Ep 197: Helping Kids Feel Safe Before Anesthesia, with pediatric anesthesiologist Dr Jacqueline Drummond Lewis

When kids need anesthesia for a medical procedure, it’s normal for both them—and their parents—to feel anxious. In this episode of Your Child is Normal, Dr. Jessica Hochman speaks with pediatric anesthesiologist Dr. Jacqueline Drummond Lewis (aka Doc JC), author of Adventures with Doc JC: The Unseen Planet. Together they explore what anesthesia actually is, how it works in kids, and how families can better prepare their children before a procedure. Dr. Lewis shares practical tips, reassures us about safety, and explains how imagination and preparation can reduce fear for everyone involved.

Click here find the book Adventures with Doc JC: The Unseen Planet

Your Child is Normal is the trusted podcast for parents, pediatricians, and child health experts who want smart, nuanced conversations about raising healthy, resilient kids. Hosted by Dr. Jessica Hochman — a board-certified practicing pediatrician — the show combines evidence-based medicine, expert interviews, and real-world parenting advice to help listeners navigate everything from sleep struggles to mental health, nutrition, screen time, and more.

Follow Dr Jessica Hochman:
Instagram: @AskDrJessica and Tiktok @askdrjessica
YouTube channel: Ask Dr Jessica

If you are interested in placing an ad on Your Child Is Normal click here or fill out our interest form.

-For a plant-based, USDA Organic certified vitamin supplement, check out : Llama Naturals Vitamin and use discount code: DRJESSICA20

-To test your child's microbiome and get recommendations, check out:
Tiny Health using code: DRJESSICA

The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagno...

