Ask the Doctor: ‘My son is 8 years old with autism spectrum disorder. How can I make sure he feels safe and calm while getting his tonsils out?’

”My son is 8 years old and has autism spectrum disorder (ASD). He gets rather upset when his routine is broken and can find new places, people, and situations very stressful. He suffers from tonsillitis frequently and his GP has recommended that we get his tonsils removed. I am worried about the stress this experience could cause him. Hospital’s tend to be noisy, busy places with lots of waiting around – three things he does not cope well with, not to mention the unknown. How best can I help my son get the care he requires while keeping him feeling safe and as calm as possible?”

Answer from Fiona Lehane, Paediatric Manager, Beacon Hospital.

Preparing a child for surgery can be a daunting thought for parents and caregivers, especially if the child has additional needs like autism spectrum disorder (ASD). The unknown or a negative association from previous experiences with hospital environments can cause apprehension and anxiety in both the parent and the child. As a parent or caregiver, the best thing you can do for your child is to prepare them and yourself for the experience so that you can know what to expect, through open communication and sharing of information.

In order to best prepare for the day, if possible, make sure that you have all other family and work commitments taken care of in advance. You can then focus on your child’s needs that day and for the coming days. Tonsillectomy will generally require an overnight stay in hospital and your child may experience some discomfort after the procedure for a number of days as well as requiring some time off school.

Contacting the hospital in advance and speaking to a nurse can be very beneficial to help answer any questions you have regarding the process for admission, fasting times, overnight stay and any questions around caring for your child after surgery. As well as answering these questions, this call is also a good opportunity to let the hospital know about your child’s additional needs. Generally small children and children with additional needs will be given an earlier theatre time, for example here in Beacon Hospital we will always endeavour to prioritise smaller children and children with additional needs on a theatre list to avoid long periods of fasting.

If your child has a special comforter, blanket, music, headphones, iPad etc make sure to bring this with you on the day. Healthcare professionals who work with children are very experienced and are able to adapt to many situations to suit the needs of the individual patient, make sure to communicate those needs. The type of language we use with children is important, certain words for example, needle, are usually best avoided. Children explore and learn through play.

Reading a book about a hospital experience is an excellent way of introducing new words relating to hospital environments and equipment used, or if you have any items such as a thermometer or toy stethoscope, allowing your child to handle and explore these items in advance can make it a less frightening experience for them.

Some children will be put to sleep for their surgery using a medicated gas and others using medication through a small plastic tube that is placed in the hand or arm called a cannula or “Freddie”. If this tube is required, the nurse can apply some cream in advance to help numb the hand. Talk to the nurse and anaesthetist about the options available and how best to approach the topic with your son. Some children may benefit from a medication given pre surgery to help relax, this can be discussed with your nurse and anaesthetist. The nurse and doctors want to work with you to keep your child as calm as possible so if possible will put you in a quiet area of the ward, limit the amount of people interacting with your child and try to stick to any routine you have as much as possible.

Have a question for the professionals you’d like answered? Get in touch with sarah.gill@image.ie with the subject headline ‘Ask The Doctor’.

This article was originally published in December 2022.