Preparing children – and their parents – for a general anaesthetic

For many families, paediatric ENT surgery brings a mixture of relief and anxiety. Relief that treatment is underway; anxiety about what happens next. And at the heart of so many of those worries is the general anaesthetic. What will it feel like? Will my child be frightened? What if something goes wrong?

Dr Yumna Haroon-Mowahed is a consultant anaesthetist at University College London Hospital and honorary clinical teaching fellow at UCL. With a specialist interest in paediatric anaesthesia and ENT surgery, she is the lead for paediatric ENT pre-assessment at her NHS practice and works closely with Mr Annakan Navaratnam across his private practice. We spoke to her about how she supports children and their families through the experience.

Every child is different

The first thing Dr Yumna is clear about is that there is no one-size-fits-all approach. “My approach is always tailored to each individual child and to their age, as they worry about different things depending on how old they are,” she explains. A toddler heading in for grommets has very different fears to a teenager booked for a septoplasty. For younger children, she might turn the experience into a game. For adolescents, the concerns are often shaped by what they have seen online.

“Teenagers are often worried about things they have seen on social media, which can be misleading. They are concerned about how disorientated they will be when they wake up and what they might say or do.” Dr Yumna is candid with them. She explains that the most common response on waking is simply feeling very sleepy, and that people sometimes murmur things they were thinking about as they drifted off. Keeping them calm beforehand is part of the preparation.

Parents set the tone

One of the most important insights Dr Yumna shares is the role parents play in shaping a child’s experience of the day. “Children feed off the energy of their parents,” she says. It sounds straightforward, but the implications are significant. A visibly anxious parent can amplify a child’s distress before a needle has been placed or a mask produced. Dr Yumna sees it as her responsibility to ensure parents are informed and feel confident, so that they, in turn, can be a steadying presence.

She gives an example of a parent who was particularly anxious ahead of her child’s procedure, in part due to her own health history. “I arranged a phone call to discuss what was going to happen. That was enough to make sure both the parent and child were fine on the day.” It is a simple intervention, but one that speaks to Dr Yumna’s broader philosophy: that communication and calm are as clinically important as any medication.

The pre-assessment: where preparation begins

For patients coming through Mr Navaratnam’s practice, preparation starts long before the day of surgery. The pre-assessment may take place weeks or even months in advance. Dr Yumna manages all paediatric patients attending for ENT surgery at UCLH, reviewing notes alongside the pre-assessment nurses and speaking with parents and children as appropriate.

This is where underlying health factors are considered. “We look at comorbidities such as cardiovascular risk factors and how well a patient can manage an anaesthetic,” Dr Yumna explains. Conditions such as high blood pressure or diabetes require careful optimisation before surgery.

Although ENT procedures are generally well tolerated and most children can eat, drink and take medication shortly afterwards, the shared airway in ENT surgery introduces specific considerations. “We work to keep blood pressure as low as possible because the surgeons are operating on very vascular areas and we want the field to be as dry as possible.”

On the day: creating calm in the anaesthetic room

Dr Yumna starts early. She sees her patients and their parents before the list begins, knowing that the window to build trust is short. “You only have a very small window to build that trust and rapport with them.” She also ensures that all medications are prepared and ready before the family enters the anaesthetic room, so parents are not unsettled by the clinical preparation they might encounter.

For younger children and babies, she will often use a mask to induce anaesthesia first and insert a cannula once the child is asleep. Distraction is a well-established tool. Where once it was a Where’s Wally book or bubbles, it is now often a tablet. “They often don’t realise what’s going on. I distract them, and then it’s usually: oh, my goodness, it’s in.”

She typically allows one parent or guardian in the room. “Even until their late teens, I give them the option of whether they want someone with them. Even as a grown-up, it can be a vulnerable experience, and you need a familiar face.”

In recovery, she waits until the airway is out before inviting the parent in, as removing an airway can be distressing to witness.

Fasting, medication, and managing the unexpected

Fasting is one of the aspects families find hardest, particularly with younger children. The guidelines are clear: six hours for solid food, four hours for breast milk, and two hours for clear fluids. “Children can get very hangry,” Dr Yumna acknowledges, “but it is incredibly important that we follow these guidelines.” Where possible, surgical lists are ordered by age or by complexity of need to minimise waiting times for the youngest patients.

Pre-medication, such as midazolam, is available for children who are particularly anxious. Dr Yumna is direct in how she frames this. “I never see these as a failure. They can just help ease nerves before going to sleep.” She also manages all post-operative medication, including anti-nausea and pain relief, noting that ENT patients are often more prone to nausea and vomiting due to the nature of surgery in and around the airway.

Throughout everything, honesty is central to Dr Yumna’s approach. “I am very clear to children that I am not lying to them and everything I tell them is the truth. It is a question of saying it in a slightly different way to each child in a way they can understand.” And from the moment a child enters her anaesthetic room to the moment they are safely awake in recovery, she does not leave their side.

For parents preparing their child for ENT surgery under Mr Navaratnam’s care, that continuity of attention offers considerable reassurance. Every child is different, every day brings its own complexities, but the commitment to calm, communication, and individualised care remains constant.