Helping your child through wisdom teeth removal can be a difficult and stressful task. It's hard for a parent to see a child in pain. It can be especially hard with an autistic child, who may feel more scared, struggle to communicate their feelings, and/or feel pain more intensely. Here is how to help your teen cope.
This guide is a supplement for professional advice, not a substitute. If you are unsure about anything, talk to your doctor, and follow their instructions.
EditSteps
EditPreparing for Surgery
- Choose a good date and time. You or another caregiver will need to be with the teen on surgery day, and for a while after. Many parents choose Friday for surgery. Try to make it earlier in the morning, so that your teen has less time to let stress build up through the day.
- Autistic teens may be extra sensitive, and take more than a weekend to recover. If possible, plan the surgery when there is no school, such as summer break.
- Talk to the dentist or surgeon about your teen's disability, if extra support is needed. If you have a high-support child, the doctors will need to know how to accommodate their needs, and how much sedation will be needed before needles get involved.
- Anti-anxiety pills, laughing gas, pain relief, and other treatments can be options to calm your child enough for them to allow IV insertion.
- Rooms with TVs running can be a distraction, especially if waiting for laughing gas to kick in. However, if there is lots of movement in the room, they may contribute to sensory overload.
- If your child is fairly low-support, then staff might not need to know they are disabled. Ask your teen if they want the nurses to know. (It may make them more patient and accommodating, but your teen may also be embarrassed. They can choose.)
- Avoid frequent mentions of the surgery in the months and weeks before, especially if your teen gets nervous easily. This way, it's less likely to loom in their mind. Try keeping your notes or dates written somewhere out of immediate sight.
- For example, leave your calendar closed on the counter, instead of open with the date circled in red. This way, your teen is less likely to notice it or count down the days in terror.
- If your child is asking questions, be honest about when it will happen. If they aren't mentioning it, don't bring it up until it is necessary.
- Arrange for anti-anxiety medication. The surgeon has dealt with frightened patients before, and can prescribe something calming, such as Xanax or Valium. Ask for a big dose for your teen, especially if they have an anxiety disorder. Most likely, your child will take one pill the night before, and one pill before getting into the car.
- Err on the side of too much medication. A drowsy or over-medicated child is much easier to handle than a panicked child full of adrenaline.
- Disclose any medical conditions your teen has, as these may affect your teen's medication options.
- Take your teen shopping for soft foods and drinks. Your teen may only be able to eat smooth, creamy foods for the first few days. This will also depend on sensory sensitivities. It's okay if their diet isn't perfect during their recovery; eating enough is more important than eating a balanced diet. Buy foods that they enjoy, because this will encourage them to eat. Your teen may want...
- Milkshakes (add peanut butter for protein)
- Fruit smoothies, well blended
- Chocolate milk
- Jello
- Plain ice cream (chocolate, vanilla, Neapolitan; not with textures like cookie dough or chocolate chips)
- Cottage cheese
- Smooth yogurt (no lumps)
- Pudding
- 100% fruit juice
- Applesauce
- Later, they can progress to things like macaroni and cheese, seedless bread with butter, and well-cooked noodles in butter or plain red sauce.
- Consider getting a reward for your teen. The reward can be given once they have successfully gone through the surgery, and can calm them. You may choose to tell them that you'll give it to them after the surgery, so they have something to look forward to. Or, you may make it a surprise.
- New movies, stuffed animals, calming stim toys (e.g. glitter jars) or favorite desserts are things they could enjoy right away.
- Activities that require more energy, such as video games, books, high-energy stim toys (like things to wave around), or exercise equipment, can be enjoyed later in the recovery process.
- Talk your teen through the steps involved. You may use only words, or create a picture chart to help them envision the process. Call and ask one of the nurses to fact-check for you to make sure you get the schedule right. Knowing what will happen can reduce anxiety in your teen. This is roughly what they can expect:
- You will not feel too stressed, because your medicine will help you.
- You will lie down in a big chair or bed.
- I will stay with you.
- You may be given a breathing mask, which will not hurt. It gives you medicine to help you relax.[1]
- Nurses will put a blood pressure cuff on your arm. It will stay on, to help them check on you and make sure you're doing okay.
- A doctor will tie a string tightly on your arm.
- You will feel a big pinch.
