Discharge Instructions for Open Splenectomy (Child)

Your child had an open splenectomy. During the procedure, your child’s spleen was surgically removed because it wasn’t working correctly. The spleen is in the upper left part of the belly. It helps protect the body from infection. To remove your child’s unhealthy spleen, the healthcare provider made a large cut (incision) in your child’s belly. Here’s what you need to know about caring for your child at home after surgery.

Incision care

Follow this advice to care for your child's incision:

• Check your child’s incision daily for redness, swelling, or separation of the skin.

• Let your child shower as needed. But don't let your child swim or sit in a bathtub or hot tub until the healthcare provider says it’s OK to do so. This helps prevent infection of the incision site.

• Keep your child’s incision clean and dry. Wash the incision gently with mild soap and warm water. Then gently pat the incision dry with a towel.

• Don't remove the white strips from your child’s incision. Let the strips fall off on their own. You may trim the edges if they start to peel.

Limit activity

Tips include:

• Show your child how to climb steps slowly and stop to rest every few steps. Limit stair climbing to once or twice a day.

• Don’t let your child lift anything heavier than 3 pounds. This is to prevent straining the incisions.

• Give your child a break from chores that take physical effort, such as vacuuming or mowing the lawn. Wait until the healthcare provider says it’s OK.

Other home care

Follow this general care advice for your child:

• Give your child pain medicines as directed by the healthcare provider.

• Have your child finish all of the antibiotics the healthcare provider prescribed, even if they feel better. Antibiotics help protect your child from infection.

• Check your child’s temperature every day for 1 week after the surgery.

• Get medical care even for mild illnesses, such as colds or sinus problems. It’s important to do this because without a spleen, your child is more likely to get an infection.

• Tell all of your child’s healthcare providers—including the dentist—that your child does not have a spleen.

• Think about getting a medical identification bracelet for your child that says they do not have a spleen.

• Talk with your healthcare provider about vaccines. Your child will be more likely to get an infection after the surgery. Specifically, ask about pneumococcus, meningococcal, haemophilus, and flu vaccines.

• If your child gets constipated, talk with the provider about a plan called a bowel regimen. Pain medicines can be constipating. More fiber, water, and a stool softener are often helpful.

Follow-up

Make a follow-up appointment as directed.

When to call your child’s healthcare provider

Call your child's healthcare provider right away if any of the following occur:

• Fever (see "Fever in children," below)

• Shaking chills

• Feeling dizzy or lightheaded

• Any abnormal bleeding

• Redness, swelling, warmth, fluid drainage or pain at the incision site

• Incision site that opens up or pulls apart

• Belly pain or vomiting

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

• Rectal. For children younger than 3 years, a rectal temperature is the most accurate.

• Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

• Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

• Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

• Mouth (oral). Don’t use a thermometer in your child’s mouth until they are at least 4 years old.

Use the rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell them which type you used.

Below are guidelines to know if your young child has a fever. Your child’s healthcare provider may give you different numbers for your child. Follow your provider’s specific instructions.

Fever readings for a baby under 3 months old:

• First, ask your child’s healthcare provider how you should take the temperature.

• Rectal or forehead: 100.4°F (38°C) or higher

• Armpit: 99°F (37.2°C) or higher

Fever readings for a child age 3 months to 36 months (3 years):

• Rectal, forehead, or ear: 102°F (38.9°C) or higher

• Armpit: 101°F (38.3°C) or higher

Call the healthcare provider in these cases:

• Repeated temperature of 104°F (40°C) or higher in a child of any age

• Fever of 100.4° F (38° C) or higher in baby younger than 3 months

• Fever that lasts more than 24 hours in a child under age 2

• Fever that lasts for 3 days in a child age 2 or older