Ear tubes, adenoidectomy for a toddler

[peggyfromwastate]

Hi- We took our 20-month old son to a ENT today and he advised us to have ear tubes and surgery to remove the adenoids of our son who has had problems with sinusitis symptoms for about 1 year. He has either had a runny nose, along with ear infections and coughing while sleeping, or he's been on antibiotics and doing ok. The ENT feels that he needs this surgery now, rather than later, because Steven also has asthma, and so the constant blockage of his sinuses means just that much less air getting into his lungs.

I know that getting tubes put in is a fairly common thing. Has anyone been through this? Is there anything special I should be prepared for? I hate the idea of him being under general anesthesia, but I know it's necessary

The surgery will be Apr 11. We are hopeful that he'll be feeling much better before we move across the country in August! Thank goodness kids are so resilient. I know if I had to have this stuff done I'd probably be moaning and groaning for 3 or 4 months, at least!

Any words of advise?

(By the way, please excuse my spelling! I don't know how to spell 15% of the words I type, and I am far too lazy to look them up!!!)

Peggy

[DCJenn]

Peggy-

Several of the kids attached to my staff have had tubes put in their ears and everyone has said that it's an amazing recovery. One little girl suddenly started talking like a champion- her parents realized that her ears were so clogged all the time that she wasn't hearing the conversations! My receptionists grandson has also had an amazing turnaround- going from always feeling sick to hardly having a day out of day care!

Jenn

Wanted to say that I have been ther and done this 3 times. When my oldest son was 18 months we had the tubes put in. After 5 different episodes of ruptured eardrums and possible hearing loss it was a miracle. He never had another infection. We did not have the adnoids out as he has a cleft uvula and would have affected his speech.

Fast forward 10 years and my oldest daughter has the same problems. One round of tubes-great for 14 months til they fell out. The proceedure lasted 15 min and she slept through it. Second set of tubes w/ adnoidectomy and she was kinda hard to deal with for a couple of days. She still has her tubes, she is 5. Tonsils out last summer were worse than all my previous experiences with my children's surgeries, but we were back to normal in about 10 days.

Long story short. Do it while they are still little. The older they get, the more they whine

Best of luck,
Trisha

[peggyfromwastate]

Thanks- I have heard in passing that getting the tubes in is no big deal. But, of course, everything is a biggie when it comes to one's own child, isn't it?

Has anybody's child had any problems/bad side effects with anesthesia?

Thanks again for the encouragement- I do think that it's much better to get this done sooner rather than later. Plus I don't like having Steven on antibiotics for so long! I think he's devastated his gut flora...

Peggy

[Rapunzel]

Both of my twins had ear tubes placed (in both ears for each!) around 10 months of age. Their surgeries went smoothly and we did not experience any longterm complications from the surgeries. (One aside, one of the reasons we had the tubes placed so early is that one of our twins daughters had been on antibiotics for months on end. She developed an allergy to sulfa drugs subsequently).

None of my children have experienced complications with anesthesia , so I can't help you there! Good luck!

[peggyfromwastate]

Thanks Rapunzel for the input. Today I was at Twins Group and one lady there talked about how some children thrash around a lot while coming out of anesthesia. Have you ever heard of that? Did your girls come out of it calmly? Did they even let you back there to be with them when they woke up?

I'm sure the docs and nurses will go over this stuff in detail. But it still freaks me out a bit to think of my baby going through surgery. His Dad hasn't even ever had a surgery! Chances are, he'll PERFORM a surgery before he needs to go through one... He's so healthy.

[Rapunzel]

Thanks Rapunzel for the input. Today I was at Twins Group and one lady there talked about how some children thrash around a lot while coming out of anesthesia. Have you ever heard of that? Did your girls come out of it calmly? Did they even let you back there to be with them when they woke up?

I'm sure the docs and nurses will go over this stuff in detail. But it still freaks me out a bit to think of my baby going through surgery. His Dad hasn't even ever had a surgery! Chances are, he'll PERFORM a surgery before he needs to go through one... He's so healthy.

You have some very valid concerns, Peggy. My children have had a total of five surgeries combined and so I can relate what our experiences were with general anesthesia and recovery from it.

Some children come out of it quite calmly, my experience is that most do NOT. This is the pattern I've witnessed in my own children: you might notice a gray palor to their skin while they are still under full anesthesia, after this they will gradually wake up and will be VERY disoriented. They will probably not recognize you for a few moments - if that happens don't worry, they'll know who Mommy is soon enough. One of my children (my son whose been under general anesthesia for three surgeries and countless MRIs) has a TERRIBLE time coming out of it. He does thrash around, pulling out iv's, kicking nurses (and me), screaming, etc. It was scary the first couple of times. What helps him considerably is that he is given a bolus of saline solution immediately when he starts waking up. It helps "clear his system" of the drug somewhat and hastens his recovery from the anesthetic effects.