- You might be asked to count backwards (10, 9, 8...). You will fall asleep as you count.
- Then you will wake up. You might feel confused.
- You'll have gauze in your mouth, and a band-aid on your hand. Don't take them off. They are helping you stay healthy.
- If I am not there, call for me, and the nurses will get me.
- Once you are ready to walk to the car, we will go home.
- Offer your teen reassurance as needed. Your teen may ask questions like "It won't hurt much, right?" or "I'll be okay?" They are looking for assurance that it won't be too bad. Give it to them. It'll reduce perseveration, and help them stay calmer.
- It's okay to underplay how bad it's going to be. While you shouldn't lie outright (e.g. "it won't hurt at all"), a little understatement can ease their anxiety. Nothing good happens from them hyperfocusing on how awful it could be.
- Your teen probably knows that you can't tell exactly what it will be like, and so they may take your words with a grain of salt. Even so, reassurance still helps, even if they only partially believe it.
- Encourage your teen to eat a lot on the day before the surgery. Your teen cannot eat or drink before the surgery, starting at midnight on the night before.[2] Have them eat a large supper, and a dessert. Making their favorite food will encourage them to eat more.
- If your teen needs to take medication in the morning, tell the doctor. Most likely, a sip or two of water will be okay.[3]
- If your teen has poor impulse control, consider hiding the food and drinks after bedtime.
- Give your teen their first anti-anxiety pill once they are completely ready for bed. It may make them very sleepy, so it's best if they have already put on pajamas and brushed their teeth. If they are scared, remind them how much you love them, and tell them you'll be there the whole time.
- If your teen is still terrified, consider sitting with them until the anti-anxiety medication kicks in, or until they fall asleep.
EditHandling Surgery Day
- Have your teen wear comfortable clothes, with short or no sleeves. The doctors will need to be able to put on blood pressure cuffs and an IV on the hand or arm. Clothes should be loose-fitting and comfy. If your teen is nervous, try picking out an outfit for them, and telling them how great they'll look in it.
- Have them wear a favorite outfit, if possible.
- Avoid sweaters for a fearful or resistant teen. They might refuse to take it off.
- Avoid ponytails or buns, as these may prevent your teen's head from laying flat during surgery. If your teen wants their hair done, suggest two braids, and tell them how wonderful they'll look.
- Consider bringing a comfort object to the doctor office. It doesn't matter if it looks "age-appropriate" or not; your teen's emotional security is far more important than what strangers may think.
- A larger or more brightly-colored comfort object, like a huggable stuffed animal or big stim toy, is harder to leave behind, because it's easier to see.
- Bring materials for yourself. You'll want a book, phone, or tablet to keep yourself occupied during the surgery. Keep a cell phone handy in case someone wants to contact you. You'll also need a notebook, to take down notes about how to care for your teen afterwards.
- Distract your teen if they seem worried. You may notice frowning, agitated stims, an increase in self-soothing, withdrawal, or even self-injury. If you stay with them and keep them engaged with something else, it will help them stay calmer. Here are ways to distract them:
- Ask them about their special interest, and encourage info dumping .
- Give them a back rub and chat.
- Do an activity related to their special interest. For example, a teen who loves Harry Potter could read it to you, re-watch the movies, write fanfic for you to read, quote favorite scenes, or tell you fun facts.
- Get a very engaging book or movie.
- Invite your teen's favorite people over (if there is time and interest).
- Keep a conversation going. Spending time with your teen can ease their anxiety.
- Offer lots of physical reassurance, if your teen likes it. You can hug them, put an arm around them, hold their hand, rub their back, give a hand massage, let them sit on your lap, and/or sit with your legs touching theirs. While some teens can't handle touch, others find it very reassuring.
- If you don't know if they can handle it, ask. For example, "Would you like me to rub your back?"
- Stay with them during surgery prep. Especially if your teen is sensitive to pain, they may be scared or crying. There may be too many nurses present for you to hold their hand, but you may be able to rub their leg and talk soothingly to them.
- Validate their pain. For example, "I know it hurts. It'll be done soon. I'm here and I love you."
- When your teen is asleep, take their comfort object. You can hold onto it and give it back once they wake up.
