Preparing for surgery for a six-month-old
May 22, 2018 8:25 PM Subscribe
Baby banana is six months old and getting tubes in his ears and scoped for reflux on Thursday morning. What do we need to know about prep and recovery? In particular, how should we deal with the no food after midnight rule?
Baby banana is getting tubes for recurrent ear infections (he's had seven so far - more details in this previous question), and, while he's under, is also getting scoped for reflux.
He's six months old, does not sleep through the night, is not night weaned, and eats mostly Alimentum (because of suspected food allergies) with as much comfort nursing as he wants (I'm on a special diet so my breastmilk won't bother him). He eats some solids but he's off them for right now because of increased reflux and constipation. Because of (what we think is) reflux, he reverse cycles and gets a lot of his calories and hydration for the day overnight. He doesn't take a pacifier except very occasionally to chew on.
The surgery is scheduled for 7:30 am on Thursday. The ENT told us he can't have anything to eat or drink after midnight. Our pediatrician thought water would be okay up to 4 ish hours before the surgery. We know the person who can really tell us about that is the anesthesiologist, who is supposed to call us tomorrow.
Even with a large bedtime feed, a 9-ish pm dream feed and an 11:45 pm dream feed, this seems like a recipe for a very grumpy, hangry baby around 4 am, if not earlier.
We're most interested in hearing:
1. How you dealt with a hungry, upset young baby before surgery when they couldn't be given food. Specific strategies would be awesome.
2. How your baby did coming out of the anesthesia (I've heard about emergence delirium, etc.).
3. Anything else about your baby's tubes surgery or other surgery you wish you'd known beforehand, including dealing with your own anxiety!
Thank you!
Baby banana is getting tubes for recurrent ear infections (he's had seven so far - more details in this previous question), and, while he's under, is also getting scoped for reflux.
He's six months old, does not sleep through the night, is not night weaned, and eats mostly Alimentum (because of suspected food allergies) with as much comfort nursing as he wants (I'm on a special diet so my breastmilk won't bother him). He eats some solids but he's off them for right now because of increased reflux and constipation. Because of (what we think is) reflux, he reverse cycles and gets a lot of his calories and hydration for the day overnight. He doesn't take a pacifier except very occasionally to chew on.
The surgery is scheduled for 7:30 am on Thursday. The ENT told us he can't have anything to eat or drink after midnight. Our pediatrician thought water would be okay up to 4 ish hours before the surgery. We know the person who can really tell us about that is the anesthesiologist, who is supposed to call us tomorrow.
Even with a large bedtime feed, a 9-ish pm dream feed and an 11:45 pm dream feed, this seems like a recipe for a very grumpy, hangry baby around 4 am, if not earlier.
We're most interested in hearing:
1. How you dealt with a hungry, upset young baby before surgery when they couldn't be given food. Specific strategies would be awesome.
2. How your baby did coming out of the anesthesia (I've heard about emergence delirium, etc.).
3. Anything else about your baby's tubes surgery or other surgery you wish you'd known beforehand, including dealing with your own anxiety!
Thank you!
Yes, it will suck. And it will especially be hard for you to comfort him since you smell like lunch. See if there might be some other caregivers around to spell dad if baby is really inconsolable.
But it might not be that bad. My daughter had a sedated MRI and two surgeries before she turned one, and she was not happy about the fasting but it also wasn't any worse than a bad day for her. So, not pleasant but not devastating either. You have the earliest appointment of the day? If not, see if you can move it even earlier - you'll have to start the fast sooner but it will also probably be during the period when he's least likely to be eating already.
My daughter had no problems coming out of anesthesia. Groggy, cranky, wanted to be held. Set yourself up with an empty bladder, some snacks, a podcast or book and a comfy chair for the long haul.
I do not recommend leaving the waiting room for any reason during the procedure. The two minutes I was gone were the two minutes the surgeon came out to talk to us. I'm sure my husband and parents captured what he said, but I still wish I'd been there for the conversation.
posted by peanut_mcgillicuty at 9:09 PM on May 22, 2018 [2 favorites]
But it might not be that bad. My daughter had a sedated MRI and two surgeries before she turned one, and she was not happy about the fasting but it also wasn't any worse than a bad day for her. So, not pleasant but not devastating either. You have the earliest appointment of the day? If not, see if you can move it even earlier - you'll have to start the fast sooner but it will also probably be during the period when he's least likely to be eating already.
