WHAT TO EXPECT AFTER SURGERY

Pain relief:

Pain is common after any surgery, even the most minor one.
Expecting some pain and being prepared to handle it is the best thing you and your child can do.
Reassurance should always be your first approach. A lot of times your child will be more anxious than in pain.
Pain level varies from child to child as well as the requirement for pain medicine. You need to treat moderate/severe pain.
Make sure we have the right pharmacy in our records. Most prescriptions have to be e-prescribed to your pharmacy.
Start with over the counter medications:
- Acetaminophen: (Tylenol, etc.)
  - Give every 4 hours while awake for the first 24 hours and then every 6 hours.
  - Do not give more than 5 doses in a 24-hour period.
  - Follow the recommended dose on the bottle/box for your child age.
  - For babies, Tylenol is available as drops. Make sure to use the appropriate dropper.
- Ibuprofen: (Advil, Motrin)
  - If your child responds well to Tylenol, avoid Ibuprofen.
  - However, Ibuprofen can be used if Tylenol alone cannot control your child pain.
  - Ibuprofen can be given every 6 hours alternating with Tylenol. Once pain is controlled with Tylenol, stop the Ibuprofen.
  - Follow the dose instructions on the bottle/box appropriate for your child age.
  - Do not use Ibuprofen for children younger than 6 months of age.
If over the counter medications do not work, or if our surgeon informs you that this option will not be enough, your next step is to use a Narcotic:
- These come in different names and can consist of a combination of a narcotic and Acetaminophen or a narcotic by itself.
  - Lortab elexir, Hycet liquid, Norco tabs, Percocet tabs and Tylenol with codeine (Tylenol #3) are all combination narcotics.
  - Oxycodone, Oxycontin (extended release) and Hydrocodone are plain narcotics.
  - Do not give Tylenol at the same time you are giving a combination narcotic, both contain Acetaminophen.
  - Alternate a combination narcotic with Tylenol or Ibuprofen every 4 hours for the first 24 hours and then switch to every 6 hours.
  - Please make sure you have your narcotic prescription with you or at the pharmacy before leaving the hospital. Narcotic prescriptions cannot be called in and have to be written. It is always a good idea to fill the prescription while waiting for your child surgery to be done.
  - Always try to discontinue the narcotics at the first sign your child is doing better with the non-narcotics alone. This might take 2-3 days in most cases.

Diet:

Most children will be somewhat sleepy and tired after surgery and they will not have a great appetite. This is expected. Some also have nausea that makes them not ready to eat right away.
Despite the fact it is OK to feed your child after leaving the hospital, it is advised to go slow.
Start with warm or room temperature liquids. Avoid carbonated liquids. Soup is OK.
Once your child tolerates liquids for a few hours, you can start introducing solid foods.
Avoid greasy, fried or spicy food for the first 24-48 hours.
Remember, it is OK if your child does not want to eat solids for the first 1-2 days. As long as your child is drinking well keep encouraging him/her.
Please let us know if your child has repeated vomiting and/or is not eating at all.

Activity level:

Babies and infants should resume normal activities right away with no restrictions.
Older children may return to daycare or school when pain is well controlled with over the counter medications. Gradual increase in activity level is advisable but your child might be ready to go back to school the day after surgery. Use your judgment.
Older children can resume sports and PE classes in 10-14 days. Listen to your body... If you are still having pain, do not overdo it.
All children have to be off narcotics for at least 24 hours before returning to school. Adolescents should not drive or operate machinery while on narcotics.

Bathing:

Your child incision and the dressing covering it should stay completely dry for the 1st 48 hours. A baby can have a sponge bath away from the incision.
After 48 hours, you can remove the tape/dressing leaving the Steri-strips in place. Your child can have a shower.
No submersion in water, bath, swimming pool for 7-10 days after surgery.
If your child has a drain, he/she should not shower with the drain in place. If you can cover the drain exit with waterproof tape, it is OK to shower. After the drain is out, wait for 48 hours for the drain site to seal before showering.

