When Your Child Needs Orthopedic Surgery

Your child is having bone or joint surgery. The healthcare provider who performs this surgery is called an orthopaedic surgeon. This sheet can help you prepare your child and learn what to expect.

Two ways of performing orthopedic surgery

Depending on why your child needs surgery, the procedure may be done one of two ways. Your healthcare provider will talk with you about your child’s surgery and the method that will be used:

  • Open surgery. This is the traditional method of performing surgery. It is usually done through 1 cut or incision. This incision is large enough for the surgeon to have a direct view of the area to be operated on.

  • Arthroscopic surgery (also called arthroscopy). This is done through several smaller incisions. A tube (arthroscope) with a tiny video camera and a light is inserted through 1 incision. This gives the surgeon a clear view of the area being operated on. Tiny surgical tools are then put through other small incisions to perform the surgery.

Helping your child prepare

The idea of having surgery can be scary. You can help your child have a more positive experience during surgery by preparing him or her in advance. How you do this depends on your child’s needs. Many children’s hospitals have a child-life specialist who can help you and your child prepare. Here are some tips:

  • Explain the surgery to your child in brief and simple terms. Younger children have shorter attention spans, so do this shortly before the surgery. Older children can be given more time to understand the surgery in advance. 

  • Point out the body part that will be operated on.

  • Explain to your child that he or she will be “asleep” during surgery. Reassure your child that he or she won’t feel the surgery being done.

  • Allow your child to ask questions.

  • Use play when appropriate. This can mean role-playing with a child’s favorite toy or object. It may help older children to see drawings of what will be done during surgery.

  • Help your child pick his or her “comfort object” to bring to the hospital. This can be any small item, such as a toy, stuffed animal, or blanket. Your child will be able to keep the item until surgery begins.

The weeks before surgery

You will be given specific instructions to help your child prepare for surgery. Carefully follow any instructions given to you by your child’s surgeon. Below are 2 instructions that are common to most surgeries:

  1. Tell your child’s healthcare provider what medicines your child takes. This includes over-the-counter medicines, prescription medicines, vitamins, herbs, and supplements. Your child may need to stop taking certain kinds of medicines before the surgery. This will help to prevent bleeding and other problems during and after the surgery.

  2. Follow any directions your child is given for not eating or drinking before surgery.

The day of surgery

Here is what to expect right before surgery: 

  • Get to the hospital on time. You will be asked to fill out certain forms.

  • Your child will be given a gown to change into.

  • A provider called an anesthesiologist or nurse anesthetist will meet with you. He or she will discuss the medicines that will help your child sleep through the surgery. Be sure to ask any questions you have.

  • You may be asked by several people to confirm which part of the body is being operated on. This is routine and is for your child’s safety. The body part may also be marked with a pen.

  • Your child will be given an IV (intravenous) line. This gives your child fluids and medicines. Depending on the age of your child, the IV line may be put into the arm or the hand. The IV may be started after your child is asleep.

During the surgery

Here is what to expect during surgery: 

  • Your child will be given general anesthesia. This is medicine that puts your child into a deep sleep.

  • A soft tube called a catheter may be placed into your child’s bladder. This helps drain urine during and right after the surgery.

  • The surgeon will perform the surgery using the method that has been discussed with you.

Recovering in the hospital

Here is what to expect after surgery: 

  • After surgery, your child will be taken to the recovery room. This is also called the post-anesthesia care unit, or PACU. Here, monitors will be attached to your child. These monitors watch over your child’s breathing, blood pressure, and pulse.

  • Your child will be given pain medicine to stay comfortable.

  • The urinary catheter will likely be removed shortly after surgery. The IV line might stay in place for a few days.

  • In some cases, surgery is done with your child as an outpatient. This means your child goes home the same day. In other cases, your child may need to stay 1 or more days in the hospital. If your child stays overnight, he or she may be moved to a regular hospital room. Ask if you can stay with your child.

Recovering at home

Here is what to expect once home after surgery: 

  • Give your child prescribed medicines as instructed. Pain control after surgery is important to help with healing, so give pain medicines on schedule.

  • Schedule a follow-up visit with the surgeon after surgery.

  • Being active helps your child heal. But too much activity can harm healing incisions. Follow any activity instructions you are given.

  • If your child needs physical therapy during recovery, this may be started soon after surgery.

  • Follow any other instructions you are given for your child’s recovery.

Call your child’s healthcare provider 

Contact the healthcare provider if your child has any of the following after surgery:

  • Fever (see "Fever and children," below)

  • Chills

  • A seizure

  • Increase in pain or swelling at an incision site

  • Unexpected drainage from an incision

  • Increased redness around an incision

  • Bleeding from an incision

  • Breathing problems

Fever and children

Always use a digital thermometer to check your child’s temperature. Never use a mercury thermometer.

For infants and toddlers, be sure to use a rectal thermometer correctly. A rectal thermometer may accidentally poke a hole in (perforate) the rectum. It may also pass on germs from the stool. Always follow the product maker’s directions for proper use. If you don’t feel comfortable taking a rectal temperature, use another method. When you talk to your child’s healthcare provider, tell him or her which method you used to take your child’s temperature.

Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.

Infant under 3 months old:

  • Ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead (temporal artery) temperature of 100.4°F (38°C) or higher, or as directed by the provider

  • Armpit temperature of 99°F (37.2°C) or higher, or as directed by the provider

Child age 3 to 36 months:

  • Rectal, forehead, or ear temperature of 102°F (38.9°C) or higher, or as directed by the provider

  • Armpit (axillary) temperature of 101°F (38.3°C) or higher, or as directed by the provider

Child of any age:

  • Repeated temperature of 104°F (40°C) or higher, or as directed by the provider

  • Fever that lasts more than 24 hours in a child under 2 years old. Or a fever that lasts for 3 days in a child 2 years or older.

If your child has a cast or splint

Call your child’s healthcare provider if:

  • The casted body part tingles or feels numb.

  • The cast feels too tight or too loose.

  • A rash develops under the cast or splint.

  • Fingers or toes swell, feel very cold, or turn blue or gray.

  • The cast or splint cracks or has rough edges that hurt.

  • The cast gets wet.

If your child has a cast or splint

Call your child’s healthcare provider if:

  • The casted body part tingles or feels numb.

  • The cast feels too tight or too loose.

  • A rash develops under the cast or splint.

  • Fingers or toes swell, feel very cold, or turn blue or gray.

  • The cast or splint cracks or has rough edges that hurt.

  • The cast or splint gets wet.