After children’s brain surgery
Straight after the operation, the surgical team takes your child to the recovery unit. This is where children are closely monitored after any type of operation or anaesthetic.
Once it’s safe to do so, your child will move to the paediatric intensive care unit (PICU) or high dependency unit (HDU).
This information covers immediately after and the first few days after surgery for a brain tumour.
The paediatric intensive care unit (PICU) or high dependency unit (HDU)
After brain surgery children are cared for in PICU or HDU as they need close supervision and lots of nursing care. Generally, in PICU children have one to one (or two to one) nursing care. In HDU, they might still have one to one care, or very close nursing care.
In most PICU’s visiting hours for parents or carers are very flexible. The team know how important it is for you and your child to be together. You can touch and comfort your child. And the team will make sure you’re involved in as much of their care as possible. You and your child’s nurse make a plan of care together.
These units are clinical. They’re busy and often noisy places that some people find strange and disorientating. Although they are often bright, the team try and make sure they follow a ‘day’ and ‘night’ pattern. This is to try and keep to the children’s natural rhythms as much as possible.
Waking up after surgery
Most children wake up a few hours after their brain surgery. But sometimes, their surgeon might decide to keep them asleep for a day or so after surgery to help them recover. They use 
to keep them asleep.
While they’re asleep, they might be breathing through a machine called a ventilator. This can be very frightening to see when you visit them. The ventilator is important as it supports their breathing while they are sedated.
When your child starts to wake up, they’re likely to feel drowsy and sleepy. They’ll also probably be a bit restless and irritable. This is normal, and it happens because of the anaesthetic and painkillers.
You being around will help them calm down and settle easier. This then helps them recover from the anaesthetic. You’ll also be able to let the nurses and doctors know if something isn’t right, as you know your child the most.
Your child’s head or face may be swollen and bruised. This swelling will go down over time.
Ask your child’s surgeon or specialist nurse what is likely to happen after surgery. They can go through everything with you, so that you can prepare as much as possible.
Observations and checks
Your child’s nurse will check them around every 15 to 30 minutes. They will carry out checks called neurological observations. These are the same tests they had before their operation.
For example, the nurse will check how alert they are. And shine a light into their eyes to see if their pupils react. The nurses might ask you about what’s normal for your child. This might include their normal movement, cry or speech. Using this information they can compare it to how your child is doing after surgery.
Your child will have:
- a blood pressure cuff on their arm
- a little clip on their finger, or a small light sensor taped to their foot. This is to measure their pulse and oxygen levels (pulse oximeter)
- 3 small sticky sensors on their chest, called ECG leads, to closely measure their heart
Your child's head wound
Your child might have a dressing over their wound site. And often a bandage around their head. This is usually left alone for about 5 days.
Stitches or surgical clips can usually come out between 5 to 14 days after surgery. Surgeons often use stitches that slowly dissolve by themselves. So your child doesn't need to have them removed.
Tubes and drains
All the tubes can be a bit frightening. But it might help to know what all the tubes are for. Not every child has all these. And some don’t stay in for long. They might include some or all of the following:
Oxygen
Once they're off the ventilator, your child might have a small oxygen mask over their mouth and nose. It gives them extra oxygen and gently ties around their head to help it stay in place. Lots of children don’t like wearing oxygen masks. They often try to take it off when they wake up. It’s important it stays on, and the nurses and play specialists will help your child keep it on.
Drips (IVs – intravenous infusions)
Drips going into the bloodstream might include medicines, blood transfusions, and fluids until your child can drink or eat again. Children often return to PICU or HDU with a central line if they didn’t have one before they went to theatre. Or they might have a small tube in the vein called a cannula. Generally, these are in the hands, crook of the arm or feet. They’re wrapped up in a soft bandage, so it’s more difficult for your child to knock or pull them out.
A tube into an artery
This might be in your child’s arm, or the top of the leg by the groin. It’s for taking blood samples and accurately measuring their blood pressure.
