by asking open-ended questions, such as “Tell me about your surgery” or “What questions do you have about your surgery”. This will give you a chance to understand your child’s thoughts and potential misconceptions.
- What to Bring
- Familiar comfort items (blanket, stuffed animal, etc) and toys/electronic devices from home. While there are toys in the hospital for your child to use, allowing your child to choose what to bring to the hospital can give them a sense of control.
- If your child is picky about snacks or has dietary restrictions, it may be helpful to bring something they like with you to the hospital.
- Comfortable clothes and personal items for caregivers, if your child is going to be spending the night in the hospital
How to Help Your Preschooler on Surgery Day
- Your child may have fears or misconceptions related to the hospital experience. They may think that they did something wrong to cause the need for surgery. Use concrete, simple language to correct these misconceptions.
- Children often fear the unknown and will sometimes create images in their minds that are scarier than what the experience will actually be like if they do not know what to expect.
- Preparation for what to expect (using videos provided here or consulting with a child life specialist) will often alleviate these concerns for preschoolers and help them learn about what will happen on surgery day.
- Keep food and drink out of sight. Your child may be hungry since they may not have anything to eat or drink before their surgery. Preschoolers may be easily distracted with toys and activities as long as they do not see food or drink. Some may want to choose a special meal or snack they will enjoy after surgery is finished.
- Be patient. It is common for preschoolers to experience regression surrounding a hospital experience; they may revert to thumb sucking or bed wetting. These behaviors are often temporary. Try to provide comfort and support to your child while remaining consistent with your approaches to discipline.
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Before Surgery Day
- A nurse will call your family the day before your child’s surgery (or the last weekday for surgeries scheduled on Mondays or the day after a national holiday) to inform you what time to arrive, and when to stop giving your child food and drink. They can also inform you whether your child is scheduled to stay overnight at the hospital after surgery.
- 1-2 weeks before your child’s surgery, talk to them about it using honest, simple language. Be truthful with your child about what they will experience and listen for any misconceptions or fears they may have. This allows your school-ager time to process the information and develop questions without allowing too much time for fears to develop.
- Preparation for what to expect (using videos provided here or consulting with a child life specialist) will often alleviate these concerns for school-agers and help them learn about what will happen on surgery day.
- Encourage opportunities for your child to express how they are feeling. You can do this by asking open-ended questions like “What questions do you have about surgery” or “What do you think will be difficult about having surgery”
- Encourage your child to talk with their friends about the upcoming surgery. Some families will organize cards or videos to show support to children while they are in the hospital. Children may also utilize technology to stay in touch with family members or peers if they are missing school or other activities.
- Speak with your child’s teachers to plan for your child to make up missed assignments and any attention your child might need once they return to school.
- What to Bring:
- Familiar comfort items (blanket, stuffed animal, etc) and toys/electronic devices from home. While there are toys in the hospital for your child to use, allowing your child to choose what to bring to the hospital can give them a sense of control.
- If your child is picky about snacks or has dietary restrictions, it may be helpful to bring something they like with you to the hospital.
- Comfortable clothes and personal items for caregivers, if your child is going to be spending the night in the hospital
How to Help Your School-Ager on Surgery Day
- Answer your child’s questions and talk about their concerns.
- Common concerns about surgery for school-agers include:
- Anesthesia: Help your child understand that their sleepy medicine doctors (anesthesiologists) will make sure they do not feel anything or wake up during surgery and wake up safely once surgery is over.
- Change in Appearance: Your child’s surgeon can tell you what to expect so you may talk with your child about ways to minimize the appearance of the change. Changes may be short or long term; consider this when discussing these plans with your child.
- Pain: Inform your child that the doctors will give them medicine to help manage pain after surgery. Encourage them to think about ways they have dealt with pain in the past and make a coping plan (deep breathing, squeezing an object or parent’s hand, listening to music, distraction with a show, movie, or game).
- Missing Activities & Peers: Many families make a plan to help their child stay connected to school and friends if they miss activities following surgery. Your child’s surgeon will inform you how long your child may need to miss certain activities or how they can engage in certain modified activities safely as they recover.
- Common concerns about surgery for school-agers include:
- Focus on the positive. Remind your child of the importance and long-term benefits of their surgery.