- Take copious notes about your teen's care. You will be given instructions while your teen is undergoing surgery. Write down everything you can, and don't be afraid to ask questions for clarification.
- It's okay if you forget a thing or two. You can always ask twice, or call the office later.
- Ask the nurses about what will happen when your teen wakes up. Ask if you can be there, and if they can take out the IV before your teen wakes. Your teen will wake up confused and disoriented, and if you are right there, it will soothe them.
- Be prepared for confusion in your teen. They may have forgotten what happened, or not realize that the surgery is done. They may ask the same questions over and over. In some cases, they may temporarily forget who you are.[4] Answer their questions patiently and consistently. This will fade.
- Your teen is unlikely to remember what happened after the surgery, or the drive home.
EditMeeting Physical Needs During Recovery
- Put your teen on a bed or couch as soon as you get home. Prop up their head; this will encourage healing.[5][6] Put a table nearby with water, medication, chapstick, entertainment devices, a pain chart, and AAC.
- Change your teen's gauze. The bleeding will most likely end within the first 24 hours, although some oozing may occur within the first 48 hours. Persistent bleeding may mean that the gauze needs to be repositioned, because it is not touching the wound.[9]
- To lessen fear, have your teen close their eyes while you change the gauze. Or, have a family member distract them.
- If bleeding continues after 12 hours, try having your teen bite a moist tea bag instead. This can speed up recovery.
- Manage your teen's medication for them. The aftereffects of surgery, combined with the executive dysfunction common in autism, means that your teen will probably not be able to stay on top of their medicine. You can be the keeper and dispenser of pills.
- Keep a written record of what they have taken, and when.
- Supervise them whenever they take the medicine. You need to make sure that they have eaten first (if the medication requires it), taken pills from the right bottle(s), and taken the right number of pills. It's easy for your teen to get confused.
- Offer food or drink along with medication. Some medications may cause nausea or vomiting if taken on an empty stomach. To prevent this, have them drink chocolate milk or eat something (dairy products work best) before taking the pill.[10] If your teen has an especially sensitive stomach, tell your doctor. They may be able to prescribe an anti-nausea medication to prevent vomiting.
- Your teen must not drink through straws, or do any sucking (e.g. on a lollipop or cough drop) during the first few days. This may reopen the wound.[11] If your teen smokes, they must stay clean for the first 24 hours.
- Use ice to manage swelling on day one, and heat after that. Your oral surgeon may have provided a headband with ice packs in it, or you can make one yourself with a pair of pantyhose.[12] Apply ice for 20 minutes on, 20 minutes off, or as directed. The swelling will reach its peak after two to three days.[13]
- Swelling can cause additional pain, although your teen might not be able to tell the difference beyond "it really hurts."
- After around the first day, heating pads will work better than ice. Get a heating pad for their face.
- Encourage your teen to nap and rest. Your teen should relax on a couch or bed, and should minimize walking around when possible. Follow your doctor's orders about bed rest, and how much activity is allowed.
- Your teen will probably not sleep through the night for a while. Encourage lots of napping.
- Have your teen go easy on their mouth. They should not explore it with their fingers or tongue, even if it's tempting, because they may reopen wounds or otherwise hurt themselves.[14] Encourage them to only eat what they feel safe eating, and not push their comfort zone for a while.
- Your teen may refuse applesauce or smoothies with seeds for a while, because they are textured. This is okay.
- Autistic teens like to know how things work, and may be curious about the location of their stitches. Encourage them to use the internet to sate their curiosity, and remind them that they could worsen their injury if they try to touch or explore it.[15]
- Keep a pain scale handy. Ideally, the pain scale numbers should come with pictures and a brief written description of each number. Your teen can point to where they are on the scale at any given time. Your teen may have a hard time understanding their pain, so you can also use scales based on observing your child,[16] such as FLACC.[17]
- Your teen may enjoy a silly pain scale, such as the one from Hyperbole and a Half (although it may not be appropriate for all ages).
- Autistic teens may not be able to reliably assess their pain, and may under-report it. Also watch their facial expression, mood, and stimming, for cues on how they're doing.
- Place AAC nearby, even if your teen is normally pretty verbal. The injury may make talking painful for them, or their speech might not be clear enough to understand. It's crucial for your teen to be able to get your attention and communicate basic needs. If you don't usually keep AAC around, try a text-to-speech app, pen and paper, or a small whiteboard.