Drains
Your child might have one or more drains coming out of their wound (connected to bags) to drain blood and tissue fluid from the operation site. Among the tubes coming out of their head bandages, there may be a drain called an external ventricular drain (EVD). This drains excess fluid from the brain to stop the fluid building up (hydrocephalus).
A tube into their bladder (urinary catheter)
This is so that they can wee and means the nurses can accurately measure how much urine they are producing. This helps the team make sure they are not getting too much or too little fluid.
A tube from their nose into their stomach (nasogastric tube)
This tube is taped with a plaster to your child’s cheek. It’s to help stop them feeling sick. Or they can have liquid food though the tube.
An intracranial pressure (ICP) monitor
This is a tube from their head which is connected to a machine. It measures the pressure inside your child’s head.
Fluids
Balancing the amount of fluid in the body is important. Especially in the first few hours and days after surgery. Too little fluid leads to dehydration. And keeping the balance right helps to stop swelling around the operation site in the brain.
Your child’s nurse will record how much your child is drinking to make sure they have an accurate balance.
Painkillers
It’s normal that your child might feel some pain after having brain surgery. However, the nurses and doctors can help control their pain with painkillers. Immediately after surgery, they might have them through the drip into their bloodstream. If your child is old enough, they can have a patient controlled analgesia pump (PCA). This pump can give a continuous amount of pain relief, but they can also press a button if they need extra pain relief.
Your child’s nurses will be checking your child regularly to make sure they aren’t in pain. This might be by checking your child’s expression, heartbeat, blood pressure and breathing, as well as asking your child about their pain.
There are ways of communicating even when it’s hard to speak. This might be pointing to pictures in a book. Or a thumbs up or thumbs down to a direct question.
Other drugs after surgery
Steroids
Surgery can cause swelling in the brain. This increases the pressure inside the skull and might make symptoms worse for a short time.
Most children have steroids before surgery and for a short while after, either as tablets, liquid or injections. Steroids can reduce swelling and pressure around the brain. This helps to reduce symptoms.
It varies from child to child as to how long they will need to have steroids.
Medicine to prevent fits (anti epileptic drugs)
Some children will need to take medicine to prevent fits (seizures). These are called anti epileptics or anti convulsants. Again, these might be tablets, liquid or injections.
Fits can be a symptom of raised pressure in the skull. They might also be caused by irritation of the nerve cells of the brain.
Your child may be able to stop taking these medicines once they have fully recovered from surgery. But some children might need to take these medicines long term.
Medicine to prevent infection
Your child might have antibiotics to help prevent infection. They usually have them through a drip.
Medicine to prevent sickness
Your child will have medicine to prevent them from being or feeling sick (anti sickness). They usually have this through a drip. But once they are eating and drinking, they can swap to liquid or tablets.
Eating and drinking
Every child is different when it comes to starting to eat and drink again. Your child can have liquid food by their nasogastric tube. The dietitian makes a feeding plan to be sure your child is getting the right amount of calories and nutrients.
As soon as the team thinks your child is ready, they can try a few sips of water. Sometimes swallowing can be difficult after surgery. So the team will watch them carefully when they first start. A speech and language therapist might check your child’s swallowing before they have anything to eat or drink.
Getting up
Brain surgery is a big operation and your child needs to rest afterwards. But it’s important for them to get playing and moving around as soon as possible.
Depending on the operation they have, your child might need to lie flat for a few days. Or they might have the head of the bed raised to reduce swelling in the brain.
Your nurse will encourage your child to move their arms and legs while they are in bed. They will regularly and gently move them from side to side. This is to keep their muscles active. And to try and prevent any blood clots from forming from staying still for too long.
The team will help your child out of bed and to get moving as soon as the surgeon says it’s safe. The and are around to help.
Brain scans after surgery
Within 72 hours after surgery, your child should have an MRI scan.
An MRI scan can show if there is any tumour still there, and how much swelling there is in the area of the operation. It can feel quite soon. But research shows this is the best time to get these pictures.
What next?
You might want to read our information about recovering after brain surgery next.