- Keep food and drink out of sight. Your child may be hungry since they may not have anything to eat or drink before their surgery. School-agers may be easily distracted with toys and activities as long as they do not see food or drink. Some may want to choose a special meal or snack they will enjoy after surgery is finished.
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Before Surgery Day
- A nurse will call your family the day before your teen’s surgery (or the last weekday for surgeries scheduled on Mondays or the day after a national holiday) to inform you what time to arrive, and when your teen must stop eating and drinking.
- Make sure your teen knows the last time they are permitted to eat and drink before surgery. They can also inform you whether your teen is scheduled to stay overnight at the hospital after surgery.
- Involve your teen in all aspects of planning for their surgery, including conversations with doctors. Encourage them to ask questions during conversations to their doctors and learn about their surgery.
- Preparation for what to expect (using videos provided here or consulting with a child life specialist) can be a great opportunity for teens to learn about surgery and discuss coping plans to manage pain and anxiety.
- Encourage opportunities for your teen to express how they are feeling. It is often difficult for teenagers to discuss their feelings with adults; encourage them to talk to peers or write in a journal to process their emotions about surgery.
- Reach out to teachers, coaches, and other important adults in your teen’s life to encourage them to continue to involve teens in events, school work, and other important milestones while they are in the hospital or recovering from surgery.
- Encourage your teen to pack a bag with some comfort items (blanket, pillow, etc.), activities, and electronics that they may use while they are at the hospital.
How to Support your Teenager on Surgery Day
- Answer your teen’s questions and talk about their concerns.
- Common concerns about surgery for teens include:
- Anesthesia: Help your teen understand that their sleepy medicine doctors (anesthesiologists) will make sure they do not feel anything or wake up during surgery and wake up safely once surgery is over.
- Change in Appearance: Your teen’s surgeon can tell you what to expect so you may talk with your teen about ways to minimize the appearance of the change. Changes may be short or long term; consider this when discussing these plans with your teen.
- Pain: Inform your teen that the doctors will give them medicine to help manage pain after surgery. Encourage them to think about ways they have dealt with pain in the past and make a coping plan (deep breathing, squeezing an object or parent’s hand, listening to music, meditating, distraction with a show, movie, or game).
- Common concerns about surgery for teens include:
- Loss of control is a common stressor for teens preparing for and recovering from surgery. They may be frustrated by a loss of independence and relying on others for help with tasks the regularly do on their own.
- Be patient with your teen and encourage safe outlets for their emotions as needed.
- Ensure that they have privacy when possible.
- A nurse will call your family the day before your teen’s surgery (or the last weekday for surgeries scheduled on Mondays or the day after a national holiday) to inform you what time to arrive, and when your teen must stop eating and drinking.
What to Expect When You Arrive on Surgery Day
- After entering The Charlotte R. Bloomberg Children’s Center building at 1800 Orleans Street, you and your child will check in at a security desk. Adults must present a photo ID and will receive a visitor badge.
- Next, you will check in at the Family Lounge on the fourth floor of the Children’s Center. The staff in the Family Lounge will instruct you about the next steps in the process.
- When it is your child’s turn, a nurse or tech will come to the Family Lounge and call their name. They will escort you and your child to the pre-op, or “getting ready,” area. Up to two caregivers may accompany patients during this process. Other loved ones who are 18 years and older may swap out to visit your child in the pre-op area.
- Your child’s pre-op nurse will explain the next steps to you and your child. While in the pre-op area, you will meet your child’s surgeon, anesthesiologist and other staff members who will take care of them. Staff members will ask you and your child questions, some of which will be repeated. This is to keep your child safe.
What to Expect After Your Child’s Procedure
- It is normal for children to have some initial discomfort after a procedure under anesthesia. We will reunite you with your child as soon as possible after their procedure. Our team can also offer suggestions about the best way to comfort and support your child while they begin the recovery process.
- Some patients can be tearful, groggy, disoriented or irritable following anesthesia. Together with your child’s nurse, you can let your child know their procedure is done and they are in the “wake-up room.”
- Some children may be more likely to experience what we call “emergence delirium.” During the early stages of recovery, a child may be tearful, difficult to soothe and unaware of where they are. Your child’s nurse and anesthesiologist will help decide if your child would benefit from additional medications to soothe them during the wake-up process.
