When it is time for your child to go home after heart surgery, you will be given an after visit summary. The after visit summary tells you about your child's hospital stay and when your child needs to come back to the hospital for follow-up appointments.
Taking care of your child's wounds
After heart surgery, your child will have an incision (surgical cut) in the middle or the side of the chest, as well as other smaller wounds where tubes and wires may have been. Check each of these wounds every day for signs of infection, including:
If you see any of these signs, or if you have any concerns within the first 4 weeks after surgery, contact the post-operative nurse practitioner (for SickKids patients, please see contact information in the At SickKids section).
Your child's chest tube site
Two days after your child's chest tube(s) is/are taken out, the bandages over the chest tube site(s) should be taken off. The black stitch will be removed before your child is discharged or at your child’s post-operative clinic appointment.
Surgical incision care
For the first 4 weeks after surgery, your child’s incisions will require special care at home to help promote healthy healing and prevent infection. This care will be required until your child’s incisions are healed and the scabs have fallen off.
Protect the incision and new skin:
- Do not submerge the incision in water (i.e. bathtub, swimming pool) for a minimum of 4 weeks and not until the scabs have fallen off.
- Keep the incision covered with clean clothing at all times and use a bib when feeding babies.
- Do not scrub the incision or pick at scabs to avoid disrupting the healing process.
- The incision might have (blue) sutures (stitches) in place. These sutures will be removed by the health-care team 10-14 days after surgery during the post-operative clinic appointment.
How to clean your child's incision:
Clean the area around the incision every day for a minimum of 4 weeks and until the scabs have fallen off.
- Wash your hands with soap and water for 30 seconds.
- Remove the dressing from the incision site using an adhesive remover.
- Wash your hands again with soap and water for 30 seconds.
- Clean the incision with an unscented baby soap, starting top to bottom, in a circular motion.
- Rinse the soap off, using clean water.
- Dry the area completely using a clean towel or wash cloth.
- Place a new, clean dressing over the incision (for 7 days). After 7 days, leave the incision open to air and dress your child in clean clothing.
Make sure your child takes shallow baths or showers daily. If the incision gets dirty (i.e. vomit, milk), clean only the dirty portion of the incision, and then clean the area around the incision with liquid soap and water.
Sun protection
Until all the scabs have fallen off and the area looks healed, cover the wounds with clothing that does not let the light through. Apply sunscreen on all of your child’s exposed skin. After the scabs have fallen off and the wounds are healed, always put sunscreen on the new scars, as that skin is more sensitive.
Managing your child’s pain
Your child may have pain for several weeks after surgery. As time passes, the pain will become less severe. When your child leaves the hospital, they will usually have a prescription for pain medicine. As your child heals, they will need to take this medicine less frequently.
If your child’s pain gets worse, see your paediatrician or family doctor. Ask your child’s nurse how to assess your child’s pain before discharge.
Limit your child’s physical activity for several weeks
Children need regular physical activity as part of a healthy lifestyle. However, your child will need to be careful for several weeks after their operation, to avoid disturbing the wounds.
Activity restrictions for babies
| Time period | Activity restrictions |
|---|---|
| For the first 2 weeks after surgery | Avoid activities that might disturb the wound. Avoid lying on the tummy. After 2 weeks, lying on the tummy is encouraged for normal development. |
| For the first 6 weeks after surgery | Protect the chest muscles and bone during all activity. Avoid lifting under the arms. Instead, lift your baby under head/neck and bottom. |
Activity restrictions for toddlers, children and teens
| Time period | Activity recommendations |
|---|---|
| For the first 2 weeks after surgery | Avoid activities that might disturb the wound. Avoid lying on tummy. |
| For the first 6 weeks after surgery | Protect the chest muscles and bone during all activity. Avoid lifting toddlers and children under the arms. Instead, lift them under head/neck and bottom. Avoid pushing or pulling heavy objects. Avoid doing push-ups, sit-ups or pulling themselves up on furniture. Avoid backward arm circle movements. |
| For the first 12 weeks after surgery | Protect the chest bone during all activity. Avoid activities that could cause a blow to the chest. These include rough play, ball throwing, football, hockey, karate or other contact sports. |
Your child’s behaviour
After surgery, you may notice a change in your child’s behaviour. The following changes are normal after a hospital stay:
- disturbed sleep patterns
- wetting the bed
- being more fussy or clingy
Medicines
If your child needs medicine at home, you will be given a prescription before you leave the hospital. It is recommended to have the prescription filled at the hospital outpatient pharmacy before you go home. Your local pharmacy may not have some of the specific medicines your child needs. The nurse or pharmacist will let you know what the medicine is for and how to give it.
When and how to give medicines
- Give the medicine at the same time every day. If your child is taking several medicines, you can ask your nurse or pharmacist to give you a chart to help you remember when to give the medicines.
- You should always try to give medicine before feeding your child. Babies are more likely to take their medicine when they are hungry, and they are less likely to throw up if they get their medicine before their stomachs are full.
- Try not to add medicine to food or drinks. When medicine is mixed with food or drink, it can be hard to know if the full dose has been taken. If you must add medicine to food or drink, put the medicine in a very small amount of food or drink so that the child will finish it all.