I have had most of my experiences with Alex (the above son 8) )at a hospital that allowed parents into surgery recovery - in fact encouraged it to the extent that the nurses paged the parents from the surgery waiting room to be there when the children were just about to wake up. This was at my husband's med school hospital (Children's in Dallas) and they took their practice from a recent study showing that emergency care for children actually benefited from having the parents present during acute procedures (especially during the worst parts for the kids).

The hospital my daughters had their ear tubes placed had the opposite policy and it was terrible. I was called back to recovery but they wouldn't "allow" me near my screaming, scared babies for quite a while - I could hear them but I wasn't allowed to see them or touch them because of some archaic rules. After I complained and said if they didn't bring them to me I was going to get them, they brought the girls out. I made sure I immediately reported the incident and the corroborating study on emergency room visits to the patient feed-back department. The archaic policy was changed shortly thereafter and we received a note of apology. It probably helped that the top administrator at the hospital is a close family friend of my husband's.

In summary: Expect your daughters to react poorly to recovery from general anesthesia. If they react well then you can be pleasantly surprised, if they react badly you will be prepared emotionally. Definitely confirm with the nurses before your children are given any anesthetic that a saline bolus will be administered via iv immediately after the surgery (ie when the anesthesia is no longer needed) to flush the drug out and hasten recovery from the anesthetic. And finally, CAREFULLY check and question the hospital's policy towards parents being present post-surgery. In my experience it is VERY important for the children, the parents, AND the nursing staff if the parents are present during the traumatic time period immediately post-op. That's my experience. I hope it helps!

Oh, I just remembered one more thing: pay VERY close attention to your children's iv's post-op ESPECIALLY if they are thrashing around. It is very possible your child will "blow a vein" and the saline solution will get pumped into the tissue rather than the vein. This is soooooo painful and if it isn't caught immediately can cause some serious problems. In my experience this is yet another reason to have parents close at hand post-op because the nurses (who usually have several patients a piece) don't notice these things as fast as a concerned parent sitting over their child constantly. What you will notice is your child screaming histerically (especially if the iv location is touched or moved), attempts to pull out the iv (although that can be normal for anesth recovery so it doesn't necessarily indicate an infiltration), and a noticeable, rapid swelling in the area immediately around the iv (ie if your child's extremity looks "puffy" that means possible infiltration and the iv needs to be removed immediately). Also, some goofy nurses forget to anesthetize the skin area prior to inserting the iv needle. Make sure whoever places the iv FIRST uses an anesthetic on the area. Also, a good nurse only takes about ten seconds to get an iv needle into a thrashing, screaming, non-cooperative, scared small child. If your nurse takes any longer than that or starts "digging around" with the needle IMMEDIATELY tell them to STOP and demand another nurse do the procedure. (This I speak from experience as well). You must be very proactive - even with minor surgeries.

[Cumberland]

As a nurse practitioner working in pediatric emergency medicine, I just need to interject about what GOOD nurses do and dont do.....

While I start IV lines on children approximately 10 times per day three times per week, I can tell you that A) it often takes more than ten seconds to start, B) searching for the vein is often necessary in a child with rolling or miniscule veins. Young children who are ill and/or dehydrated will consequently have veins that are difficult to find. Parents who insist that the provider stop in the middle of the cannulation automatically guarantee that their child receives another needlestick as well as a delay of treatment. While I encourage parental involvement at evey level of treatment, it is important that the parent recognize their role as parent rather than healthcare provider.

Similary, a nurse is not "goofy" because they do not place topical anesthetic prior to placing the intravenous line. Rather that nurse may be "following the policy and procedures of the hospital". Topical anesthetics may be the standard of care at some hospitals, but certainly not all. If the nurse does not place it, perhaps instead of labeling him or her as 'goofy', you might complain to the hospital administrator who refuses to purchase the anesthetic due to its high cost, or even to the insurance executives who refuse to reimburse the hospital for the use of it.

[Meenah]

I have to interject here too. As an ER nurse I have to "stick" kids almost every time I go to work. I have been doing this for over 10 years and I have NEVER put an IV in a baby in less than 10 seconds. Last weekend I had to start an IV, draw, blood and insert a urinary cather into a "thrashing" 2 month old. If I had done that in just a few minutes I doubt I would have been being very careful!!! It usually takes more than 10 seconds to just find a decent vein.

As to anesthesia, my daughter has had it twice and she did thrash about and kick. This isn't that unusual.
Luanne

[DCJenn]

Apparently after one of my many oral surgeries, I 'thrashed' to the point that I kicked the surgeon in the 'family jewels'. My mom said all of a sudden she heard this yelp of pain and then the radio got really loud in the waiting room.

I always felt like poo after my oral surgeries- often like I had the flu. It took me a few days to get better.