Wound care:

Most of the time the surgical wound will be closed using dissolvable sutures underneath the skin so no sutures need to be taken out. Vary rarely your child will have outside stitches that will need to be removed 7-10 days after surgery.
The wound will be covered by thin Band-Aids called Steri-strips and then there will be a gauze on top with a transparent dressing. Sometimes the wound will be covered with skin glue and in this case no transparent dressing will be in place.
As mentioned, keep the wound dry for the 1st 48 hours. Afterwards, you can take off the transparent dressing and the gauze leaving the Steri-strips behind. These will star peeling off on their own.
If your child has an open wound, special instructions will be provided to you on what to do. Most time a piece of gauze soaked in Saline will be used to cover the wound with a dray gauze on top. This is called "wet to dry" dressing.
If your child has a drain, keep the site of the drain exit clean and dry as long as the drain is in place. No water to touch the drain. Keep the site covered at all times. Our surgeon will let you know when your child needs to come back to have the drain removed. The nurses at the hospital will show you how to empty the drain bulb and record the amount. Make sure to keep a daily log of the amount and empty the drain at least every 1 hours. It is important to record the amount of drainage to guide us regarding timing of removal.

Bowel management:

Constipation is very common after any surgical procedure. It is caused by a combination of factors including mild dehydration from not eating or drinking, anesthesia, lack of movement after surgery and most importantly narcotic intake.
To reduce the incidence of constipation, keep your child well hydrated the day before surgery. If he/she has a tendency to be constipated, start Miralax 2 days before surgery.
Miralax is an over-the counter laxative. It comes in a powder form and when mixed with a liquid, absorbs water into the intestine and colon making the stools softer. Mix 17 grams (a capful) of the powder with 8 oz of water or juice. Juice is preferred as it masks the taste of the powder. For babies and toddlers, half a capful mixed with 4 oz of juice or milk works well. Miralax usually takes 24-48 hours to have an effect.
To minimize the incidence of constipation after surgery, let your child drink a lot of liquids and avoid narcotics if not needed.
If your child does not have a bowel movement 2 days after surgery (or the day after surgery if prone to constipation) Start giving the Miralax.
If your child does not respond to the Miralax after 24-48 hours, you can add a stimulant laxative like Senna products. These stimulate the colon to contract. Ex-lax comes in a tablet form and in chewable chocolate squares. Infants and toddlers love the chocolate squares. To have quicker results consider giving a suppository stimulant laxative like Dulcolax (5 mg if under age 10 years and 10 mg if age 10 years and older).
If no bowel movement 24 hours after the suppository, give your child a Pediatric Fleet Enema.

What to expect after surgery

​

Pain relief:

Pain is common after any surgery, even the most minor one.

Expecting some pain and being prepared to handle it is the best thing you and your child can do.

Reassurance should always be your first approach. A lot of times your child will be more anxious than in pain.

Pain level varies from child to child as well as the requirement for pain medicine. You need to treat moderate/severe pain.

Make sure we have the right pharmacy in our records. Most prescriptions have to be e-prescribed to your pharmacy.

Start with over the counter medications:

Acetaminophen: (Tylenol, etc.)

Give every 4 hours while awake for the first 24 hours and then every 6 hours.

Do not give more than 5 doses in a 24-hour period.

Follow the recommended dose on the bottle/box for your child age.

For babies, Tylenol is available as drops. Make sure to use the appropriate dropper.

Ibuprofen: (Advil, Motrin)

If your child responds well to Tylenol, avoid Ibuprofen.

However, Ibuprofen can be used if Tylenol alone cannot control your child pain.

Ibuprofen can be given every 6 hours alternating with Tylenol. Once pain is controlled with Tylenol, stop the Ibuprofen.

Follow the dose instructions on the bottle/box appropriate for your child age.

Do not use Ibuprofen for children younger than 6 months of age.

If over the counter medications do not work, or if our surgeon informs you that this option will not be enough, your next step is to use a Narcotic:

These come in different names and can consist of a combination of a narcotic and Acetaminophen​ or a narcotic by itself.

Lortab elexir, Hycet liquid, Norco tabs, Percocet tabs and Tylenol with codeine (Tylenol #3) are all combination narcotics.​

Oxycodone, Oxycontin (extended release) and Hydrocodone are plain narcotics.