- They need to be able to get your attention without getting up. If their AAC does not make sound, try getting a bell or an app where they can make a sound by pushing a button.
- Important phrases include "It hurts," "hungry," "thirsty," "toilet," "too hot," "too cold," "tired," "want medicine," "wrong medicine," "nausea," "want quiet time," and "lonely."
- Supervise your teen. Autistic teens can struggle with having good judgment, and sedation or loopiness from painkillers may worsen this. While you don't have to constantly pay close attention, it's good to always have an adult nearby. This is especially important for when your teen takes their meds, because if left alone, they may forget to do it properly, or at all.
- Autistic teens (especially hyposensitive ones) may try to be too independent, such as trying to walk on very unsteady legs, or trying to eat food they aren't ready for. Someone should be around to stop them.
- Try not to leave them alone for more than an hour. Have someone check in, and help them take their meds, if possible.
- If you must leave your teen unsupervised, give them detailed medication instructions. Assume that if you leave something out, they won't know or do it. Label their medication very clearly. Take a cell phone and make sure they know what number to call if a problem comes up. Keep in mind that your child may not be organized enough to follow your instructions, even if you write them perfectly.
- Have your teen swish with salt water[18] or a water/mouthwash mixture after the first day. (Kids' mouthwash may have a more agreeable flavor.) Instead of using their mouth to swish it, they should tilt their head side to side, letting gravity move the solution instead of their mouth muscles. This will avoid irritating their injury.
- Your teen must not spit. (This can increase the risk of dry socket.) Instead, they should lean over the sink and let the liquid dribble out. Then they can wipe their mouth with a tissue.
- Don't let this fall by the wayside. Make it part of a routine, such as after eating, or use a timer to implement a schedule, such as every two hours. Curbing swelling is important to keep your child's pain from becoming too bad.
- After the first day, your teen may be able to undergo very gentle teeth-brushing.[19] If they are nervous, offer to do it for them, and avoid the back of their mouth.
- Taper off pain medication with care. You can balance it with over-the-counter medication, such as ibuprofen. If your teen is having a hard time tapering off, or is still in a lot of pain after several days, contact your doctor for advice.[20]
- Keep track of when your teen takes over-the-counter medication, and do not exceed the maximum dosage in a given day.
- Peek at your child's mouth if they report problems. Take a flashlight and instruct them to open their mouth as wide as they can (which may be limited due to soreness). Have them point to or describe where and what they feel is unusual. You may see stitches and lumps. If you don't see anything unusual, you can assure your teen that it looks normal.
- Whitish things in the mouth are normal. If there's a lot, make sure your child is doing enough mouthwash/salt water rinses.
- Your child may feel hard things in their mouth, like stitches. Instruct them not to touch or worry, because it's normal. If your child has protein stitches, they will dissolve slowly, and can be swallowed safely.
- If you see something unusual or confusing to you, don't be afraid to call your teen's dentist or oral surgeon and ask about it. They can explain what it is, and tell you whether you need to take action or not.
- Expect an unusual recovery time. Autistic people may experience pain differently, and often (but not always), more intensely.[21][22] If your teen is hyposensitive, they may be very quick to feel better. If they are hypersensitive, it may take longer to recover. Do your best to meet their physical and emotional needs.
- Encourage a hyposensitive teen to take it easy. They are still injured, even if they don't feel it. Entice them with fun sedentary activities (TV, video games, board games), and prepare their meals and snacks to ensure they're eating soft foods.
- Offer care and comfort to a hypersensitive teen. Their pain may be intense and long-lasting, so the recovery period can be awful for them. Provide plenty of distraction, and give them a little extra affection and positive attention. This can help on the psychological front, especially if your child is fearful.
EditMeeting Emotional Needs During Recovery
Both you and your child may be emotionally exhausted during this difficult time. Here is how to take good care of yourself, and keep your child's mood as non-terrible as possible.
- Rotate caregivers. Your teen will be very needy for a while, so to prevent exhaustion, have different loved ones take turns looking after your teen. Consider parents, relatives, and siblings.
- Not all caregivers have to be adults. Siblings can hold your teen's hand, talk to them, read to them, fetch things, watch movies together, and get an adult if needed.
