31 mo DD nursling needs anesthesia for dental procedure; questions!

[Siera]

31 month old DD needs general anesthesia via IV for some fillings.  The instructions are no milk or food after midnight the night before. Only water after midnight.  Well, DD nurses throughout the night.  Any tips on getting through the night with no nursing when she's never done that before?  Any tips/suggestions would be appreciated!

[Marissamom]

did they specify no breastmilk? because I vaguely remember reading somewhere that breastmilk moves through the digestive system so quickly that it can be had much closer to anesthesia than food or formula. 

[NEastMomma]

Please double check w/ the doctor, but my DS just went under anesthesia for ear tubes.  I was told no food/drink after midnight, with two exceptions:
- Breastmilk (4 hours before surgery)

- Clear liquids (eg: apple juice, 2 hours before surgery)

What time is the procedure?  Ours was at 7:30, but we had to arrive at hospital at 5:30am.  So last possible nurse for my DS was at 3:30 (he more often than not sleeps thru the night recently, but had painful fluid in his ears, so I knew he'd wake up).   Then we had to wake him at 5am to go to hospital.  He was distracted for some time at hospital, so didn't even look to eat/nurse for quite some time.  The last half hour was tough though, as I am sure he was starved.  Luckily I had help from the sweet nurses who tried to distract/entertain DS with toys and chats. 

I hope the procedure is scheduled nice and early for you.  Good luck!

[MunchiesMom]

Oh mamas, I've BTDT for DS when he just turned two. I had major anxiety over it and it really wasn't bad.

Here's our story...

http://www.mothering.com/community/forum/thread/1230860/2yo-had-general-anesthesia-for-dental-work-update#post_15478974

I was told no BM for 24 hours by the surgery center but LLL and the BF friendly dentist said to just go with the four hours. DS was attached nursing all night normally.

We got in the car as soon as he asked to nurse earyl in the am so I didn't have to tell him 'no more milk'...since i knew he'd fall back asleep in the car. I also wore a sweatshirt, which I never do, so he as less fixated on his "boo boos".

If you want to chat pm me!

[NEastMomma]

What a beautiful story.  I'm so happy it all worked out so well for you.  I wonder where you live, as I am in Boston - DS had his ear tubes at Mass Eye & Ear.  Sounds like things might be slightly more relaxed here.  They had me hold him in a hugging position while they administered the gas, and had me kiss him once they put him on the table.  The surgeon walked me out and everyone was so sensitive to how difficult this was for *me*.  They called me to tell me it was over, and then about 5 min later they called to tell me to come on down to recovery.  Recovery was a room full of babies/kids who were still "out" on their beds.  I was able to be with DS while he was still out and there as he awoke (a nurse also stayed with me).  She told me that the moment he woke up, he was mine.  I could pick him up immediately.  I did just that, and we nursed in a rocking chair next to the bed.  She drew the curtain to give us privacy. 

I think it was super helpful to be able to cuddle DS as they administered the gas (he did struggle a little, as the gas smelled really bad) and it was great to be there as he awoke.  Perhaps the OP could look in to these things? 

[Siera]

Thanks so much for the replies!  To be honest, this dentist is not breastfeeding friendly, so I haven't even mentioned that I breastfeed her.  I don't want to be scolded as being responsible for her two cavities.  So, I hate to bring it up now.  If I have to, I will, I understand that. I just don't want to open a door that I know the dentist is not happy with.  This is a pediatric dentist that our regular dentist has referred us to to specifically to fill DD's cavities.  I guess I should just suck it up and say I nurse her and then go with it!

[Siera]

MunchiesMom -- that was a great post!  It really helped me to understand what to expect that day.  This procedure will be done at the dentist office with a team of pediatric anesthesiologists there.  The way the place is set up, I had expected I would be there the entire time with DD, but from your post, it sounds like that might not be an option.  Definitely something I need to check into.  Thanks again! It is definitely very scary, but I like what you said about not removing all fear, but being there for them.  I just hope our appt. goes as smoothly!

[MunchiesMom]

How did it go? I would imagine in a dentist's office you could stay with you LO. Maybe a more family-friendly environment.

