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SickKids
Close up of surgeon hands high fiving during operation

Before Your Child’s Surgery

Preparing before the surgery will help things run smoothly on the day of your child’s procedure. Below, we have made a list and provided useful links to help you make sure you and your child are ready. Also review information on what to expect the day of surgery.

Important: stop eating and drinking before anesthesia or sedation

The rules about eating and drinking before an operation are very important. Any food or liquid in your child's stomach while going to sleep under anesthesia can flow up to the mouth and pass down into the lungs. This is very dangerous for your child.

If these rules are not followed your child's procedure will be cancelled. Please read them carefully.

  • At midnight (12 a.m.) before operation time:
    • Stop solid foods
    • Solid foods include liquids with solid components/bits (i.e. orange juice, soup broth) as well as jello
    • Patients who no longer drink from a bottle should not have solids or any time of milk after midnight
    • No gum or candy after midnight
  • 6 hours before operation time:
    • Stop bottle feeds/tube feeds
  • 4 hours before operation time:
    • Stop breast milk
  • 3 hours before operation time:
    • Stop clear fluids
    • Clear fluids are fluids you can see clearly through (i.e. water, clear apple juice, ginger ale)
    • Jello is not a clear fluid
This diagram shows when patients need to stop eating and drinking solid foods, bottle/tube feeds, breast milk and clear fluids before surgery.
It's important to stop eating and drinking in the 24 hours before surgery.

Day before surgery

Expand the sections below to learn more about each step before your child’s surgery.

It is important that your child does not have any other illnesses that will make it harder for them to recover from their surgery. A fever, cold, cough, runny nose, or sore throat can become much worse after an anesthetic, or make it harder for your child to breathe during or after the procedure.

Does your child have any of the health issues listed below?

  • Asthma
  • Breathing, heart or other medical issues
  • Common cold

If your child has any of these above listed symptoms, or has nausea, vomiting or diarrhea, first call your surgeon's office and if necessary, please call us at 416-813-5088.

We will advise you on coming to the hospital to see your surgeon or not. The surgeon will decide if it's safe for your child to proceed with the surgery, procedure or test.

View weather reports for the following day and plan your time accordingly. Print out a map with alternate routes to the hospital if necessary. For instructions to SickKids by car or public transit, review Map & Directions. For places to park around the hospital, please see Parking Information. 

Leave yourself lots of time to get to SickKids  so you arrive two hours before the scheduled surgery time.

For those staying overnight and looking for places to stay close to SickKids, please visit Staying Overnight. 

  • Bring all medications and herbal remedies that your child is currently taking in original containers. This includes: pills, inhalers, puffers, injections, eye drops, vitamins, etc.
  • Bring your child’s Ontario health card
  • Bring your child's SickKids hospital card, if they have one
  • Bring contact information of your family doctor and/or paediatrician, as well as any specialists
  • Bring any medical supplies that your child requires daily (i.e. feeding tube attachments, mobility devices).
  • Bring all pre-operative forms. These forms are generally given to you, or mailed to your house. Please ensure they are filled out as requested. these forms may include:
    • Parent Pre-Operative Questionnaire
    • Pre-Operative Medical Record (physical exam and history to be completed by your family doctor or paediatrician)
    • Medication History Record (list of medications)

At SickKids we do our best to prevent infections after surgery. You play an important role in reducing your child’s risk of infection by ensuring they have been bathed properly before their surgery.

Because skin is not sterile, there are steps that need to be taken to make sure your child’s skin is as free of germs as possible before surgery. You can reduce the number of germs on the skin by carefully bathing them before surgery using the instructions below. Please report any rashes, infections, open areas or sores on your child’s skin to their surgeon before the scheduled surgery date for any further instructions.

Important: Your child will need to bathe with liquid soap. The soap needs to be in liquid form to prevent cross contamination that occurs with bar soap. The brand of soap does not matter.

Younger children should be bathed by a parent or guardian; older children should be supervised to make sure that washing is done effectively.

Patients coming for surgery should remove all nail polish and not wear any makeup on the day of surgery.

Review Preoperative Patient Bathing (pdf) for full instructions.

We do not recommend bringing any other children to the hospital with you on the day of surgery. If possible, we recommend alternative arrangements for siblings. Siblings are not permitted to visit patients in the recovery room, nor the intensive care unit, or some other areas of the hospital where patients require very specific care.

