Going to Sleep Depending On Their Age, Children Perceive Anesthesia In Different Ways

Breathing through a mask that covers her small face, the little girl slips into a state of unconsciousness. Her mother and father release their hold on her tiny hands, then reach out for one another’s. They watch as the anesthesiologist wheels their daughter out of the induction room, then down the hall to surgery. And they worry about their child’s safety and comfort.


Before the use of modern anesthetics, surgery was rarely attempted — or, at best, hastily performed. Thanks to modern pediatric anesthesia, however, this little girl will not feel pain during her operation. And as she recovers, what pain she does have can be effectively controlled.

Anesthetics, used in surgery as far back as ancient times, inhibit communication between the brain and the nervous system and thereby create insensibility to pain. Modern-day anesthetics make it possible to perform the surgeries your child needs — regardless of the length and complexity of the procedure.

Dr. Richard Helffrich, a pediatric anesthesiologist, describes anesthesia associated with surgery in three stages: the preoperative workup, care during surgery (intraoperative care), and postoperative care, which includes recovery and pain control after the surgical procedure.

Preoperative Workup

Preparing for anesthesia begins before the procedure. In general, the preoperative workup involves getting a health history on your child, along with a physical exam. Experts will assess the child from a psychological perspective to determine the best way to sedate him and separate him from you, depending on his age and state of mind.

Laboratory tests also will be performed if they are determined to be helpful in the preoperative evaluation. Then a physical exam, generally done by an anesthesiologist, will include an examination of your child’s airway, heart, and lungs. It also includes an exam of his veins for intravenous line (IV) placement. An IV line is sometimes used to provide fluids and medications during the surgery.

During the preoperative evaluation, the anesthesiologist will discuss the anesthesia and what you and your child can expect. Education is important because the more calm, informed, and relaxed you are, the more relaxed your child will be, too.

The anesthesiologist will also discuss the importance of making sure your child has nothing to eat or drink for a period of time before surgery. This is important to prevent vomiting and aspirating (breathing in) stomach contents during the operation.

Care During Surgery

The actual beginning of the intraoperative anesthesia begins with induction of the patient. ‘Induction’ is the transition between the normal alert, awake state and the ‘sleep’ of anesthesia. Induction may be by way of an oral medication, a shot, or inhaled anesthesia gases. The best way to induce anesthesia is determined to a great extent by the child’s age and the physical and psychological assessments.

Children often have their own fears about the anesthesia and surgical procedure. A child’s age and developmental level play a large role in what fears he has about anesthesia. There are distinct age groups, each with its own anxieties. Here are some general comments about these groups. Keep in mind that these are generalizations that vary from child to child.

Under 1 Year Old

At this age, infants have not developed a fear of non-family members, are unconcerned about what the health care provider is doing, will separate easily from family members, and will have no recall of the induction experience.


Toddlers are verbal, yet they can’t interact meaningfully with the health care provider. They fear needles, so anesthesia is usually done with mask induction. Also, they don’t separate easily from parents, so sedation might be necessary.

Age 3 to 8

Children in this age group fear needles, fear being separated from their parents, and feel more secure being with parents in a preoperative holding room or induction room until they fall asleep.

Age 9 and Above

At this age, children can articulate their fears, are concerned about exposure of their body parts during surgery, and are concerned with cutting and scarring of the body. They are also worried about loss of control, as well as postoperative pain and the risk of death.

Calming Down

Children are often highly sensitive to the fears and anxieties of their parents. A calm parent sends a different message to the child than a terrified one. Your doctor or nurse educator will help you explain anesthesia and surgery to your child. One piece of advice you might hear is to avoid the phrase “being put to sleep,” since that may worry some children.

One common concern children have is whether or not they will receive a needle and, if so, whether it will hurt. A kind of local anesthetic cream can be rubbed on the skin to remove the pain of needle pricks when starting an intravenous line. This usually works well with children by helping to soothe their fears of getting a shot.

This information was provided by KidsHealth, one of the largest resources online for medically reviewed health information written for parents, children, and teenagers; www.kidshealth.org; www.teenshealth.org

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