Children with extra needs: autism, anxiety, asthma and more

Autism, sensory differences and strong anxiety

An anaesthetic day has many of the things autistic and very anxious children find hardest: a new building, waiting, strangers, gowns, touch, noise, and things being done to their body. The good news is that most of it can be planned for.

Before the day

• Tell the hospital when the procedure is booked, and ask whether the anaesthetist can call you or see your child at a pre-admission visit.
• Ask about the waiting. Raising Children Network suggests asking for a quiet waiting room or sensory space, and booking the first appointment of the day if waiting or busy spaces are difficult. Ask whether your child can be early on the list.
• Prepare with the tools your child already uses. Raising Children Network suggests reading a social story with your child every day for a few days beforehand, using photos, pictures or other visual supports for each step, and marking the appointment on a calendar.
• Write a one-page note about your child: how they communicate, what calms them, what to avoid (touch, a particular word, bright light), how they show pain, and what has worked before. Ask for it to go on their file.

On the day

• Bring sensory items and comfort objects. Raising Children Network mentions something like a soft teddy or a puzzle cube.
• Ask about calming medicine before the anaesthetic. ANZCA says the anaesthetist may give sedation (a premed) to help with anxiety.
• Ask which way of going to sleep suits your child better, a mask or a drip, and whether the gown is necessary before they are asleep.
• Decide with the team who goes into the anaesthetic room and what that person will do.

Children who are very distressed in the run-up are not “being difficult”. Asking for a different plan is reasonable: the aim is a calm start for your child, not a standard routine.

Asthma

ANZCA lists asthma among the conditions anaesthetists ask about. Before the day, tell the team how well controlled your child’s asthma is, whether it has flared recently and whether they have needed extra medicine or a hospital visit.

• Keep giving usual asthma medicines, including on the morning of the procedure, unless the doctor says otherwise. The Royal Children’s Hospital says regular medicines should be taken on the day of surgery, with a clear liquid such as water, unless the doctor says not to.
• Bring the reliever inhaler and spacer with you.
• If asthma flares in the days before, phone the hospital rather than waiting for the morning.

A cough or cold on top

Any child can catch a cold before an anaesthetic, but for a child with asthma, sleep apnoea or a complex condition it matters more, and so does phoning early. If your child is unwell in the days before, phone the hospital or the surgeon’s rooms before you set out. Coughs, colds and fevers explains how the decision is made and what to have ready when you call.

Loud snoring and obstructive sleep apnoea

The Royal Children’s Hospital says about 15 to 20 per cent of children snore, and about 2 to 3 per cent have obstructive sleep apnoea, where breathing is repeatedly blocked during sleep. Signs include loud snoring, pauses in breathing, choking or gasping, restless and sweaty sleep, and breathing through the mouth at night. The commonest cause in children is enlarged tonsils.

Snoring matters to an anaesthetist because sedation and anaesthesia make it easier for the throat to block and harder to wake up in response, as the Sleep Health Foundation explains. It advises telling the anaesthetist before surgery if you have sleep apnoea or think you might; the same applies to your child. ANZCA also lists loud snoring among its standard questions.

Tell the anaesthetist about:

• loud snoring most nights
• pauses, gasps or choking in sleep
• any sleep study your child has had, and its result.

A child with sleep apnoea may be watched more closely, and for longer, after the procedure. If tonsils are being removed because of sleep apnoea, ask beforehand whether an overnight stay is planned.

Babies born early

Babies born prematurely can be at risk of pauses in breathing (apnoea) after an anaesthetic. ANZCA’s guideline on anaesthesia for children (PG29(A), section 10.1.6) says these babies should not be sent home the same day unless they are medically fit and have reached a postmenstrual age of 54 weeks, and that the risks should be discussed with parents individually.

Postmenstrual age is the baby’s gestation at birth plus the weeks since birth. A baby born at 32 weeks who is now 18 weeks old has a postmenstrual age of 50 weeks. If your baby was born early, ask whether an overnight stay is planned. ANZCA’s guideline also says hospitals should make arrangements for at least one parent or carer to stay with children admitted overnight.

Other things to mention

ANZCA’s standard questions are a good checklist for any child:

• heart problems or other medical conditions
• every medicine, supplement and herbal product, and any allergy to medicines
• loose teeth, braces or plates. healthdirect lists damage to teeth among the minor complications
• whether anyone in the immediate family smokes
• whether anyone in the family has had a problem with an anaesthetic.

Children with complex medical needs are sometimes cared for at a larger children’s hospital. ANZCA’s guideline says anaesthetists caring for medically complex children need additional training. If your child has a complex condition, ask the specialist who looks after them where the procedure should be done.

In an emergency, call 000. This information is general and does not replace advice from your treating practitioner. Your child's anaesthetist, surgeon, dentist or hospital knows your child, and their instructions come first.