Learn about guidelines for Visiting a Patient.

Whether your child is staying overnight or just for the day will determine what you pack for your stay at SickKids.

Packing for day surgery (you will go home the same day)

This means your child will not be admitted to the hospital overnight. If your doctor has told you that your child will be coming for a day procedure, we suggest bringing the following items from home.

For your child

  • A loose-fitting, comfortable outfit that will fit over any applications (such as a cast) that your child may have after the surgery. Also, make sure it's easy to put on and won’t rub against the area of their surgery.
  • A security object that your child may want to bring into the surgery with them. We suggest limiting this to one or two items (stuffed animal, blanket, favourite toy, etc.)
  • An empty bottle or sippy-cup for your child to drink clear fluids from after the surgery (for younger children)
  • A plastic bag or plastic container that you can use if your child feels sick on the way home
  • Eyeglasses and case, or retainer and case, if your child wears them.

For yourself

  • A pen and paper to write down the surgeon’s recommendations for care of your child at home
  • A book, magazine, crossword, or other material for yourself during your child’s surgery
  • Snacks for yourself. It is important to remember to eat throughout the day. Feeling weak or lightheaded will interfere with your ability to care for your child.

Same day admit (you will stay overnight at the hospital after surgery)

This means your child will be admitted to the hospital overnight on the same day of their surgery. They will go to a unit after their surgery and stay overnight. Your child will be provided with pajamas, slippers, a pillow and bed linens. One parent will also be provided with a pillow and blankets. We suggest the following items from home.

For your child

  • A security object that your child may want to bring into the surgery with them, we suggest limiting this to one or two items (stuffed animal, blanket, favourite toy, etc.)
  • An empty bottle or sippy-cup for your child to drink clear fluids from after the surgery (for younger children)
  • An extra pair of pajamas for your child to wear a day or so after the surgery. If they will be staying more than one night, children sometimes feel better wearing their own clothing
  • Toiletries, such as toothbrush, toothpaste, and hairbrush for both you and your child
  • Reading material or a favourite low-key entertainment options (card games, board games) for your child to do while recovering on the unit

For yourself

  • A book, magazine, crossword, or other material to occupy yourself during your child’s surgery
  • Snacks for yourself, it is important to remember to eat throughout the day
  • Phone number of family and friends whom you would like to contact

Note: please do not bring electronics, jewelry or anything valuable with you.

Common health issues that increase anesthesia risk

Asthma, breathing and heart conditions, common colds, medications, and supplements can affect children under anesthesia. The information below will help you navigate common health issues ahead of surgery, but do not replace the guidance of your family doctor or paediatrician.

Children with asthma are at higher risk for bad reactions, like breathing problems, either during or after surgery. If your child has asthma, you can help reduce the risk by making sure their asthma is well managed before the procedure or operation.

Children with asthma may have symptoms like:

  • Wheezing
  • Coughing
  • Tightness in the chest
  • Shortness of breath
  • Sensitivity to irritants like cold air, common allergens and second-hand smoke

If your child has asthma and often has these symptoms, please book an appointment with your family doctor or paediatrician to try to get them under control well before their procedure or operation. A change in medicine or a visit to a specialist may be needed. Please book this appointment at least six weeks in advance of the surgery, procedure or test.

If you have questions about anesthesia and your child’s asthma, please contact the Pre-Anesthesia Clinic for more information.

Asthma medication on the day of surgery

It is very important that you bring your child’s puffer or other medicine to treat symptoms, on the day of surgery.

Your child should take any prescribed asthma medicines (such as Flovent) as usual on the morning of surgery. Your child may be asked to take this medicine, even when not having symptoms on the day of the procedure and possibly in the days before as well.

Children with breathing, heart or other serious medical issues need special care when given anesthesia for a procedure or operation. Your child’s anesthesiologist will work to reduce your child’s risk of reacting badly to the medicines before the procedure and will care for them during and after the anesthesia to make sure they are stable.

If your child has a chronic (ongoing) or complex medical problem, you must tell your anesthesiologist about their normal health routines and conditions. You need to work with your anesthesiologist to make a care plan that is best for your child. If your child has a specialist, the anesthesiologist may require documentation or need to communicate with them in order to determine the best way to support them during and after the surgery.

