Therapeutic parenting... post operatively
Tiny had his tonsils and adenoids out on Friday. It’s fair to say that none of us were looking forward to it. He hates doctors and hospitals and is not good at taking medication at the best of times. At home he’ll generally take ‘pink medicine’ (Calpol) fairly happily but anything else is a challenge. He’s also prone to anxiety and had generally been in a bit of a regressive phase recently… I only realised how much so when I spent a bit of time with a friend’s nearly one year old last weekend and realised that despite being nearly 4, Tiny had so many behaviours in common with him.
Given that Little had a similar operation at the same hospital not too long ago, we at least had a fair idea of what was going to happen and were able to write Tiny a pretty comprehensive story explaining it all. We read it with him as much as we could beforehand and he took it into nursery too and shared it with some of his teachers there. I made sure I packed several of his comfort things for the day and we let a lot of things slide in the days before… as long as he felt safe and contained, most of the other demands on him fell by the waysides.
It’s fair to say that the whole experience was pretty traumatic for him. The staff were lovely, and generally did everything they could to put him at ease. Because he’s tiny for his age, he had to stay overnight afterwards and the longer we were there, the more he regressed, to the point that when we left in the morning he wasn’t speaking and I couldn’t even go to the toilet without him on my lap! He took his pre-op meds fine (with significant encouragement and persuasion from me) but no amount of cajoling, bribery or otherwise could get him to take the cocktail of painkillers he was supposed to have afterwards. The nurses insisted on them being given (quite rightly, it’s their job after all) and so I basically had to hold him down while they forced them into him, which was traumatic for everyone concerned.
The challenge now we’re home is meeting his medical needs while continuing to parent therapeutically and help Tiny to feel safe again. He’s supposed to be on regular paracetamol and ibuprofen, plus prophylactic antibiotics and ear drops but there’s no way he’d have any of that without physical force. We could do that, and the nurses have told us we have to do it, but neither of us are comfortable with it, and I think the damage it would do to the therapeutic relationship is not worth the risk. He’s clearly in pain, and winces whenever he eats or drinks, and we’ve been told that pain management is key to his recovery, as the children who continue to eat and drink well are the ones who recover better. There’s also a risk of post op bleeding, which increases the more he cries with pain, and a risk of post op infection which would mean going back to hospital.
So clearly, him taking painkillers and antibiotics would be a good thing, and if we could get them in him without trauma, we would, absolutely. But if crying with pain increases the risk of post op bleeding, then surely so does screaming in protest while we force medication into him, and it certainly does nothing to reestablish the sense that he’s safe with us. He’s still barely talking and just whimpering and pointing to communicate his needs, and he needs one of us with him at all times, to the point we’re taking it in turns to sleep on an air bed in his room. He can talk completely normally when he needs to, so it’s all about his need to regress rather than anything else. The second medication is mentioned he starts screaming. We know it’s not taste related for Calpol at least, so it must be that the whole experience has just freaked him out so much. He’s a pro at detecting liquid medicine hidden in drinks and yoghurts so that’s not an option either.
So we’re powering through. We’re absolutely clear between us that the second he spikes a fever or stops eating and drinking because of the pain then we need to force some medication into him, but until that point we’re letting him be in charge of his pain management. He was clearly in a lot of pain this morning but when I asked whether his throat hurt a lot or a little bit, his answer was ‘a little bit so I don’t need medicine’, which just shows how anxious he is about is. I work in the NHS and have a lot of respect of medical professions, and I’m sure some would be horrified by the next bit, but the one thing we do seem to be able to sneak into food undetected is the ground up equivalent fraction of an adult paracetamol tablet, so that’s what we’re trying to do. We got away with it in the peanut butter on his toast this morning and stirred into some custard last night, and that seems to be enough to keep things at a manageable level for now. It’s far from ideal and we’re just crossing our fingers that there are no complications as I’m sure we’ll get a complete dressing down from hospital staff if we have to go back. But for the moment things are on the right track. After insisting on pyjamas for 2 days, he brought me a shirt this morning and asked me to help him get dressed, and he’s even spoken (albeit in a baby voice) and played a little since. Right now he’s eating crisps. Working in mental health, I know that recovery is not just about medication and he does seem to be feeling better in himself. So the only other thing we can do for now is to keep a very close eye on him and hope that we’re doing the right thing…
Given that Little had a similar operation at the same hospital not too long ago, we at least had a fair idea of what was going to happen and were able to write Tiny a pretty comprehensive story explaining it all. We read it with him as much as we could beforehand and he took it into nursery too and shared it with some of his teachers there. I made sure I packed several of his comfort things for the day and we let a lot of things slide in the days before… as long as he felt safe and contained, most of the other demands on him fell by the waysides.
