When your child is discharged from hospital you will be given nursing and medical discharge summaries. If the medical discharge summary is not available when you leave, it will be posted to you in the mail. A copy will also be sent to your general practitioner (GP).
Follow-up appointments
Your child will be given follow-up appointments before discharge with your child's surgeon (in 2-3 weeks) and cardiologist (in 4-6 weeks). Your child will need a chest
x-ray before your follow-up visit to the surgeon. You will be given an x-ray form and appointment card before being discharged.
Medications
Your child may need medicines for a few weeks, or sometimes longer, depending on their heart condition and the type of surgery they have had. Your child's surgeon or cardiologist may adjust or stop the medication in follow-up visits.
During your hospital stay the nurses will give you instructions on how to give medications to your child. The more comfortable you feel about giving medications to your child while you are in hospital, the easier it will be at home.
The Hospital Pharmacy will provide a small supply of medications free of charge. Any medications that are not readily available at your local pharmacy may be purchased at the Hospital Pharmacy for a standard fee. You will be given a prescription for the Hospital Pharmacy and a separate prescription for your local pharmacy.
If your child develops diarrhoea or vomiting, please seek medical advice as soon as possible, as you may need to withhold some of your child’s medications.
Wound care
Your child’s dressing will be removed before they are discharged, unless otherwise instructed.
Once you are home you can wash the wound gently and pat dry, but avoid using harsh soaps. It is best not to immerse or soak the wound in the bath (or go swimming) until after your child’s follow-up appointment with the surgeon, about 2 weeks after discharge. At this appointment your child's surgeon will advise you about using moisturisers and ointments.
Please contact the Cardiothoracic Nurse Practitioner (CNP), during business hours, if you notice any redness, swelling or oozing at your child’s wound site. Please seek medical advice if you are concerned about your child’s wound after hours.
Sun exposure can slow the healing of your child’s scars. Protect your child’s scars from direct sunlight for as long as the scar looks pink and raised. Your child’s scar will fade and eventually go back to their normal skin colour.
School
It is best not to let your child return to school or childcare until after the first follow-up visit. Your child's doctor should give you an idea of when normal activities can be resumed at your follow-up appointment.If a medical certificate is required, please ask your nurse before discharge.
Activity
It is a good idea to keep strenuous exercise to a minimum in the two weeks after discharge. However, light activity can be very helpful to your child’s recovery and can be increased slowly. A rest during the day can also be helpful.
The breast bone takes about six weeks to mend. Your child should not play contact sports, lift heavy items, or be lifted from under the arms during this time. Please check with your child's surgeon as to when it is okay to start tummy time.
Normal activities can start again after follow-up with your child's cardiologist, usually after six weeks, unless advised otherwise. If you have any further questions about activity or contact sport, check at your follow-up appointments.
Immunisation
If your child is due for immunisations, it is better to wait until after the follow-up appointments. Vaccinations may cause a reaction that can be confusing when trying to determine if an illness is due to the surgery, or the side-effects of the vaccine.
If your child is due for vaccinations, please speak to the Complex Discharge Nurse or the Cardiac Clinical Nurse Consultant (CNC) before leaving the hospital. Alternatively, you can discuss with the cardiologist at your child’s follow-up appointment when they should have their next vaccinations.
Dental care
It may seem strange, but many of the germs in our mouths are the germs that can cause infections in our hearts. It is important to encourage your child to brush and floss their teeth at least twice every day and have regular dental check-ups.
Some children with heart conditions will need oral antibiotic medication before and/or after dental procedures. This is known as 'endocarditis precautions'. Please ask your child's nurse or cardiologist whether your child needs these precautions.
Diet
Your child may eat and drink as usual, unless a different plan has been provided. If a dietitian has helped with your child’s feeding in hospital, it is important to follow this routine at home.
Encourage a healthy, balanced diet that promotes healing and recovery, including fruit, vegetables, wholegrains, lean meat and dairy products. Continue
a nutritious diet throughout their childhood, as this will assist in healthy growth and development.
It is important to watch your child for signs of dehydration. Call the Cardiac CNC if you notice your child has less wet nappies, is urinating less or has darker coloured urine, dry mouth or sunken fontanelle (the soft spot on your baby’s head).
Remember to give your child extra drinks on hot days or when he or she has been very active.
Emotional and developmental support
Our social worker and psychologists at the Heart Centre for Children specialise in providing emotional care for babies, children and young people with heart disease, and their parents, siblings and grandparents. This includes helping children and young people to cope emotionally with all the different thoughts and feelings they may have about themselves, their heart condition, and their treatment. It also includes helping parents and families to cope with their thoughts and
feelings about all that has happened since the time of diagnosis. To talk to the social worker or one of the Heart Centre psychologists use the phone numbers on the following page.
The first few weeks at home
The operation and hospital stay will have been stressful for your child and your family. You may notice changes in your child's feelings and behaviours. During this time you need to support and reassure your child. Everything should be back to normal in a few weeks.
Complications can occur after you return home. Some warning signs of illness are:
- temperature above 38 degrees centigrade
- vomiting
- decrease in appetite
- lethargy/weakness
- abdominal pain/back pain/shoulder pain
- increasing breathlessness
- dry cough
- redness/pus/excessive pain at wound site
- irritability
What to do if you are worried
If your child looks very sick you should call an ambulance to take your child to the nearest hospital.
If any of the above symptoms develop, or if you have any other concerns, please call the Cardiac CNC, or if after business hours, contact the Cardiology
Fellow on call via The Children’s Hospital at Westmead (CHW) switchboard.
You can also take your child to the Emergency Department at your closest hospital. Inform the emergency doctor and nurse that your child has had recent heart surgery and ask them to contact the Cardiology Fellow on call, via the CHW switchboard. Give the admitting doctor or nurse a copy of the medical or nursing discharge summary.
If you see your GP or go to another hospital, it is important to let the Cardiac CNC know, especially in the first few weeks after surgery.
Phone numbers:
Cardiac Clinical Nurse Consultant (CNC): (02) 9845 2346
(Monday to Friday 7.30am – 4pm)
Cardiothoracic Nurse Practitioner (CNP): (02)9845 0000
(via Switchboard) Page 7096
Heart Centre for Children: (02) 9845 2345
(Monday to Friday 8.30am – 5pm)
Edgar Stephen Ward: (02) 9845 1133
Social Worker: (02) 9845 2641
Cardiac Psychologists: (02) 9845 0088.
The Children’s Hospital at Westmead
(02) 9845 0000 (CHW Switchboard)
Additional information can be found at
www.heartcentreforchildren.com.au
or by calling us on (02) 9845 2345.
Remember
On discharge your child will receive a number of forms. Keeping all of your child’s medical documents together will help make the weeks following discharge easier. Your child will receive:
- Medical and nursing discharge summaries.
- Follow-up appointments with your child’s surgeon and cardiologist.
- Chest X-ray request form.
- Prescriptions for both the CHW Hospital Pharmacy and your local Pharmacy.