- Your child’s doctor will inform you whether your child will go home following their procedure or if they will stay overnight at the hospital for recovery.
If your child is being discharged (going home) following their surgery:
- Your child will be brought to the recovery area, or PACU (post-anesthesia care unit), following their procedure. Our goal is to reunite you with your child as soon as possible.
- Once your child has reached a medically safe point, their nurse will request that you be escorted to their bedside by a patient representative from our Family Lounge. Your child may be starting to wake up or may still be sleeping; both are normal.
- When your child wakes up, the bedside nurse will assess their pain, offer them snacks and drinks if appropriate, and prepare them to leave the hospital. You will remain with your child throughout this process until your child is discharged from the unit.
- Up to two caregivers at a time may be with patients in the PACU, and other visitors 18 years and older may swap out to visit your child once visitation has begun.
- Most caregivers receive a phone call from a recovery nurse the day after their child’s procedure to check in. Ask your child’s surgeon or nurse if you will be receiving a phone call or if there is another type of check-in you will receive. All patients are given emergency contact information in their discharge instructions to use as needed.
PACU Up! | Early Mobilization After Anesthesia
Some patients will be appropriate to participate in our PACU Up! initiative, which promotes early mobilization (such as walking or other movement) after anesthesia. Watch this video to learn more about the program and the benefits of early mobilization following a procedure under anesthesia.
If your child is being admitted (staying overnight at the hospital) following their surgery:
- If your child is admitted to the pediatric intensive care unit (PICU), pediatric cardiac intensive care unit (PCICU) or neonatal intensive care unit (NICU) following their procedure, you will be reunited with your child in their room. When the medical team is ready for you, a staff member from the Family Lounge will escort you to your child’s room. Visitation policies, including how many loved ones may be at the bedside at a time, will be explained by the unit staff.
- If your child is staying overnight in a nonintensive unit following surgery, they will be brought to the recovery area, or PACU (post-anesthesia care unit), following their procedure. Our goal is to reunite you with your child as soon as possible.
- Once your child has reached a medically safe point, their nurse will request that you be escorted to their bedside by a patient representative from our Family Lounge. Your child may be already starting to wake up or may still be sleeping; both are normal.
- When your child wakes up, their bedside nurse will assess their pain, offer them snacks and drinks (if appropriate), and prepare them to move to their overnight room. The amount of time your child will spend in the PACU depends on many factors: your child’s medical needs, their room being available, and staff to help move you and your child to their overnight room. PACU staff members will do their best to keep you updated on this process.
- Up to two caregivers may be with patients in the PACU at a time, and other visitors 18 years and older may swap out to visit your child once visitation has begun.
Frequently Asked Questions
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In most cases, you will get a call between 8 a.m. and 5 p.m. the business day before your child’s procedure. This call will inform you of what time to arrive at the hospital, what time your child needs to stop eating and drinking, and any other information needed to prepare to arrive at the hospital.
We know that this may be stressful, as it is difficult to plan care for other children, transportation and other logistics without more advanced notice. Due to being a hospital setting that cares for surgical emergencies and critically ill patients, we are unable to provide surgery times sooner than the day before your child’s procedure, in most cases.
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Once you and your child arrive at the hospital, there are various steps to help ensure your child is ready for their procedure.
These include (but are not limited to):
- Having their vital signs taken
- Meeting with your child’s surgery, anesthesia and nursing teams
- Reviewing their medical history
- Administering any necessary pre-surgery medications
To ensure that these steps are completed thoroughly and safely, we kindly ask that you arrive at the time provided so we may ensure that your child’s care runs smoothly on surgery day.
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There is a parking garage across the street from the Children’s Center at 1800 Orleans St. Follow signs for the Bloomberg Children’s Center, and you will cross a bridge to enter the hospital. When you arrive, you will stop at a security desk to receive your visitor badge (adults must bring a photo ID).
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We are unfortunately unable to validate parking for patients when they come to the hospital. The parking garage has a maximum daily rate of $15. If you are concerned about being able to pay for parking for your child’s appointment, please let your child’s nurse know when you arrive in the pre-op area.