Transcript

Unknown: 0:00

Hello, listeners. This is Dr Jessica Hochman. I'm excited to share that I am now booking sponsorships for your child as normal for this fall. If you have a product, service or a message that you think our listeners would benefit from, whether it's for parents, kids, healthcare or family life in general, this could be a great opportunity. You can find details on how to sponsor by checking the show notes. Just click the link that says how to sponsor an episode, and I'll let you know for a good match and get back to you now welcome to your child is normal. Today, we're talking about a topic that can bring up a lot of anxiety for families. Anesthesia, whether it's for ear tubes, dental work or more involved procedure, the idea of your child going under can be scary. But what if there was a way to prepare your child and yourself that felt empowering instead of overwhelming. My guest is Dr Jacqueline Drummond Lewis, better known as Doc JC, she's a pediatric anesthesiologist and the author of a beautiful new book, adventures with Doc. JC, the unseen planet. Her book is a wonderful tool for helping children prepare for anesthesia by using imagination instead of fear. In this episode, you'll learn how anesthesia works, what parents should know about safety and why preparing kids in advance can make such a big difference in their experience. Whether you're facing a procedure next week or you simply want to be informed for the future, this conversation is packed with calm, clear and practical guidance. And before we get started, if you're enjoying this episode or other episodes from the past, please consider sharing your child is normal with a friend, sharing episodes and leaving a review is the best way to help this podcast grow so I can continue my mission of helping parents enjoy their parenting journey. Now on to my conversation with Doc. JC, Dr Lewis, I'm so excited to have you here. Welcome to your child is normal. Tell us about yourself and what do you do for work? Jessica, thank you. It's been an honor to be here. And I am a pediatric anesthesiologist, and my passion is really to help children come to us, trying to imagine us as friends, and that's the reason my book adventures with Dr, JC, the unseen planet is now here I see that curiosity and their imagination, and we are not tapping into that, so I want this book to open that for them. And my passion is anesthesia. Why? Because I like to help them to go through procedures that are super painful, but they go with zero pain and zero anxiety, and at the end, they just go back to their normal life. For many families, I imagine they must experience anxiety before they have a procedure that might require anesthesia for their child. So it sounds like you wrote a book to utilize the natural imagination of children to make them more comfortable. That is correct. And I feel that the reason anesthesia creates such an anxiety, not only in little ones, but in big ones too, is because when it's portrayed in movies like for example, there was one that came that is just like, yeah, horrific stories about anesthesia, right? And we don't have the chance, because we don't have an office, per se, to establish communication with the family until they walk into the procedure place, either a clinic or a hospital, and at the same time, it's a very intense conversation to have. So anesthesia is seen like, yeah, that unseen planet that my kid is going to go but I don't know anything about it. Nobody has talked to me. So I think that's the bridge that I want to create as a pediatrician. I do find that a lot of parents come to me when when their child is recommended to have a procedure that may require anesthesia. Many parents come to me with questions and concerns. They're nervous that anesthesia might pose some harm to their child. Can you speak to that at all? Are there any harms from general anesthesia that parents should be aware of for their kids? Yeah, and I will start by just reassuring like I'm going to quote here that back in 20, 24 million procedures in pediatric care has been done successfully through general anesthesia. And when I talk about pediatric anesthesia, I'm talking from neonates. Those are the ones that are from zero to 30 days of life they have, then the toddlers and then the teens, all of them are really being care by pediatric anesthesiologists. And back in 2016 the FDA created this announcement or warning about the effects of anesthesia in children that are less than three years of age, but it's also related with that duration of the procedure, and it's longer than three hours or multiple procedures, and especially in those cases, is not a one. One to One, but has been cases reported that decreases learning or affect the learning of the child, but just in general, those are not the typical procedures that the child are going to have. So to answer to your question, anesthesia has been really, really safe, and I heard in one of your podcasts with one of my favorite ENT physicians to work with, Dr Nina Shapiro, she said surgery in children is much safer because anesthesia is safer. And I 100% agree on that. I feel very grateful that we live in an era when anesthesia exists, that's for sure. Yes, but I I find it very helpful to hear from you that when it comes to risk, which I think is what is on the forefront of all of our minds when we have a child that's about to have a procedure, that if it's a shorter procedure, it seems like that risk is much lessened. Yeah, the explanation of the risk was mainly about the side effects that anesthesia can have longer term for the learning disabilities that the FDA was saying so short procedures for sure, we can say confidently there's nothing to worry about. So the numbers are less than three years of age and longer than three hours or multiple procedures. So if that's not the category, I will say, feel confident that there's really no effect long term. And even in those one in those categories, there's still studies to really make sure, because it's not a one to one. Now, a lot of parents, they get nervous just by hearing the word anesthesia. Can you explain what anesthesia really is, and how is it different from children compared to adults? And I will say to the parents that are listening, is completely normal to feel nervous about anesthesia. The word itself is so clinical and so serious, but I have to say, as I mentioned, it's pretty safe. And if I want to break