My daughter had no problems coming out of anesthesia. Groggy, cranky, wanted to be held. Set yourself up with an empty bladder, some snacks, a podcast or book and a comfy chair for the long haul.
I do not recommend leaving the waiting room for any reason during the procedure. The two minutes I was gone were the two minutes the surgeon came out to talk to us. I'm sure my husband and parents captured what he said, but I still wish I'd been there for the conversation.
posted by peanut_mcgillicuty at 9:09 PM on May 22, 2018 [2 favorites]
My eldest daughter had emergence delirium, and I wasn’t forewarned. It was spooky. She thrashed and couldn’t be comforted. The nurses were, “oh, yeah, that happens, don’t worry about it.”
Fortunately she came out of it quickly. (Possibly genetics. I exit anasthesia unusually quickly)
posted by blob at 9:40 PM on May 22, 2018 [1 favorite]
Fortunately she came out of it quickly. (Possibly genetics. I exit anasthesia unusually quickly)
posted by blob at 9:40 PM on May 22, 2018 [1 favorite]
Pester the medical staff; find someone who is knowledgeable specifically about breastfeeding. I was told that breastmilk was considered a clear liquid for medical purposes and was permitted for most cases where fasting was called for. If water is okay 4 hours before, breastmilk should be, too.
That might not be true here - sometimes, they really do need an empty stomach - but make sure that someone who knows that breastmilk is not the same as formula has confirmed that.
7 hours of hunger for a 6-month-old stomach seems like a lot. Get them to confirm that a cranky, exhausted, stressed and scared baby is medically better than one who was fed a few hours before the procedure. And if so... see if you can get extra sleep the day before and spend those last few hours comforting a baby who can't be given his primary form of comfort.
Having someone else comfort him for those last few hours may be better. He'll likely be fussy with Dad but inconsolable with you - he can tell that the milk is right there! and you're not giving it to him.
posted by ErisLordFreedom at 10:52 PM on May 22, 2018 [4 favorites]
That might not be true here - sometimes, they really do need an empty stomach - but make sure that someone who knows that breastmilk is not the same as formula has confirmed that.
7 hours of hunger for a 6-month-old stomach seems like a lot. Get them to confirm that a cranky, exhausted, stressed and scared baby is medically better than one who was fed a few hours before the procedure. And if so... see if you can get extra sleep the day before and spend those last few hours comforting a baby who can't be given his primary form of comfort.
Having someone else comfort him for those last few hours may be better. He'll likely be fussy with Dad but inconsolable with you - he can tell that the milk is right there! and you're not giving it to him.
posted by ErisLordFreedom at 10:52 PM on May 22, 2018 [4 favorites]
Our daughter has had tubes twice, at 11 months and 19 months. Both times I was allowed to nurse her four hours before surgery. I would get confirmation from your doctor again.
posted by notjustthefish at 11:04 PM on May 22, 2018 [2 favorites]
posted by notjustthefish at 11:04 PM on May 22, 2018 [2 favorites]
My daughter had the exact same symptoms and surgery at that age (and her adenoids removed). We played with her to tire her out the night before, and she woke up to feed and we let her sooth herself back to sleep. It was rough but kids are tough and able to handle it.
Handing her over to the doctors was rough, they put her under, we barely had time for a coffee before they had finished. Coming out she had emergence delirium, I just held her and talked to her as she growled and thrashed, and then calmed down enough that she could feed.
The end results were fantastic, the fluid in her ears had been impacting her hearing and speech development. She is a strong active 4 year old now.
posted by nickggully at 5:36 AM on May 23, 2018
Handing her over to the doctors was rough, they put her under, we barely had time for a coffee before they had finished. Coming out she had emergence delirium, I just held her and talked to her as she growled and thrashed, and then calmed down enough that she could feed.
The end results were fantastic, the fluid in her ears had been impacting her hearing and speech development. She is a strong active 4 year old now.
posted by nickggully at 5:36 AM on May 23, 2018
This article explains the debate over fasting before surgery, including the risks of having the patient be dehydrated or malnourished.
This may be helpful in informing your discussion with the anesthesiologist.
posted by Mr.Know-it-some at 6:01 AM on May 23, 2018 [1 favorite]
This may be helpful in informing your discussion with the anesthesiologist.
posted by Mr.Know-it-some at 6:01 AM on May 23, 2018 [1 favorite]
We did this in January with a 10-month-old. I was incredibly anxious beforehand but the surgery was incredibly quick — they actually told us not to leave the waiting area because it would be so quick — and our son immediately had improved hearing afterwards. (As measured by his reaction to music.) He also hasn't had an ear infection since, which has been awesome.