Please call the Pre-Anesthesia Clinic as soon as you can to begin the screening process. You may also be contacted by the Clinic directly.

If your child has a cold or respiratory tract (ear, nose, mouth, throat or chest) infection the risk of reacting badly to anesthesia is higher than if your child is in perfect health.

A very mild cold increases the risk only a small amount. The worse the cold, the higher the risk of your child having trouble breathing during and after anesthesia. A serious chest infection increases this risk even more.

If your child has a bad cold, their procedure may have to be cancelled until they are healthier. We examine the risks against many factors. The procedure will often be done if your child has a mild cold if you are comfortable with the risks.

The procedure may need to be rescheduled if your child:

  • Has a fever
  • Is producing lots of phlegm (i.e. has a wet, productive cough)
  • Has abnormal breathing sounds when we listen to their chest
  • Is wheezing or has asthma-like symptoms with the cold
  • Otherwise appears unwell (e.g. not their usual playful manner)

Monitor your child’s health before the operation

If your child gets sick in the weeks before the scheduled procedure at SickKids, you should see your paediatrician or family doctor, they may prescribe medicine that will improve your child’s condition in time for the anesthetic.

If your child remains sick or gets sick in the days before the procedure and has one or more of the symptoms above, they will probably not be able to have anesthesia.

Please call your surgeon or clinic to rebook the procedure as soon as you can so that the time slot can be used for another child.

Speak to your family doctor or paediatrician, surgeon and anesthesiologist well before your child’s procedure or operation to find out how and when to take prescribed medicines.

In most cases, your child should take their medications as prescribed up to, and including, the day of the procedure in order to make sure they stay as healthy as possible during the operation.

There are some medicines that may increase the risk of your child having complications while under anesthesia. These medicines can include:

  • Insulin for diabetes
  • ASA (acetylsalicylic acid) medicines
  • Blood pressure medicines

Remember that your child can’t have any liquid, including water, three hours before the anesthesia. If your child usually swallows a pill with water, talk to your anesthesiologist about when the pill should be taken.

To keep your child safe, talk to your anesthesiologist about all medicines your child normally takes.

If you have not been contacted by the Pre-Anesthesia Clinic at least two weeks prior to your procedure, please contact us to talk about your child’s prescription medications.

Over the counter medications are bought in the drug store without a prescription. All medications, even common over the counter medicines, have side-effects and may cause problems during anesthesia or surgery.

Your child should not take some over the counter medications before anesthesia.

These include:

  • Ibuprofen
  • Acetylsaliclyic Acid (ASA)

Medications can cause side-effects during anesthesia, such as too much bleeding and high blood pressure which can cause your child’s condition to become unsafe during the procedure or operation.

Please ensure you review these medications with your child's anesthesiologist in order to determine whether to stop using them before surgery.

Learn more about some over the counter medicines at AboutKidsHealth.ca: Acetaminophen, Aspirin, and NSAIDs.

Herbal medicines and supplements may be a big part of your child’s usual health routine. However, some herbal medicines that are normally safe can cause problems if your child is having a procedure or operation under anesthesia.

Herbal medicines can be unsafe for children under anesthesia because they:

  • Are not regulated, and your doctor will not know exactly what is in the medicine
  • May increase your child’s risk of bleeding
  • Make anesthesia last longer
  • May cause low or high blood pressure
  • Can cause many other side-effects and complications

It is important that you tell your anesthesiologist about all herbal medications your child has taken.

If you have not been contacted, call the Pre-Anesthesia Clinic at least two weeks before your child’s procedure or operation.

AboutKidsHealth resources

Preparing for surgery and hospitalization

As a parent, you can play an important role in preparing your child for a stay in hospital. Learn about your child's operation, ask questions, and find out how you can prepare your child.

General anesthesia

Your child's stomach must be empty before a general anaesthetic. Follow these instructions to help your child get ready for an operation, test or treatment.

Talking to your child about surgery

You can help your child if you learn as much as possible about their condition, modeling calm behaviour and explaining what is going to happen using words they can understand.

More in this section

Coming for Surgery

Review this important information to help prepare for surgery.

Surgery Day & After Care

Parents and children can navigate fear and anxiety by knowing what to expect on the day of surgery, and reviewing after surgery care information.

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