Adenoidectomy- managing 7 year old's anxiety (sorry long!)

After 3 years of wait and see with the ent, trying different medications, working with the pediatrician and the allergist, the time has come for my sweet girl to have surgery.

/Backstory for those who may be dealing with something similar... Or jump to the bottom for my concerns and questions.

For the last 3 years, from fall to spring, she has fluid in her ears and congestion. Year 1 (pre-k) was bad with a couple ear infections and pneumonia, but by May the fluid cleared and she could hear again. Year 2 (k) was still bad, but didn't start until almost December of that year so we though her immune system was getting stronger.. But in that year she had 6 ear infections, 2 bouts of strep, a serum reaction to abx which caused painful swollen ankles for months. Then the fluid cleared in the spring and she was fine all summer into this last October. This year seemed so much better... No ear infections or strep, but she has had varying amounts of fluid almost continually since October. The congestion is causing some reactive airway issues, and even though she is on an inhaler, steroid nasal spray, and allergy med (Claritin)... And it's July... Her head is filled with fluid and she can't hear. We did a neck X-ray last week and her adenoids are huge (take up almost 80% of the space between the base of her skull and her palate--- should only take up 30% at most).

/End of back story.

So because she has been to doctors a lot in the last 3 years, there are certain things that she doesn't like and freaks about now. Blood work is the major one... But even looking in her ears causes some anxiety (over zealous peds resident last year turned the otoscope a little and it hurt inside her ear).

She knows she is getting her adenoids out and that the doctor is going to drain the fluid from her ears while she is sleeping. She is talking about the procedure and has explained it to all her friends, her lax coaches, random people she met who worked at this birthday party place.. So she is processing it. She knows she needs to go get her blood drawn and as prep, she is coming with me tomorrow to watch me get my blood drawn. I'm hoping that seeing the situation without the anxiety and panic might help her calm down a bit.

Any other tips from btdt moms about how to help her? We are answering her questions, trying to give her tools to mange her anxiety (breathing exercises to calm down), I told her beloved tiger (fav stuffed animal) will come with her and be with her while she is asleep. We are going on vacation for two weeks and then have a week to do pre op appointment, so we have 3 weeks before the surgery. Thanks for reading my long, rambling, pre-coffee brain dump.

 

EMLA cream!  Is that stuff available over the counter yet?  Basically it's a numbing cream, you can use it before the blood draw so she doesn't feel it.  It might help her be not as anxious about the stuff that follows. . .

 

From quick google search, it's over the counter in Canada and uk, but not here in us. Maybe I will ask my friend who lives in uk to buy and send it- or just call the ped and ask for a script.

 

That's a great idea to get the numbing cream! I have no btdt advice, but as a mom to an anxious kid - my advice would be to limit the amount of time it's talked about once she has asked all the questions and understands the procedure. If she likes to talk about it a lot (Lennon loves to talk about things that are stressing him out over vas over again), maybe allow 5 minutes at breakfast and then "close" the conversation til tomorrow. This was the advice from Lennon's ot during his choking anxiety and I couldn't believe how well it worked!

 

Thank you so much Jori!  I love this idea because I definitely think she can talk herself into a frenzy and then start obsessing over it.  We have 3 jam packed weeks of fun visiting family so hopeful there will be lots of other things to occupy her mind.

 

Pediatrician should be able to just do a Rx.  It's great stuff, just goop it on, cover with saran wrap and let it absorb for an hour.  Voila!  No pain.  

 

The place she is having this surgery done SHOULD be able to do it pre-procedure with the numming cream. 
 
Ask if they have someone who could be with her, possibly distracting her with an iPad.  I was worried sick with the last MRI for Audrey and there was nothing to worry about.  She did great!  Good luck!

 

If they are putting her out for the surgery, won't they do blood draw/IV after she's out? That's what our ENT did for Anna with her surgeries.

 

This is for her pre op testing before surgery.

 

Both of mine have had adenoid surgery as outpatients -, one place requested bloodwork before the surgery, the other place did it once he was out for the surgery. We had the numbing cream both times, it was great.
 
They also got a sirup to make them drowsy and forgetful as soon as we arrived at the outpatient center so they could not work themselves up into a frenzy while waiting and having the pre-surgery routines done. Maybe ask about that too. Places that do a lot of surgery for children offer it automatically here, but we had to ask for it in the other outpatient center which had fewer kids as patients.
 