it down to simple words, anesthesia is the medication that we administer to our patients, in this case, to your children, so they be able to go to procedures without feeling anxiety, no recollection and no pain? Is it different from adults? Yes, it is because we take in consideration that children has different way of metabolizing the anesthetics that we give so all of that takes in consideration before we administer the medication, their age, their weight, their medical history, and their development and their anxiety. Now I get many phone calls from parents that will mention a type of anesthetic that is going to be used in a future procedure, and they ask me, in particular, if that medication is safe for children. Can you explain the different types of anesthesia that may be offered and explain also, maybe, how you may decide which one is safest for each child? Yes, we have four main groups, but that decision has to be determined with the type of procedure, and then we take in consideration the age of the children and if it's going to be an outpatient procedure, or is going to be procedure that is going to be done in the hospital. And last but not least is the level of anxiety of the child. For example, I'm going to start with the simple one is the local anesthesia. It's an injection that is used for very minor procedures like stitching someone. The second one is what we call regional anesthesia, and this is when we inject medication in a bigger area, like, for example, for an arm, a hand, a leg. So it's really specific areas, and specifically in pediatrics, this is something that we use to decrease the amount of pain medication used during the procedure and after the procedure, they will require less because the pain medication is already given. The third one we call monitor anesthesia. We call it also Mac. It's not a Big Mac, it's Mac, MS, monitor Anesthesia Care. And with that one we will administer through an IV medications that will decrease their pain or their level of anxiety. This one is used for very minor procedures, not for real big, involved procedures. And the third one is what people have in mind when they hurt anesthesia is really general anesthesia. What is that? That medication is really putting your kid in a. Deeper level of sleep. During that deep level, the child is not going to be experiencing any pain, remembering anything, and not having any anxiety. So any procedure as painful as they can see, is going to be really seamless on their general anesthesia. All of these procedures are really taking care by specialized team and beat to beat, bread to bread, moment by moment, we are adjusting whatever is needed to keep your child safe. And let's say somebody finds themselves with their child at a hospital where the child may benefit from having anesthesia before a procedure. Does it have to be a pediatric anesthesiologist, or could it be a general anesthesiologist? That's a topic of discussion, but I will say not all the hospitals have pediatric anesthesiologists, but as a part of our training, we have pediatric anesthesia training as well. So it's just a matter of comfort, and what is the practice of the hospital that is taking care of that for the parents? I will say, when you have that conversation, you can ask, you can ask, how comfortable you are with doing children like the age of my child, and depending on that, you can assess and make that decision. I think that's great advice. I really do, because you can get a lot from ascertaining the confidence from the anesthesiologist by asking the question, do you feel comfortable giving my child anesthesia and see what they say, I agree with that, because unfortunately, I find there are not a ton of pediatric anesthesiologists. I agree with that, yeah, yeah. But that doesn't mean that they are not other general anesthesiologists that are very confident doing pediatrics, I will say, for the majority, less than one year of age or two years of age, they really have to be a pediatric anesthesiologist, because the physiology, you have to be more confident with that. I'm not saying not with the other ones. But if I have to make a distinction, I will say to the parents, really ask about the background of the anesthesiology that is going to be involved and make that decision. In my experience, there have been many situations where I've seen it can go both ways, where a child, for example, could get stitches without being under anesthesia, and also, I've seen them get stitches under anesthesia. And one big benefit, I think, to using anesthesia is the child does not remember at all, because the kids that we've had to use purposes for to hold them down to put stitches in, I can tell that subsequent visits to our office, they're a lot more nervous where when they don't remember what happened. That's to the child's benefit. In a lot of ways, I agree with that. And in that term, I think the preparation also takes time, if it's only stitches, if you can really explain, you can have them to participate and not for something. And that's number one, we have to take the child to be the center of the care and not the procedure. So if the child is really not prepared, even when you talk, he's not really interested in being participant, why you going to impose something like Apple post? It's not going to work. It's just going to increase his anxiety or her anxiety. So in that sense, I think it's better just to talk to them in their own language and see where they are and meet them and provided what they need so they can have the better experience that they can have in that procedure. So do you have any unique tricks up your sleeve as an anesthesiologist to help kids feel more safe and feel calmer before having a procedure, personally the night before, when I talk with the parents, I talk to them and I ask them, I assess, how is the family being prepared for that? Not surprisingly, the majority, no, we haven't say anything, and I say, No, no, this is the moment that you're going to have a conversation. And take that conversation as you're going to Disneyland on a ride. Is really frightening, but you are excited about it. So that's what you need to translate to your child. Your child is very intuitive, and regardless you don't mention anything, they feed on your fear, but if they hear that, okay, it's gonna be like a ride. Is really nerve wracking, but the benefits are this and this and this, that makes a difference. And I will