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After checking in at the security desk, you will take an elevator to the fourth floor of the Children’s Center. When you exit the elevator, there is a glass door to the right of the security station; enter this door to get to the Family Lounge, where you will check in for your child’s procedure.
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We allow up to two parents or caregivers/visitors age 18 and up to accompany patients into the pre-op area. Additional loved ones may wait in the Family Lounge, and swap out with each other to visit patients in the pre-op area.
In order to keep the pre-op area safe, we do not allow siblings under 18 years old or other children to accompany patients. Parents and caregivers remain with their child while they are in the pre-op area and are reunited with them when they get to the recovery room.
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Patients may not have anything to eat or drink before going under anesthesia (also known as being NPO). This is to ensure your child’s safety. If they have contents in their stomach while under anesthesia, it increases their risk for complications with anesthesia, including aspiration (choking on vomit).
If you are concerned about how long your child is ordered to be without food or water, please ask their nurse, who will provide guidance about this important safety practice.
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We do our best to make sure children are comfortable and relaxed when transitioning into the operating room to receive anesthesia and begin their surgery. We can usually offer relaxing medications and distraction strategies to help keep your child calm during this process.
In some cases, it may be safe and appropriate for one caregiver to accompany the child into the operating room until they fall asleep. This is evaluated based on various factors, including staffing needs and the patient’s medical history. If you are interested in accompanying your child into the operating room, you may ask your child’s anesthesiologist about this on surgery day.
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Your child’s medical team will discuss the safest way for them to receive care during their surgery experience. Our team is committed to helping your child have a safe and supportive anesthesia experience.
In most cases, patients who are age 11 and older will be evaluated in the pre-op area to have an IV placed before going to sleep. Exceptions may be considered based on the patient’s developmental stage, anxiety level and other medical factors. Most patients age 10 and under will go to sleep by breathing anesthesia gas through a mask.
Most patients will have an IV placed while they are in the operating room (if it is not placed while they are in the pre-op area) to help maintain their safety and comfort while under anesthesia. If this is the case, your child’s IV will remain in place until they are ready to be discharged from the hospital. This allows your child’s care team to give them additional medications as needed. If you have concerns about how your child will tolerate having an IV in place, please let the nurse know; there are strategies we may implement to help support your child’s coping with this experience.
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If your child is being admitted to an intensive care unit (PICU, PCICU, NICU) after surgery, you will be reunited with them in their hospital room once surgery is complete. If your child is going home after surgery or staying in the hospital on a nonintensive floor, you will be reunited with them in the recovery room (PACU).
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All children wake up at different speeds following a procedure under anesthesia. Some will already be starting to wake up when they arrive to the recovery room. We will reunite you with your child as soon as possible. Once you are reunited with your child, you will remain with them throughout the rest of their time at the hospital.
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In most cases, patients may eat and drink after waking up from anesthesia. Your child may have restrictions on what they may eat or whether they may eat and drink after surgery; your child’s medical team will advise you about these restrictions, if necessary.
The recovery room offers snacks and drinks to patients who are permitted to eat and drink after surgery.
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If your child is being admitted to the hospital overnight, we have various menus to accommodate many dietary needs. To learn more, please ask their nurse. A Kosher pantry is available by request.
If your child is going home after surgery, we recommend bringing a few snacks or drinks that suit their needs to offer them in the recovery room. Please ask your child’s nurse for assistance if any of these items need to be refrigerated. Many patients prefer their own cups or eating tools; you are welcome to bring these to be used while your child is at the hospital.
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Your child’s surgeon will inform you of any bandages, tubes or other visible changes to be prepared for when your child wakes up in the recovery room. Additionally, most children will be connected to a blood pressure monitor, a pulse oximeter and heart monitors as they wake up. These items ensure your child is safely recovering from the procedure. Some children will also have an oxygen mask over their face when they are in the recovery room.
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Your child’s recovery nurse will advise you about the milestones your child needs to achieve before being ready for discharge. Some children wake up fussy or unhappy; in some cases, your child’s nurse may suggest that getting them ready to go home may help them return to baseline faster.
If you do not feel comfortable at the time it is suggested that your child is ready to go, please speak to your child’s nurse. We want you to feel safe and confident bringing your child home after surgery.