[Siera]

Thanks for asking.  We haven't gone yet.  Her appt. is in March.  But, I have an appt. with a more family-friendly dentist soon for a second opinion.

[MunchiesMom]

That's good to hear. I think its important to have a ped dentist who supports you in your lifestyle. That's why I interviews with four before I settled. Not that she would EBF herself, but at least she didn't demand we wean or blame the cavities on night nursing (which I've concluded is NOT the cause...after extensive research on KellyMom and through LLL). So if you have more options, I think it would be great to explore them!

Also, just to throw this out here, after the research that I did I concluded GA should ONLY be done in a hospital or surgery center. I personally don't feel safe using it in a doctor's office unless it has all the lifesaving equipment in house (defibultors, etc...) so if you're looking, maybe you should consider doctored who offer other options.

How bad is the decay? I ask because that wad a big indicator for me on what I would allow, how and in what facility.

[Peony]

Even in offices they often do not let the parents stay especially with GA. Parents sometimes freak out or interrupt the procedures so many practices have blanket no parent rules in place. With our practice, they had a doc for the child, dentist, 1-2 assistants and all the monitoring equipment, there was no room for parents even if it was allowed. We did conscious sedation and it was all I could do to walk back with DD1, wait until she was out and then leave. They got me before she woke up. And I have to say also I'm not comfortable with GA in most office settings for my children either. We tried the conscious sedation because that was all I was willing to do before moving to a hospital setting, it worked and she got 5 cavities fixed that day. 

[kalamos23]

We did general anesthesia for DD at around 27mo because she had a lot of dental surgery needed (crowns, extractions, etc.). Anyway, she is a huge night nurser and they just said 3-4 hours before the surgery to stop nursing - I offered her some apple juice at 2 hours before and scheduled the surgery first thing in the morning so that she could eat as soon as she wanted to after coming out of surgery. She nursed as soon as she was awake/groggy. 

Hope that helps! I will say, I was first tri pregnant when the surgery was done and so my supply was on the lower end to begin with so I don't think she was getting all that much anyway, but still the surgery center had said it was totally fine to have breastmilk 3-4 hours before. 

[Siera]

That's good to know!  Thank you!

[CheriK]

My DD had an anesthetic procedure at 16 months.  We were also told by the surgeon (ophthomologist) NPO after midnight.  But, breastmilk is considered in the same category as clear fluids by the American Society of Anesthiologists and the recommended fast time is 3-4 hours.  I wrote a letter to her surgeon, included their statement, and referenced some research papers on the topic & her surgeon changed his recommendation.  The LLLI site (http://www.llli.org/FAQ/anesthesia.html) and kellymom (http://www.kellymom.com/health/illness/baby-surgery.html) are good places to start for more info.

Have you looked into doing the procedure without GA?  We chose our pediatric dentist because he would work on a young child without GA (many won't) and the same DD needed a tooth pulled at 2 years after killing the root when she fell and chipped it.  She was able to sit still and be calm, which not all little ones can do, but if your child is likely to be able to be still you might look for a local dentist who will do the work without GA.  DD had nitrous oxide, her dentist was incredibly gentle, calm and fast, explained everything to her during the procedure, showed her on her hand what all the equipment would feel like, and I sat right next to her the whole time.  She's since had 2 other teeth pulled (spacing issues not decay) and several cavities filled, and at 9 loves going to the dentist, so no bad memories!

[sewaneecook]

DS1 had a similar surgery (fillings and caps) at 2 1/2.  While I didn't get any clearance from the dentist to breastfeed, he said DS could have apple juice or SPRITE (um, no, he can't have sprite!) up to 4 hours before surgery, so I let DS nurse up to that point.  Breastmilk is usually considered a clear liquid for surgeries.  He was able to nurse again as soon as he woke up from the surgery. 

We considered finding a dentist who would do the procedure without GA, but after weighing pros and cons we went ahead with GA.  DH and I both have a bad association with a dentist doing too much without enough anesthesia and I didn't want my baby to experience the same thing.  Overall, we felt the GA was the gentler way to go for him.  He woke up asking for me and he nursed just a few minutes later and I had a harder time with the surgery than he did.