Jenn

[peggyfromwastate]

Thanks for all the input, everyone. I'm glad that there are nurses (or former nurses) who post here. I know you guys have such hard jobs! I have had general anesthesia for oral surgery, too, Jenn. I could barely walk after that. It was pretty scary for me to feel so out-of-control. I was prepared for it, so I can't imagine what my son is gonna feel like! I just am glad that kids are so resilient.

By the way- He's got big veins! I hope this helps for the IV situation. He's already had his blood drawn from his arm for a blood test for a mustard allergy he has. Let me tell you, this little guy has been non-stop bizarre health problems from in utero. At the very least, I hope these ear tubes and adenoidectomy will help take care of the sinusitis problem so that we can move on to the asthma and allergy issues...

Genetically speaking, it's all my fault! My husband is super healthy. I am the source of asthma and allergies...

Thanks again, everyone---

Peg

[Meenah]

How in the world did you discover a mustard allergy? Sounds like the little guy has been through alot. Best of luck to you.
Luanne

[Rapunzel]

To the nurses on the site (btw my mom is also an RN): You have your opinions of what goes on in the ER and that is fine, but I spoke as a parent of children going into operations or MRIs/CTscans - a parent who has had small children undergo general anesthesia more than 10 times in the last few years (as well as at least 30 seperate ivs). I stick by everything I have said as the advocate for my children's best interests. I have observed both good and bad behavior in nurses in a pediatric setting and have had many discussions with my own RN mother regarding appropriate/inappropriate actions. Sorry you disagree with some of it, but again, I speak from the experience of a parent guarding my children from as many problems as possible (and I've encountered inept nurses who use the "rolling vein" excuse to do very long, painful "vein fishing expeditions" which I have stopped and had subsequent nurses come in and immediately find the "problem" vein in less than ten seconds. The better nurses don't seem to have as many "rolling vein" issues in my experience with my children and my own hospitalization.)

Specifically speaking about the "goofy" nurse who didn't remember to use the anesthetic prior to the needle stick: This nurse FORGOT to use it in a hospital that routinely uses it. Again, it was an issue with an inexperienced and possibly incompetent nurse. We had been to that hospital numerous times prior and I knew what the policies were. As far as having a nurse who cannot locate a vein - after a certain amount of time the intense pain in conjunction with the psychological trauma/fear of a young child becomes medical torture that the parent needs to proactively put an end to and request a more competent nurse with a better track record of needle sticks. I realize this requires a second needle stick, but better to call the first painful session quits and have someone get it in quickly and correctly than to have a big needle literally digging around in a little arm. I would give a nurse no more than 30 seconds of "digging" before I called in a second nurse. In my experience the best nurses got the needle into the vein within 10 seconds flat - regardless of other issues. My advice to Peggy is to specifically request when you walk in the door that you have the most experienced nurse with the best needle-stick track record do the job. Generally speaking, Pediatric nurses are going to be better and quicker at finding small veins of children than general RN's. If you are going to a Pediatric hospital, still ask for the Peds RN with the fastest, most reliable needle stick.

Peggy is going to have to be very vigilant in seeing that her son gets excellent care from all of the medical staff - period.

[peggyfromwastate]

How in the world did you discover a mustard allergy? Sounds like the little guy has been through alot. Best of luck to you.
Luanne

Luanne- It's kinda interesting how we found the mustard allergy. He has no other food allergies- just mustard it seems. When he was about 13 months, he was eating a hot dog (and he's not allergic to hot dogs) and I gave him some mustard for dip, and he did ok. But that was the first exposure. Then, a few days later, he had some BBQ sauce, which has mustard seed as one of the last ingredients, and his face immediately turned bright red, his eyes got puffy, he got hives all over his face, he started sneezing, and his nose was running! He was obviously having an allergic reaction, and we suspected the mustard seed b/c he'd been exposed to all other ingredients various times. Anyway, we avoided mustard from then on, but we gave his sister BBQ sauce one time to dip chicken nuggets. Apparently we didn't wash her hands well enough because when the twins went to bath, Stevie got hives only on his skin that was in contact with the water. Strange. I've never seen a topical allergic reaction like that. Now, we don't have mustard or BBQ sauce. And it's too bad, because I really like those two sauces, and mustard is a common ingredient in lots of tasty sauces. We keep hoping he'll grow out of it! Our allergist was really surprised by that allergy- 15 years and she'd never seen it. That's why he had to have his blood tested, since there is no other allergy test for it. And it came back positive.

Funny thing is, after seeing our son and having him tested, our allergist went on a vacation and met a friend who also has a violent allergy to mustard!

Now we carry epipens wherever we go, and we have to ask at all the restaurants, etc if they have ANY mustard in ANY sauce. We can't even go to McDonalds because they slop that stuff on everything.

There- A detailed explanation if there ever was one!

[Rapunzel]

A mustard allergy - WOW! That sounds about as difficult to keep in check as a peanut allergy!