The decision to have a young child undergo general anesthesia (GA) for dental work can be stressful for parents. GA is frequently recommended for children who require extensive treatment, have significant anxiety, or cannot safely cooperate for the procedure’s duration. GA ensures the child feels no pain and has no memory of the dental work, allowing the dentist to complete high-quality treatment in a single session. Understanding the preparation, safety, and recovery process can help parents feel more prepared.
Preparing Your Child for General Anesthesia
The most important pre-procedure instruction is strict adherence to the “nothing by mouth” (NPO) guidelines. These rules ensure the child’s stomach is empty, reducing the risk of aspirating stomach contents into the lungs during anesthesia. While specific timing will be provided by the anesthesiologist, a common protocol requires no solid food or non-clear liquids, including milk or formula, after midnight the night before the procedure.
Clear liquids, such as water, Pedialyte, or plain apple juice, are permitted until two hours before the scheduled arrival time. Parents must be vigilant to ensure the child has not consumed any forbidden items. Failure to follow these fasting instructions will result in the procedure being cancelled for the child’s safety.
Emotional preparation should be simple and reassuring, focusing on the idea that doctors will help their teeth feel better while they are asleep. Explain that they will breathe special air through a mask that smells like a favorite scent, which will help them take a nap. Bringing a favorite blanket or soft toy provides comfort in the pre-operative area. Ensure the child wears loose, comfortable clothing, preferably a short-sleeve shirt, for easy placement of monitoring devices.
Anesthesia Safety and What Happens During the Procedure
Modern pediatric general anesthesia is safe when performed by a dedicated anesthesia team in a monitored setting. The American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD) require a qualified anesthesia provider to be present whose sole responsibility is the administration and continuous monitoring of the patient. This provider may be a board-certified anesthesiologist, a certified registered nurse anesthetist (CRNA), or a dentist anesthesiologist.
The anesthesia team attaches monitoring devices to the child, which continuously track vital signs throughout the procedure. These monitors measure heart rate, oxygen saturation, blood pressure, and core body temperature. The depth of anesthesia is also closely watched to ensure the child remains comfortably asleep and stable.
Induction often begins with the child breathing an anesthetic gas through a small face mask. Once asleep, an intravenous (IV) line is typically placed to administer fluids and maintain the anesthetic. The provider may also place a breathing tube or specialized airway device to protect the airway and assist breathing. The anesthesia provider’s constant observation ensures immediate response to any physiological changes.
Immediate Recovery and Post-Procedure Care
Following the procedure, the child is moved to the Post-Anesthesia Care Unit (PACU) where a specialized nurse monitors their recovery. Parents are typically called to join their child once they are safely settled in the recovery area. This immediate period can be characterized by grogginess, crying, or temporary agitation, which is a common side effect of the anesthetic wearing off in young children.
Once discharged, close parental supervision is necessary for the remainder of the day. The effects of the anesthesia can cause the child to be uncoordinated and sleepy for up to 24 hours. Activity should be limited to quiet play, and all strenuous activities like swimming, biking, or running must be avoided. If the child naps, they should be placed on their side where a parent can see them clearly.
Pain management typically involves age-appropriate liquid acetaminophen (Tylenol). Parents should avoid giving ibuprofen unless specifically directed by the care team. The child should start with small amounts of clear liquids, such as water or apple juice, to ensure their stomach can tolerate them.
A soft food diet, including applesauce, yogurt, mashed potatoes, or soft noodles, should be maintained for the first day or two to protect the newly treated teeth. If extractions were performed, the child must not use a straw, sippy cup, or pacifier for 24 hours, as the sucking motion can dislodge the forming blood clot.
Parents should contact the dentist or seek emergency care if the child experiences any of the following:
- A high fever above 101 degrees Fahrenheit.
- Prolonged or repeated vomiting.
- Bleeding that does not stop after applying pressure.