Do not give Tylenol at the same time you are giving a combination narcotic, both contain Acetaminophen.

Alternate a combination narcotic with Tylenol or Ibuprofen every 4 hours for the first 24 hours and then switch to every 6 hours.

Please make sure you have your narcotic prescription with you or at the pharmacy before leaving the hospital. Narcotic prescriptions cannot be called in and have to be written. It is always a good idea to fill the prescription while waiting for your child surgery to be done.

Always try to discontinue the narcotics at the first sign your child is doing better with the non-narcotics alone. This might take 2-3 days in most cases.

​

​

Diet:

​Most children will be somewhat sleepy and tired after surgery and they will not have a great appetite. This is expected. Some also have nausea that makes them not ready to eat right away.

Despite the fact it is OK to feed your child after leaving the hospital, it is advised to go slow.

Start with warm or room temperature liquids. Avoid carbonated liquids. Soup is OK.

Once your child tolerates liquids for a few hours, you can start introducing solid foods.

Avoid greasy, fried or spicy food for the first 24-48 hours.

Remember, it is OK if your child does not want to eat solids for the first 1-2 days. As long as your child is drinking well keep encouraging him/her.

Please let us know if your child has repeated vomiting and/or is not eating at all.

​

Activity level:

Babies and infants should resume normal activities right away with no restrictions.

Older children may return to daycare or school when pain is well controlled with over the counter medications. Gradual increase in activity level is advisable but your child might be ready to go back to school the day after surgery. Use your judgment.

Older children can resume sports and PE classes in 10-14 days. Listen to your body... If you are still having pain, do not overdo it.

All children have to be off narcotics for at least 24 hours before returning to school. Adolescents should not drive or operate machinery while on narcotics.

​

Bathing:

Your child incision and the dressing covering it should stay completely dry for the 1st 48 hours. A baby can have a sponge bath away from the incision.

After 48 hours, you can remove the tape/dressing leaving the Steri-strips in place. Your child can have a shower.

No submersion in water, bath, swimming pool for 7-10 days after surgery.

If your child has a drain, he/she should not shower with the drain in place. If you can cover the drain exit with waterproof tape, it is OK to shower. After the drain is out, wait for 48 hours for the drain site to seal before showering.

​

Wound care:

Most of the time the surgical wound will be closed using dissolvable sutures underneath the skin so no sutures need to be taken out. Vary rarely your child will have outside stitches that will need to be removed 7-10 days after surgery.

The wound will be covered by thin Band-Aids called Steri-strips and then there will be a gauze on top with a transparent dressing. Sometimes the wound will be covered with skin glue and in this case no transparent dressing will be in place.

As mentioned, keep the wound dry for the 1st 48 hours. Afterwards, you can take off the transparent dressing and the gauze leaving the Steri-strips behind. These will star peeling off on their own.

If your child has an open wound, special instructions will be provided to you on what to do. Most time a piece of gauze soaked in Saline will be used to cover the wound with a dray gauze on top. This is called "wet to dry" dressing.

​

Bowel management:

Constipation is very common after any surgical procedure. It is caused by a combination of factors including mild dehydration from not eating or drinking, anesthesia, lack of movement after surgery and most importantly narcotic intake.

To reduce the incidence of constipation, keep your child well hydrated the day before surgery. If he/she has a tendency to be constipated, start Miralax 2 days before surgery.

To minimize the incidence of constipation after surgery, let your child drink a lot of liquids and avoid narcotics if not needed.

If your child does not have a bowel movement 2 days after surgery (or the day after surgery if prone to constipation) Start giving the Miralax.

If no bowel movement 24 hours after the suppository, give your child a Pediatric Fleet Enema.

These come in different names and can consist of a combination of a narcotic and Acetaminophen or a narcotic by itself.

Lortab elexir, Hycet liquid, Norco tabs, Percocet tabs and Tylenol with codeine (Tylenol #3) are all combination narcotics.

Most children will be somewhat sleepy and tired after surgery and they will not have a great appetite. This is expected. Some also have nausea that makes them not ready to eat right away.