say it doesn't have to be the night before you. So if your child is someone that really wants to know more, why not start the conversation early? And there's an article showing that that perioperative time doesn't start right when you walk into the hospital. It starts way before, and that way before, only you and your child will know how long you need to prepare. And that's why I think this adventure with Dr C to the unseen planet is a tool, because it's going to help you get an idea, in a magical way, about what is anesthesia. So hopefully the parents or the adults of the family will be able to get more relaxed and will open the conversations for you. Dr Lewis, do you have any special tricks that you use on kids to help them feel more at ease and more comfortable? It depends is really, I think that's part of the of the job that I really love, is to meet them where they are. Some of them bring a toy, and they talk to me about the toy, so I engage through the toy. What is going to happen? And they really love it that way. Other ones they are coloring, so we just talk about coloring. So it's really to meet them where they are, but it's not only meeting the child, it's meeting the parents as well. And my trick is, I start by, are you sure they are your parents, like, Are you sure you're with the right team? And I start from there. We have magic doors. So they get to open the magic doors when they want it. But it's not one tool fits everyone. They have their own and unique way, and I love it. Their imagination is amazing. That is for sure. I am constantly inspired by the imagination of children. Now, I find that the real concern that parents ask me when it comes to anesthesia with their kids, they ask, how can you guarantee that my child will wake up? That's a big, dark fear that I notice a lot of parents have. What is your answer to parents, when you hear that question, I say, we gonna be giving the medication even though he's going into deep levels of sleep, we have all these monitors that are telling us if the medication is a lot a little or is just right? So by knowing that, we become like this pilot that is reflecting on the information that is receiving from the corporate to really tell how much they have to tweak. So we tweak the whole time. Is not like we just put them to sleep, and we wait until the procedure is done, no B to B, bread by bread, we look into how is the response to the medication that we are giving, and we know that every child have different responses to different medications, and we have the tools to treat them depending what needs to be done that's a very helpful way to understand it. I think one of the most common scenarios where parents are considering anesthesia and they have questions and concerns are children who have sensory issues anxiety, or a lot of kids with autism, for example, have a hard time with especially I find dental procedures, yes, and dentists will recommend to them, we do have, we do have a pediatric anesthesiologist. I would consider using using this tool to make the procedure easier. And parents are quite nervous. And what I find is a lot of parents will ask me, How important is it that we fix this cavity? For example. You know, they'd almost rather leave the cavity in than consider using anesthesia sometimes. So how would you reassure parents that are particularly nervous with using anesthesia? So I say in general. So that's two points that you have. But let's, let's go back to the child with special needs, right? For those, I think that conversation needs to start, not the night before, but way, way before. Once they are scheduled to have a procedure, you can reach to the physician who's ordering to say, how can I get in touch with the team that is going to do it? Because you have the right to say, This is what makes my child more comfortable, like, for example, bright lights really disoriented. So we can deem the lights, we can deem the lights in the operating room, and it's still efficient. And in that sense, the child knows that he or she being respected by keeping what makes them more comfortable hearing? There's a lot of different sounds, a lot of different smells that there's no way to prepare them. But if that's something that is triggering for especially with sounds, we can decrease the amount of stimulation or find those headphones. Phones to cancel the noise. So there's a lot to be creative about that, and especially for those child I really think are there is in the power of the parents to speak for them, to let us know what works for them, what doesn't work. And especially there's some words right that we can say that make them comfortable. And in my book, I have these interactive section, and that's where I give the whole family the power to create their own adventure. In your adventure, you want to bring this, you bring it, and that's how you present to us. Okay, this is my adventure, and this is who I'm coming and bringing to my adventure. In that sense, it doesn't feel that we are imposing something. And for autistic children, I think knowing what is there ahead of time will give them at least the chance to refresh it. I think it goes back to what you're saying about meeting families where they are, because I do find for many parents where kids suffer from severe anxiety, for example, when you offer them the option of anesthesia, I find that that gives families a lot of relief. And just going to finish with the anxiety of the parents, I will say the majority of the time is not knowing what is going to happen with the child. And again, this tool gives you an idea what is anesthesia. And I want to make clear that even though I'm showing one way of giving anesthesia, that doesn't mean that when you go to the hospital, you demand. This is the way that needs to be done. This is a story based on true facts, but he's making it a magical adventure so parents and children have an idea of what is to visit planet anesthesia, and that will decrease your anxiety. If you have known to this story more, you're going to be able to be open and again, children and their home team, they really need to speak the same language so they can really to a storytelling learn together and communicate what they feel is going to be more empowering for them. I'm very much looking forward to your book making its rounds, because it seems like it's going to be a very helpful tool for many families. Yes, thank you. Now when it comes to the anesthesia