Our four-year-old child is scheduled for hip surgery to correct a problem from birth. He doesn’t separate easily from us but even worse is that his mother (my partner) doesn’t separate well from him. Are there ways the medical staff deal with this kind of problem? Should I try and alert them somehow ahead of time?

Separation anxiety between parent and child is a common problem. Nurses who prepare patients for surgery are usually already prepared when they know the patient is a child. But it can’t hurt to call the hospital or surgery department where the procedure will be done and give them a heads up as to what to expect.

If you can talk with your partner about the problem, it may possibly help ease her anxiety as well. Pre-sedation is one way to reduce the distress over parent-child separation. In this case, we are referring to sedating the child, though some parents request a mild sedative for themselves to help ease the transition.

One of the new tools surgical teams have available for use with children is called an mucosal atomizer device (MAD). It takes medications and turns them into tiny droplets that are sprayed into the nose.

Orthopedic surgeons like this method of drug delivery to manage pain and for sedation before and during surgery.

Surgeons say that atomized intranasal pain relievers are really appreciated when the child is in severe pain from bone fractures, joint dislocations, or other orthopedic emergencies.

Other physicians sing their praises when it comes to managing pain from burns or large surface injuries to the skin (called abrasions). And during an emergency, using a spray on a child rather than poking around to gain access to a vein for an intravenous delivery significantly reduces anxiety and trauma associated with the injury and its treatment. The intranasal spray is also helpful in first calming a child when an IV is unavoidable.

There’s one other big advantage in using intranasal atomized medications in children and that’s reducing parental distress. When the child is sedated before surgery, there is less distress in separating the parent and child in order to take the child into the operating room.

Studies show that intranasal drug delivery isn’t as effective as intravenous administration (with a needle into the vein). But that can be remedied by increasing the amount of drug (dosage) atomized into the nasal passageways. The sedating (calming) effects of drugs given intranasally are slower than the intravenous (IV) route but not by much.