For DS the plan was also adenoid surgery and draining the fluid from the ears but the infection was so bad that the operating doctor decided spontaneously during the surgery to place tubes too. He had mentioned this as a remote possibility at the pre-surgery appointment. It turned out to be a good  decision because it took about 2 weeks with tubes and local antibiotics to clear the infection he had been fighting all winter. But it was so worth it - just to hear him say the morning after the surgery "mom, why is the water so loud" while brushing his teeth.

 

Thanks everyone. When she had her clogged tear duct opened at 14 months old, they gave her versed which made her loopy. Interesting that some doctors do the b/w right before the surgery... I was told that it's part of the process to clear her for surgery so they need the info ahead of time.

 

Leighann, this has nothing to do with your question and I apologize for jumping in here.  My best friend's youngest son had his adnoids taken out when he was in pre-k (age 4) and one of the things she said she did not realize, was how bad his breath would be afterwards.  Be prepared for that!  But after having the surgery he could hear much better and has been sick less, so I wish your little lady all the best.
I do agree with Jori, limit her time discussing the surgery.  I have two anxious children, so I know when they are talking about something over and over and over again, they are worried about it.  So we limit the time.  I think the numbing cream, deep breathing exercises, assuring her that you will be there when she wakes up and that she's going to be okay will help.  And telling her feeling a little anxious is normal but that the doctors and nurses will take such good care of her.

 

if you're using the EMLA make sure you place it ANYWHERE you think they may draw blood - inside of both elbows, both wrists and back of both hands - that way you're covered in case they miss in any one of those places.

 

Just a quick update... She has her pre op blood work and appointment with the anesthesiologist tomorrow morning at the hospital. When I scheduled this appointment I asked about emla and was told they provided emla for all the peds patients! Yeah no ouchies . This info has helped calm her a lot.

I'm sure the next week is going to be tough, but we are trying to limit how much she perseverates on it, and trying to help her refocus on how much better she will feel after the surgery is all done. It's helped a lot that several friends this year have had some kind of surgery because she talks about them and the treats they got after (couple of tonsillectomies in 1st grade last year). She has planned her menu of must have soft food for after surgery, and is happy her beloved tiger can come with her. Next Wednesday can't come fast enough though... Thanks again for all the advice and support.

 

Update to my update- EMLA cream rocks!!! That plus watching despicable me on the iPad and she didn't even flinch when they did the blood draw. No tears, no anxiety, which is huge to helping her not be anxious when we go back to the hospital next week for the surgery.

 

Hooray!  I'm glad she had a non-traumatizing blood draw.  Hopefully that should make next week better and less stressful for her.  (Not for you though.)  You know we're waiting to hear from you once the surgery is done.  :wub:

 

Thanks bex. I will definitely update here to let everyone know how she is. Right now we are just trying to get to Wednesday without her getting sick. I have a sinus infection and she was up half the night with horrible ear pain, so off to the pedi today, two days before her med clearance at the same pedi. Ug. The only other time she has woken and cried with ear pain is right before her ear drum ruptured... :wacko:

 

Did you make it to today without being sick?

 

We did! She did great today. She ended up having both the adenoidectomy and myringotomy (drain the fluid from her ears without inserting tubes). She wasn't scheduled until this afternoon and dealt with the whole fasting thing so well this morning. She was nervous at the hospital but was a total trooper. She was a little upset coming out of the anesthesia, but after a few minutes calmed down, had some water, watched some tv, and asked to go home! We got home and she had applesauce, room temp soup, and the begged for yogurt and bread. She got upset when I had to do the ear drops, but I expected it. The nurse said they might sting, but she didn't get totally freaked out the way she has in the past. So today was a long day, but we all hung in there. Hopefully she sleeps well tonight.

 

:hug: Leighann!  Glad did she so great and the surgeries went well.  How did she sleep?

 

She slept all night and woke up this morning in a good mood! She isn't in any pain, but her tongue is still pretty swollen so I gave her some Tylenol and she is happily playing with Ana.

 

Glad it went so well.

 

Glad that it went well.... Hope she recovers fast