Caring for your Child after Orthopedic Surgery
At American Family Children’s Hospital we care about decreasing your child’s pain. While we
cannot completely relieve your child’s pain after surgery, we work with you to help control your
child’s pain. Research studies and our experience with other children, who have had surgery, tell
us that the best way to control pain is to combine medicines and other techniques.
Pain control tips
ξ Use the pain scale used in the hospital at home to check your child’s level of pain.
ξ Use it often to check the first two days at home. We expect pain to decrease daily.
Check less often as pain decreases.
ξ Don’t let pain get out of control; it is best to treat it early.
ξ Use a number of things together to treat pain.
ξ Your child may have an increase in pain during physical or occupational therapy
sessions. We suggest giving pain medicine before therapy sessions.
When to call
ξ If your child’s level of pain is getting worse, or is not decreased by pain medicine and
ξ If toes or fingers are very pale or bluish, and cool or cold to touch. If your child has a
dressing, cast or brace, check for blood flow. Toes and fingers should be pink and warm,
and your child should be able to wiggle them. If the toes or fingers are not pink and warm
it may be too tight.
ξ If there is numbness, tingling, or loss of movement in the arm or leg.
ξ Swelling not decreased by elevating arms and legs. Often arms and legs can be very
swollen. Elevating them above the level of your child’s heart may help decrease swelling
Non drug Therapies
Using non-drug therapies with pain medicine may decrease pain. There are a number of things
you can try with your child to help control pain.
Tense or stiff muscles may increase pain. Helping your child to relax may decrease pain. If you
would like to try relaxation exercises and have internet access, go to the web site
www.uwhealth.org. and type in relaxation in the search box.
If you don’t have access to the internet, have your child lie in bed with eyes closed. Starting at
the toes moving up to the head, ask your child to tense and relax each body part.
Here is one way to guide your child in a relaxation exercise:
“Think about your toes; While you are thinking about your toes, curl them into a ball and hold
them tight while I count to three; One, two, three. Now, relax your toes. Take a deep breath and
feel the relaxation in your toes. Now think about your legs; Hold them very tight while I count to
three; One, two, three. Now, relax your legs. Take a slow deep breath and feel the relaxation in
your legs. Keep going and moving up the body all the way to the head.
Guided imagery is a way to focus the mind on a relaxing idea that lets the body relax.
Guided imagery supports the body’s natural desire to heal. If you are would like to try guided
imagery and have internet access, go to the web site www.uwhealth.org. and type in guided
imagery in the search box for information and resources.
Distraction is a way to take your child’s focus away from pain. It works best if it is something
that your child becomes absorbed in. Below is a list of ideas.
ξ listen to music
ξ read a great book
ξ draw or color pictures
ξ play video games
ξ watch a favorite movie
Using cold and heat packs
Cold or heat may help swollen or sore body parts. Check with your health care provider
before using this treatment. Ask if it is ok to put cold packs on the incision site.
Put the cold or heat pack on for up to 20 minutes. Wait at least 30 minutes between treatments.
Cold pack temperature should be around 59 degrees Fahrenheit (15 degrees Celsius). Heat packs
should be around 104-115 degrees Fahrenheit (40-45 degrees Celsius).
If your child has any pain or numbness when using the cold pack, take it off and talk with your
health care provider.
Do not use cold or heat packs on open parts of skin, or if your child has poor circulation.
Common medicines used for relief of pain
Our goal is to give your child the best relief from pain. We combine pain medicines that work in
different ways. Not every child can or should take all the medicines listed below. Not every
child needs all of these medicines. Please follow specific directions from your health care
provider given at discharge.
Tylenol® can be used by itself. It also works with other pain medicines to decrease pain. It is
common to take it “around the clock” for the first 5-7 days after surgery. It can be taken this
way after discharge too. It is common to take Tylenol® before opioid pain medicine. If
Tylenol® does not give enough relief, the opioid can be taken.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
This group includes medicines such as ibuprofen, naproxen, ketorolac and Celebrex®. They give
relief from pain, and decrease inflammation. They can be taken with Tylenol® and opioids. After
surgery ketorolac is given through an intravenous (IV). Once your child no longer needs an IV,
it can be given by mouth or changed to ibuprofen. Ibuprofen can be a scheduled medicine after
discharge for a few days. It can also be given as needed.
Oxycodone is an effective pain medicine to use if your child does not have relief from Tylenol®
or the NSAID. Your health care provider prescribes a dose for your child to take in the hospital
and at home. Follow the directions on the prescription. Give the prescribed dose until a few
days after surgery and your child is ready for a lower dose. Try a lower dose using the directions
on the prescription to guide you. If your child’s pain increases go back to giving the larger dose.
Try to decrease the dose again in a day or two. If your child is not feeling relief from pain,
contact your healthcare provider. It could mean a change in your child’s condition. Do not give
more medicine than your child’s health care provider has prescribed.
Opioids and Addiction
An opioid is a medicine that people may become addicted to. It is not common for people to
become addicted to an opioid if it is used as prescribed. Addiction can happen when the opioid
is used for reasons other than pain control, such as sleep, anxiety or because of the way it feels.
But sometimes addiction happens. Addiction is a disease and some people have genetic traits
that put them at higher risk. If you have concerns about addiction disease, talk to your child’s
health care provider.
Weaning pain medicines
If at discharge, your child is taking scheduled Tylenol® and ibuprofen, and oxycodone as
needed, medicines should be stopped in this order.
1. First, the oxycodone
2. Next, either Tylenol® or ibuprofen
3. Then the other, either Tylenol® or ibuprofen
Opioid medicines can cause severe constipation. Call your provider if your child has not had
a stool by 2-3 days after discharge. Eat a high fiber diet, drink plenty of fluids, and take
medicines as prescribed by providers. If your child is prescribed medicines that make stools
easier to pass please use them. Miralax® is the most common medicine used. It is a powder that
can be mixed into a drink and taken daily.
Physical therapy can be very helpful to increase strength and range of motion. At times it may
decrease pain. It may also increase pain if your child hasn’t gotten out of bed since surgery. Our
hospital nursing staff give your child pain medicine before physical therapy sessions in the
hospital. We would like you to use pain medicine and non-drug therapies before home or clinic
physical therapy sessions.
If your child needs an assistive device after surgery, this is assessed before or after surgery. We
give you the device before discharge, or it is dropped off at your home.
Caring for your child after surgery
These are general concepts, you will get written instructions at discharge that are
personalized for your child.
ξ Keep casts and dressings dry and covered when taking a shower.
ξ Do not soak incisions in a tub for at least 3 weeks. This promotes healing and decreases
risk of infection.
Proper care promotes healing and decreases the chance of problems.
ξ Wiggle fingers and toes to decrease swelling and increase circulation.
ξ If there is redness or broken skin around the edge of the cast, call your provider.
ξ To relieve itching under the cast, blow cool air in with a hair dryer.
ξ Do not shake powder into the cast, or stick objects into the cast to scratch the skin.
If your child’s dressing becomes soiled, it needs to be changed. Dressing supplies are given at
discharge. Call your provider if you notice drainage.
Back to school
Pediatric Orthopedics staff suggests your child not go to school while taking opioid medicines.
If your child feels well, school work can be done at home. Requests for home teaching are
approved on a case by case basis. Providers write notes for school and gym excuses if needed,
and order Tylenol® or ibuprofen for use during school. Please ask your provider if this is
needed for your child.
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 7/2015 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7799