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The aim of this fact sheet is to explain what you can do to help your child prepare for heart surgery, and how a Molly’s Dolly can be helpful in that preparation.

Preparing your child for surgery will help them to understand their illness and treatment better. The Children’s Heart Federation has specially made rag (male/female) dolls with surgical scars. These can be used to introduce the idea of operations and scars to your child.

Your child may like to play with the doll and use it as a ‘patient’ to play hospital at home. Children use play as a way to communicate and this can help them to prepare for their hospital stay. Allowing children to see, touch and play out their worries with toy medical equipment and dolls before they come into hospital, provides an opportunity to ask questions and familiarise themselves with what is going to happen to them. It can also help them to play out their experiences afterwards and come to terms with what has happened. They may also wish to bring the doll with them, when they come into hospital.

Why should I prepare my child?

• It helps them to understand their illness and treatment.
• Preparing your child psychologically for surgery can help them to recover more quickly afterwards. It lowers the risk of long-term distress following their experience in hospital.
• It helps to correct any misunderstandings your child may have about what happens in a hospital, or during their particular surgery.
• It gives your child a chance to express their worries and feelings (for example, Will it hurt? What will my scar look like?).
• It helps your child to find ways of coping with the treatment (for example, watching my favourite cartoon will help to take my mind off things).
• It speeds up recovery. Children tend to be more co-operative when they understand what is happening to them.

When should I prepare my child?
You know your child best. Some things to consider are:

• How old is your child?
• What developmental stage are they at?
• Do they have any previous experience of hospitals?
• How well or unwell do they feel?

These will affect how and when you prepare your child.

Toddlers (18 months to two and a half years old): will only understand that they are in a strange place, with strange people who sometimes do things to them that are painful. They will need lots of cuddles and reassurance. Distracting them at the time of a painful procedure is the best way to help and support them.

Pre-school (three to five years old): may have no understanding of time, so preparing them a few days before they come into hospital should be enough.

School aged children (five to eleven years old): one to two weeks before is usually about right.

Older children/teenagers (eleven years old plus): may need much more detailed information and time to absorb it. They may need more time to adjust to the idea of the procedure they are going to have.

From a young age, children are often keen to discuss what they know about hospitals. This could be right or wrong information. You may think that it is best not to tell your child about the operation, but this usually causes more distress in both the short and long-term.

What do I say?

• Use words that your child is familiar with (scar, zipper and line). You can use the doll to show these to them.
• Give truthful, factual information (it may hurt a bit, but mummy will be there with you and you will have medicine to help).
• Explain why they need to come into hospital (it will make you feel better, feel less breathless).
• Describe the people your child may meet (doctors, nurses).
• Explain the procedures he/she may have, for example a chest x-ray, ECG (electrocardiogram), Echo (echocardiograph) or blood test. Check with your child’s doctor or nurse if you are unsure which tests they may have or what the tests involve.

School aged children often talk about operations with vivid and sometimes frightening descriptions, such as cutting and pulling things out. As a parent, you may find this distressing to hear. Make sure you look after yourself and prepare yourself as much as possible before talking to your child. If your child asks a question that you do not know how to answer, or are too shocked or distressed to answer, give yourself some opt out time. Say ‘I do not know the answer, but I will find out for you.’ This gives you the time to have a break, contact someone for support or have time to find a suitable answer.

What if my child won’t talk to me?
Parents often say ‘if only he/she would tell me what is wrong’. Children use play and behaviour as a way of communication. Role play (acting out), ‘naughty’ behaviour or being extra quiet (withdrawn) may be a way of letting you know what they are afraid to say or do not know how to say. Hitting the doll or giving repeated painful injections can indicate anger towards the illness or impending operation. Every child will express themselves differently.

Who can I contact for support?
Do not forget, you are not expected to know everything. If you would like more information on what to do, contact your cardiac centre and talk to the play specialist and cardiac liaison nurses. Alternatively, visit the website Action for Sick Children at www.actionforsickchildren.org or contact the Children’s Heart Federation on 0300 561 0065 or visit www.chfed.org.uk

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