He had stopped night feeding at that point, but we were concerned about not being able to feed him in the morning. Waking him up super early, keeping him in a carrier, and talking to him in the hospital constantly seemed to do the trick — we tried to keep him distracted and occupied, and because he was so young, his surgery was scheduled very early. (They have the younger kids go first.)
Only one of us was allowed back with him when he was waking up. It was me. I went back, and he was crying hysterically for a few minutes, but immediately calmed down when they gave him some Motrin and Tylenol. They also had me give him a small bottle of Pedialyte to get some calories into him, and then I was allowed to feed him in recovery. I sang to him and after he ate, he fell asleep.
For the drops they'll give you for afterwards, we found that showing the baby a YouTube Sesame Street video did the trick. (He doesn't typically watch screens.) But he would stay still long enough for us to drip the drops in, which was great.
If you have questions, talk to the doctors. They should all be incredibly used to working with young babies and parents. We were very pleased with every single person we encountered at the children's hospital. They all made us feel much better about what was a very scary day in our minds, but just a normal Tuesday for them.
posted by melodykramer at 7:26 AM on May 23, 2018
He had stopped night feeding at that point, but we were concerned about not being able to feed him in the morning. Waking him up super early, keeping him in a carrier, and talking to him in the hospital constantly seemed to do the trick — we tried to keep him distracted and occupied, and because he was so young, his surgery was scheduled very early. (They have the younger kids go first.)
Only one of us was allowed back with him when he was waking up. It was me. I went back, and he was crying hysterically for a few minutes, but immediately calmed down when they gave him some Motrin and Tylenol. They also had me give him a small bottle of Pedialyte to get some calories into him, and then I was allowed to feed him in recovery. I sang to him and after he ate, he fell asleep.
For the drops they'll give you for afterwards, we found that showing the baby a YouTube Sesame Street video did the trick. (He doesn't typically watch screens.) But he would stay still long enough for us to drip the drops in, which was great.
If you have questions, talk to the doctors. They should all be incredibly used to working with young babies and parents. We were very pleased with every single person we encountered at the children's hospital. They all made us feel much better about what was a very scary day in our minds, but just a normal Tuesday for them.
posted by melodykramer at 7:26 AM on May 23, 2018
For #2, my kid was like 10 months when we did tubes, I think ... and he was just SO MAD when he woke up. So, so mad. But he calmed down quickly. The whole experience was not as bad as I feared at all. The nurses, etc have all done this before and are generally great with helping with anything.
posted by freezer cake at 8:08 AM on May 23, 2018
posted by freezer cake at 8:08 AM on May 23, 2018
Response by poster: Thank you all for the great advice. Baby banana did great!
In case this is useful for future readers:
We called and asked about breastmilk and were told he could have formula up to 6 hours before, breastmilk up to 4 hours before, and water up to 2 hours before. With some carefully timed dream feeds and some overnight help from our doula (highly recommended if possible!), he was actually pretty happy right up until the surgery.
He was pretty mad afterward - he screamed for about half an hour before he wore himself out, then napped for 30 minutes in the recovery room, and then cried with less intensity for another 20-30 minutes before they discharged us. By the time we got him out to the car, he was done crying, and he was essentially back to normal (including laughing, smiling, and rolling all over) about 3.5 hours after the surgery started. Yay!
posted by bananacabana at 8:41 PM on May 26, 2018 [1 favorite]
In case this is useful for future readers:
We called and asked about breastmilk and were told he could have formula up to 6 hours before, breastmilk up to 4 hours before, and water up to 2 hours before. With some carefully timed dream feeds and some overnight help from our doula (highly recommended if possible!), he was actually pretty happy right up until the surgery.
He was pretty mad afterward - he screamed for about half an hour before he wore himself out, then napped for 30 minutes in the recovery room, and then cried with less intensity for another 20-30 minutes before they discharged us. By the time we got him out to the car, he was done crying, and he was essentially back to normal (including laughing, smiling, and rolling all over) about 3.5 hours after the surgery started. Yay!
posted by bananacabana at 8:41 PM on May 26, 2018 [1 favorite]
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I'd go for a walk outside during the procedure.
posted by Kalmya at 8:33 PM on May 22, 2018 [3 favorites]