Tonsillectomy tales: part 1, Preparing a child

This week, my three-year-old daughter had her tonsils and 75% of her adenoids removed. This is a standard surgical procedure and is often listed dismissively by patients when they provide their medical history, as if it was no big deal. But as a parent -- no surgery is too small. The next few blog entries are going to describe my experiences as a parent, psychologist, and someone who knows the inner workings of hospitals -- as does my wife, who is a registered nurse. Today's entry will focus on the psychology of the preparation phase for a three-year-old child.

To begin with, you really have to put yourself in the mindset of the child and remember that he/she does not have your life experiences and that a hospital is likely going to be a strange and scary place. But my wife and I decided we had to tell her the truth because if anything we say to her is going to have any impact in the future, she needs to know she can trust us. So for a few weeks, we told her that she was going to go to the hospital, where she will see the doctor to get her tonsils out. We told her where her tonsils were located and why they had to come out. We repeatedly conveyed the message that "everything is going to be ok" and that "daddy and mommy will be there." This is important because the child needs to feel emotionally and physically safe and maintaining that parent-child bond is crucial. We also told her that we had our tonsils out when we were children too, which also makes it feel more safe for the child.

We tried to always emphasize the positive, such that she will get to eat lots of ice pops, ice cream, and pudding afterwards and this made it sound fun to her. We also made a little joke with her that she would ask the doctor for ice cream as soon as she saw him. She found that funny. So after weeks of preparation the day finally arrived and I am certain that it helped get her out the door without a hitch. We brought one of her stuffed animals for additional psychological security purposes. Whenever you are taking a child from the safety of their home, it is a good idea to bring something that represents the home environment with them because it maintains that connection.

When we arrived to the hospital, the goal for us was to make every part as fun as possible. For example, when her name was called by the registration clerk we made her feel special by saying someone was calling just for her. When given an ID bracelet and allergy bracelet, we made this out to be like she was receiving a gift, rather than a mandatory hospital policy. Sometimes, you just can't think of everything though and she just did not want to slip into the hospital gown. Therefore, we just continuously focused on the tigers on the gown and how the doctor said she had to wear it in order to get her ice cream. Eventually, she listened. Going hours without food was not easy either, but the continued promises of ice cream did wonders to appease her.

Giving her as much warning about any transitional changes was very important in preventing her from becoming too scared. We explained to her that the doctors wear silly hats and white coats and that the doctor needs lots of helpers like Santa Clause does. When the medical team came for her, despite all the preparation, she was still scared and did not want to be taken away. Thankfully, the doctor let my wife take her to the operating room, where my wife and the nurse sang her a song and the anesthesia quickly took effect. The surgery was a success and five minutes after waking up she looked at me, smiled, opened her mouth wide and with a big blue ice pop in her hand said "Look daddy! I just got my tonsils out."