- Write instructions for your teen for waking up during the night. This can decrease the chances of them waking you up because something is wrong and they don't know what to do. Your teen will probably not sleep through the night for a while. If-then instructions can help them know what to do about various problems (e.g. "If your ice pack is melted, put it in the freezer, take the other ice pack from the freezer, and go back to bed").
- Show them where you are putting the medicine, their water, and the instructions.
- Write down when they can take medication. For example, "You can take the pain medicine, the one with the red O written on top, anytime after midnight. Have food or chocolate milk first. Then write down the time when you took the medicine on this line _______, so I know when to give you the next dose in the morning."
- Expect some moodiness and temporary regression. Your teen may be very stressed, and may not be able to do all the things they usually can. This is normal and temporary. Treat them at the developmental level where they are at now, and know that they'll regain lost abilities once they feel better.
- Provide plenty of distractions. If your teen is engaged with something else, they'll feel better and concentrate less on the fact that they're in pain. Put a TV remote in reach, remind your teen of any video streaming services such as Netflix, place interesting books in reach, and consider offering a laptop as well.
- Use special interests to your advantage. These can be powerful distractions. Look for options related to your teen's favorite things.
- Encourage your teen to express emotional needs. Your teen might feel sad and lonely. If you suspect they are longing for comfort, prompt them with "Are you lonely?" Then reward them with loving attention. You can also give them an AAC card that says "lonely." Even if you're just sitting next to them while you answer your email, they might really want the company.
- If they say they are lonely, and you don't have time to give them some love, tell another family member that your teen is lonely and ask them to hang out with them. Maybe Daddy would love a chat and a cuddle, or your daughter would enjoy watching movies with her big sister.
- Do your best to reward an "I'm lonely" with positive attention. This will make your teen less likely to seek attention by acting out.
- Expect a second round of pain once your child stops taking prescription painkillers. It may seem like you're nearing the finish line, but instead, this is round two. Your child's pain level may go up, and you may see more moodiness and crying. Keep comforting and distracting your child.
- As an absolute, hard maximum, your teen can take up to 12 ibuprofen (Advil) tablets per day.[23] This means 2 tablets every 4 hours. Do not exceed this under any circumstances.
- Offer comfort and praise. Your teen is in a vulnerable place. They'll feel better if you tell them how brave, strong, and wonderful they are. Offer physical contact if they like it, or express your love through kind words. Your love and support is what your teen wants most.
EditTips
- Your teen may be more comfortable with their mouth open, which can lead to chapped lips. Keep chapstick nearby, and encourage your teen to use it.
- Sharp edges in the mouth, discoloration/bruising, stiffness of the jaw, and dry lips are all normal after surgery.[24] Talk to your doctor if you have concerns.
- You can buy stuffed animals that have a pouch for a microwaveable heating pad.[25][26] This can be a good way to console your teen, especially if the toy has good textures for stimming.
- Oxycodone can boost your teen's mood, and is a potentially addictive substance. If your teen notices that they feel happier after taking it, they may fear they are addicted. Assure them that this is a normal side effect, and as long as they are following instructions, they are not addicted.
EditWarnings
- Call a doctor if bleeding does not stop after the first 24 hours of surgery.[27]
- After rinsing their mouth, don't let your child wipe their mouth with toilet paper. It will partially dissolve and unpleasantly stick to their lips and tongue. A facial tissue, such as Kleenex, is best.
EditRelated wikiHows
- Tolerate Getting Wisdom Teeth Pulled
- Handle an Autistic Child's Behavior
- Support an Autistic Person
- Deal with a Clingy Child
- Choose AAC for an Autistic Person
- Handle Anxiety in Children
- Help a Hypersensitive Autistic Person
- Help a Hyposensitive Autistic Person
- Help Your Teen Cope With Anxiety
- Clean Your Teeth After Wisdom Teeth Removal
- Recover after Wisdom Teeth Surgery
EditSources and Citations
- Article started by an autistic person after her wisdom teeth surgery. Her parents followed these steps and made everything much, much easier.
- Detailed instructions on wisdom teeth care
- Content note: Some articles discuss blood and other medical details, so squeamish people should take care.
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from How to of the Day http://ift.tt/2gchXw8
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