- Clean the oral syringes, spoons or medicine cups with hot water and soap after each use.
- Do not mix different syringes with different medicines. Each medicine must have its own syringe.
Read all the information about your child’s medicine
- Read the written information about your child’s medicine before you leave the hospital. The pharmacist, nurse or doctor can answer any questions you may have.
- Always read the labels on the medicine that you get from the pharmacy. Make sure that you know when to give it and how much to give.
- Some of the medicine that your child takes may need to be refrigerated. Be sure to check the labels and store them correctly.
If you miss a dose or your child throws up
- If your child throws up all of the medicine right away, give your child another dose.
- If your child throws up 15 to 20 minutes after you have given the medicine, do NOT give your child another dose. If you are not sure what to do, call your doctor or pharmacist.
- If you miss a dose, do not double up on the next dose. If you are less than two hours late, go ahead and give the medicine. If you are more than two hours late, give the next regular dose at the regularly scheduled time. If you are not sure what to do, call your doctor or pharmacist.
Other things to remember
- Check with your doctor or pharmacist before you give any over-the-counter medicines.
- Bring all of your child’s medicines with you to each visit to the hospital and/or take pictures of the medicine bottles on your phone.
Keep all medicines locked away and out of the reach of children at all times.
Routine health care
Your child should see their paediatrician or family doctor within 1 or 2 weeks after your child leaves the hospital. They will follow your child’s ongoing general health needs. If you have any general concerns about your child’s health, speak to their paediatrician or family doctor.
Immunizations
If you have questions about your child’s immunizations, talk to your child’s paediatrician or family doctor. There are special considerations for some children who have had heart surgery, for example the immunization schedule may be delayed if your child received blood products. If these considerations apply to your child, this will be noted on the after visit summary that you receive when your child is discharged.
Dental care, surgery, and other procedures
Talk to your child’s cardiologist before your child has any dental treatment, surgery or other procedures. Ask your child’s cardiologist if your child needs to take special precautions before these procedures. Before your child has any procedures, make sure your child’s health-care providers know that your child has had heart surgery.
Going back to school or day care
Your child can go back to school 2 weeks after surgery, or when they feel physically well enough to go. Babies and toddlers can go back to daycare after 2 weeks.
If other children at the day care or school are sick or have an infection, your child should not go back until 4 weeks after the surgery. Good hand washing and avoiding contact with others who are sick can stop the spread of infection.
Travel
If you and your child live out of town, you may need to stay close to the hospital until you have had your post-operative clinic visit. Once the cardiologist is happy with your child’s condition, you can go home.
If your child has ongoing health concerns, this may limit your travel or vacation plans. If you are not sure what your child can do, contact your child’s cardiologist.
Car seat
When travelling in a car, you must make sure that your children are safely seated in a car seat or secured with a seat belt at all times. There is no need for modifications to the car seat or straps if your child has had heart surgery.
Learning first aid
Basic Life Support or BLS courses are recommended for all parents. These skills could let you save your child’s life or someone else’s. If you are interested in taking one of these courses offered by the hospital please visit http://www.cvent.com/d/g4qls1.
Feeding your child
If your baby or child has special nutrition or feeding needs, or requires tube feeding, you will receive additional information from a dietitian and/or an occupational therapist before discharge.
Follow-up appointments at the cardiology clinic
When your child leaves the hospital, you will be given a time to meet with your child's cardiologist. In the future, you can schedule follow-up appointments with the cardiologist during your child's clinic visits.
One week after your child leaves the hospital, you may have a follow-up appointment in the post-operative clinic. During this visit, your child may:
- have their wound checked by the nurse practitioner
- have a chest X-ray, echocardiogram (heart ultrasound), or blood work
- see the dietitian or occupational therapist
During the follow-up appointment, you and your child will both be able to ask questions and talk about any concerns.
Please arrive on time for your appointments, and come prepared. Appointments can sometimes be delayed, or you may need to wait for tests to be done. Bring books, toys, snacks, diapers and anything else you and your child need to be comfortable while you wait. Before an appointment, write down questions you may have and bring them to the clinic. If you cannot come to an appointment, call the cardiology clinic as early as possible to reschedule.
When to seek medical attention
For SickKids patients, please see the "At SickKids" section for who to contact if you have concerns about your child’s heart condition.
What to do in case of an emergency
Contact 911 or take your child to the nearest emergency department if your child is:
- having trouble breathing
- experiencing seizures
- not waking up
Non-urgent health concerns
If you have any questions or concerns about your child’s health that are not related to your child’s heart problem, please contact your child’s paediatrician or family doctor.
At SickKids
For SickKids patients, if you have any questions or concerns related to your child’s heart condition within 1 week after your child is discharged from the hospital contact the 4D Cardiac Inpatient Unit at (416)- 813- 6901.
If you have concerns that your child's wounds may be infected within the first 4 weeks after surgery, call (416)-813-6901 ext. 2 and ask to speak to the Post-Operative Nurse Practitioner during regular business hours.
If you have any non-urgent questions or concerns after 1 week of discharge from the hospital and you have been seen in post-operative clinic, contact your clinic nurse directly or call 4A Cardiac Clinic at (416)- 813-5848 during regular business hours. You may also leave a message after hours.