Going Home After Surgery (Pediatric Orthopedics)

Before taking your child home, you will have a discharge consultation with a nurse, nurse practitioner, or doctor. During this consultation, you will receive information about:

• Postoperative home care instructions
• Home care rules and restrictions
• Prescribed medications and how to administer them

Please ask any questions if something is unclear or if you have concerns.

Only the checked items apply to your child.
Your child has:

• Surgical Wound

Check the wound daily for signs of infection. This is important.

Signs of infection include:

• Redness
• Increased warmth
• The wound not closing or reopening
• Yellow discharge or pus
• Fever above 38.5 °C

Perform wound care (dressing changes) daily as instructed in the hospital.

• External Fixator

• Your child has an external fixator. The bone has been stabilized with metal pins. An external fixator is relatively heavy; therefore, the affected arm or leg should be supported. Swelling may occur, especially in the first days after surgery. If swelling develops, support the affected limb slightly above heart level during rest.
• Clean the pin entry sites and surrounding skin daily, as instructed in the hospital.
• Monitor carefully for signs of infection (such as fever, redness, or discharge).

• Cast or Hip Spica Cast (Gips / Gipsbroek)

Important information regarding care while your child is in a cast is outlined below.

Circulation: Regularly check whether blood circulation in the arm or leg inside the cast is adequate. The skin should feel warm and appear normal in color. There should be no coldness, marked paleness, or bluish discoloration.

Positioning: During rest, support the arm or leg with a pillow and keep it slightly elevated above heart level. This helps reduce swelling and may relieve pain.

Diaper Use (Hip Spica Cast): If your child has a hip spica cast and wears diapers, using two diapers is recommended:

• Place a smaller diaper inside the cast.
• Place a larger diaper over the cast.

Comfort: A stroller with a reclining backrest or a wheelchair is recommended. This allows your child to rest in a more comfortable position.

Support: Always support the cast when lifting your child.

Cast Hygiene: To help keep the cast clean, a felt-like protective material called “Celona” may be applied over the cast. You may request a prescription for this from your doctor.

Car Seat: Special car seats for children with a hip spica cast are available for loan. For more information: www.maxi-cosi.nl/c/maxi-cosi-happy-hips-service

• Compression Bandage (Drukverband)

Unless your doctor advises otherwise, the compression bandage may be removed 48 hours after surgery.

Showering and Bathing

• The surgical wound should be kept dry for the first 10 days after surgery. From day 3 onward, your child may shower with a water-repellent dressing (for example, Tegaderm).

• No bathing for the first ___ days after surgery. When bathing is permitted, limit the duration to 5–10 minutes to prevent the wound from becoming too soft.

• Sports and Movement

Your doctor will discuss how much your child is allowed to move. The need for crutches or a wheelchair will also be assessed. These mobility aids can be obtained from Vegro(www.vegro.nl) or home care supply stores.

After surgery, for the period specified by your doctor:

• Weight-bearing is allowed for ___ days/weeks
• No swimming for ___ days/weeks
• No sports for ___ days/weeks
• No cycling for ___ days/weeks
• No heavy lifting for ___ days/weeks

During the recovery period after surgery, your child may need rest.

• Your child should not attend school or daycare for ___ days/weeks after surgery.
• After this period, your child may return according to the doctor’s advice.

Full-day attendance may be tiring at first. It is recommended to discuss partial attendance (for example half days) with the teacher or caregiver.

After surgery, your child may need pain medication and, if necessary, other medicines. The prescribed medications and dosages will be determined by your doctor. (Only the checked and completed medications apply.)

Pain Medications

After surgery, your child will need pain medication. You may give:

• Paracetamol (suppository/tablet/liquid): ___ mg, ___ times a day
• Diclofenac (suppository/tablet): ___ mg, ___ times a day
• Nurofen (tablet/liquid): ___ mg, ___ times a day
• Tramadol (tablet/liquid): ___ mg, ___ times a day
• Oxynorm (tablet): ___ mg, ___ times a day
• Oxycontin (tablet): ___ mg, ___ times a day
• Forlax/Movicolon: ___ sachets, ___ times a day
• Other medications: __________________________

Example schedule:

Frequency	Morning	Afternoon	Evening	Midnight
4 times a day There must be 6 hours between medication intakes.	06:00	12:00	18:00	00:00
3 times a day There must be 8 hours between medication intakes.	08:00	16:00		00:00
2 times a day There must be 12 hours between medication intakes.	8:00		20:00

Medications can be collected from the Outpatient Pharmacy located in the Passage of Erasmus MC.

In exceptional cases, medications may be obtained from a local pharmacy. In that situation, the hospital will provide enough medication for the first 24 hours.

As your child’s pain decreases, medication should be reduced gradually.
Do not stop all medications suddenly.

Reduction should follow this order:

1. First reduce prescription (stronger) pain medications.
2. Then reduce paracetamol.

Finally, give paracetamol only if your child has pain.

Your child’s wound may have been closed using one of the following methods:

• Dissolvable Stitches

These stitches dissolve on their own. They do not need to be removed.

• Steri-strip Dressings

These strips support wound healing. Slight loosening of the edges is normal.
They usually fall off on their own after approximately 7 days.
If they do not fall off, you may gently remove them.

• Non-dissolvable Stitches

These stitches must be removed ___ days after surgery.

The stitches will be removed:

• By your General Practitioner (GP)

Or

• During the hospital follow-up appointment

Your doctor will send a discharge letter to your General Practitioner (GP).
You can also view the discharge letter via the My Erasmus MC patient portal:
www.erasmusmc.nl/patientenzorg/mijn-erasmus-mc

• Your child will return to the hospital for a follow-up examination.

Appointment details will be communicated to you through:

• My Erasmus MC
• E-mail
• Letter by post Blood tests, X-rays, or ultrasound examinations may be required. If so, this will be stated in the appointment notification.

• Your child does not require a follow-up appointment.

Hospital experiences can be challenging for children. Your child may need time to understand and emotionally process what has happened. The following reactions may occur:

• Fear of being alone
• Sleep disturbances
• Bedwetting

These reactions are usually temporary.
If the symptoms persist, please contact your General Practitioner (GP).

Your child may require physiotherapy at home. If needed, you will receive a referral letter.

Within the first 2 weeks after surgery, contact us without waiting if your child develops any of the following symptoms:

• Fever above 38.5 °C
• Redness or signs of infection at the wound site
• Significant swelling around the wound
• Severe pain that does not improve despite pain medication
• Persistent vomiting
• Pain during urination or inability to urinate (if a catheter was used)
• No bowel movement for 3 days or diarrhea lasting 3 days • Swelling of the toes or areas around the cast
• A cast soiled with urine or stool
• Keep the cast as clean as possible.
• If necessary, gently clean it with a dry cloth or baby wipe.

Do not wait to call if you are concerned about your child’s condition.
For other medical issues, please contact your General Practitioner (GP).

Monday – Friday, 08:00–16:00
Pediatric Orthopedics Office: (010) 703 66 57

Outside these hours
Pediatric Surgery Ward: (010) 703 61 84

After 2 weeks following surgery
Please contact your General Practitioner (GP).
More Information: www.heupafwijkingen.nl

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