wearing off, can you give parents some awareness about what to expect in terms of recovery from anesthesia? Well, I have to start by saying every child metabolized anesthesia differently, but just general tools. We expect to have them in the recovery room 45 minutes to an hour. But that conversation goes back and forth between the nurse taking care of the child, looking at the vital signs, looking how he's waking up, and what is the plan if the child is going to be discharged to a hospital room, or he's going to be discharged home, those things are in conversation between the surgeon, the anesthesiologist, and the nurse taking care in the pacu, or how I call the recovery station. I'm reflecting on parents stories. In the past, I've had some parents that will tell me that it would that it frightened them, because when their child was coming out of anesthesia, they seem to have a bad dream, or they yelled out loud. Is that something common that you can speak to so that if parents hear this from their child, that they know that it is normal? Yes, and yeah, I always say to them, the child that you brought today is not the same that you're going to meet in the recovery room, and that's absolutely normal, and how it's going to be different. Can be groggy, can be really agitated, and especially when they have procedures like ear tubes, those procedures, they go into a deep state really fast and come out of that really fast as well. Plus their hearing is augmented, right? So it's very disoriented. So there's no way to feel bad that they are feeling really agitated, because it's a lot happening on them, but rest assured, is gonna wear off. So by the evening, you might have a child that looks a little bit similar to the one that you brought us, but for sure, after the following day, you will get your child back. So work with your child, try to keep the environment as quiet as possible and really give them the time to process because it's a big procedure that has happened. Another thing that helps is things that they really like, a blanket or a toy that is really meaningful to them to when they. Wake up to have it near. So it's a sense of familiarity in the midst of all the things that are happening after anesthesia. Yeah, and I think that's a great explanation, because I think for parents, the more that they know ahead of time what's normal, what what they might expect from their child, what might be different after they recover from anesthesia, I think will relieve a lot of anxiety. So that's a great explanation, and especially the ones that have siblings, because they come with the idea, oh yeah, she did great, fantastic. And I say, totally fine. But every child, even siblings, will have a totally different experience. So be prepared. Might be similar, might be completely the opposite, and both are normal. Out of curiosity, have you noticed an improvement in anesthetic procedures since you've been in the field of anesthesia? Oh, tremendously, really? Yeah. It's fascinating how we are really more child centered approach. And I love that I am from Guatemala, and I did some rotations, and unfortunately, during my medical training, we were just the doctors doing whatever was best for the child. We were not the doctors doing what's best for the child with the child. We were for the child, but not with the child. And that, to me, is a big, big bonus, educating the public, empowering the family to Yeah, you need to be the center. And because we do X amount of procedures, that doesn't count is one procedure at a time, I'm sure what must make a tremendous difference in easing the family's nerves. I'll bet when they meet you, you have such a calm, relaxing, informative presence that I'm sure after they talk to you, they feel much more reassured and much better about their child having anesthesia. Thank you. Thank you. It's part of the passion. I think, in general, I have not yet found a pediatric anesthesiologist that is not is working with children really keep us that child like attitude that we want to inspire, right? So I think is in general, that's my bias that's is because of them. And I'm curious how much, how much more training does a pediatric anesthesiologist have to have compared to a general anesthesiologist? So after you complete your three years of general anesthesia, is one or two years depending for your training. So I did one year and six months of pediatric ICU, wow. Well, on behalf of all the children that you take care of and the families that you that you care for, thank you so much for thank you so much for putting in that extra time. Thank you. So if there was one final message that you could leave with families, if they're considering anesthesia for their kids, what would it be? Yeah, yeah, anesthesia, especially in children, is not only the child is the whole team, and that's how I call it, the home team. So the more prepared you are as a team, and especially for the adults in the home team, please make sure that you get answers that you speak with people that are going to be taking care of your child so your anxiety level doesn't get feed to your child. But really, I want children to be safe, so in order to do that, the adults and especially the home team, needs to do those questions and make sure that your child is being seen and taking care from where the child is, and tell everybody about your book. Where can they find it? Because I think that will be a great help to families if they're preparing for their child to go under anesthesia. This is called Adventures without JC, the unseen planet has been available since June 3, and you can find it in Amazon. There's also in Spanish. As a Spanish speaker, I think it's important for the child to choose the language of choice, so it's aventuras con dog. JC, el planeta no vedoso and felicidades si equista, aventuras el planeta no vedoso on my website, WW, adventures with Doc. JC, you have more information, and you can reach me and post your questions, or also on Instagram, at.jc cable. It took a case to libro as despondible, and lost and lost those English that is, gracias a guy Los Angeles, tenemos ESA riqueza cultural porque no Explora LA. Amazing. Well, thank you so much. Thank you for thank you for doing what you're doing. It gives me a lot of comfort to know that children that are in our community will have you as a potential pediatric anesthesiologist. So thank you for the work that you do. Thank you. Bye. Bye. You