It’s fair to say that the whole experience was pretty traumatic for him. The staff were lovely, and generally did everything they could to put him at ease. Because he’s tiny for his age, he had to stay overnight afterwards and the longer we were there, the more he regressed, to the point that when we left in the morning he wasn’t speaking and I couldn’t even go to the toilet without him on my lap! He took his pre-op meds fine (with significant encouragement and persuasion from me) but no amount of cajoling, bribery or otherwise could get him to take the cocktail of painkillers he was supposed to have afterwards. The nurses insisted on them being given (quite rightly, it’s their job after all) and so I basically had to hold him down while they forced them into him, which was traumatic for everyone concerned.
The challenge now we’re home is meeting his medical needs while continuing to parent therapeutically and help Tiny to feel safe again. He’s supposed to be on regular paracetamol and ibuprofen, plus prophylactic antibiotics and ear drops but there’s no way he’d have any of that without physical force. We could do that, and the nurses have told us we have to do it, but neither of us are comfortable with it, and I think the damage it would do to the therapeutic relationship is not worth the risk. He’s clearly in pain, and winces whenever he eats or drinks, and we’ve been told that pain management is key to his recovery, as the children who continue to eat and drink well are the ones who recover better. There’s also a risk of post op bleeding, which increases the more he cries with pain, and a risk of post op infection which would mean going back to hospital.
So clearly, him taking painkillers and antibiotics would be a good thing, and if we could get them in him without trauma, we would, absolutely. But if crying with pain increases the risk of post op bleeding, then surely so does screaming in protest while we force medication into him, and it certainly does nothing to reestablish the sense that he’s safe with us. He’s still barely talking and just whimpering and pointing to communicate his needs, and he needs one of us with him at all times, to the point we’re taking it in turns to sleep on an air bed in his room. He can talk completely normally when he needs to, so it’s all about his need to regress rather than anything else. The second medication is mentioned he starts screaming. We know it’s not taste related for Calpol at least, so it must be that the whole experience has just freaked him out so much. He’s a pro at detecting liquid medicine hidden in drinks and yoghurts so that’s not an option either.
So we’re powering through. We’re absolutely clear between us that the second he spikes a fever or stops eating and drinking because of the pain then we need to force some medication into him, but until that point we’re letting him be in charge of his pain management. He was clearly in a lot of pain this morning but when I asked whether his throat hurt a lot or a little bit, his answer was ‘a little bit so I don’t need medicine’, which just shows how anxious he is about is. I work in the NHS and have a lot of respect of medical professions, and I’m sure some would be horrified by the next bit, but the one thing we do seem to be able to sneak into food undetected is the ground up equivalent fraction of an adult paracetamol tablet, so that’s what we’re trying to do. We got away with it in the peanut butter on his toast this morning and stirred into some custard last night, and that seems to be enough to keep things at a manageable level for now. It’s far from ideal and we’re just crossing our fingers that there are no complications as I’m sure we’ll get a complete dressing down from hospital staff if we have to go back. But for the moment things are on the right track. After insisting on pyjamas for 2 days, he brought me a shirt this morning and asked me to help him get dressed, and he’s even spoken (albeit in a baby voice) and played a little since. Right now he’s eating crisps. Working in mental health, I know that recovery is not just about medication and he does seem to be feeling better in himself. So the only other thing we can do for now is to keep a very close eye on him and hope that we’re doing the right thing…
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