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There should be an established policy to ensure clear communication of continuing requirements at discharge (e.g. analgesia) to include communication with primary care. This should include written information about common concerns (restarting medication, driving, etc.) and how to contact the hospital when required post discharge. Surgical teams will ordinarily be responsible for most of this process.

The particular needs of children should be considered at all stages of perioperative care. Children should receive an appropriate preassessment from staff with appropriate paediatric experience.²⁰⁷

The child should be helped to understand events that are happening or will happen, with the use of age-specific and developmentally appropriate explanation and materials.^208,209 There are specific issues around consent for children that need to be understood, including the particular requirements for children who are not under the care of their parents.²¹⁰

A parent or legal guardian should ideally be with the child up to the point of moving into the operating theatre.²¹¹

Consideration should be given to appropriate strategies for recognising and managing anxiety of children particularly at induction e.g. play specialists, counselling, psychological support and anaesthetic training around managing preoperative anxiety.

Anaesthesia for children should be undertaken or supervised by anaesthetists who have undergone appropriate training. In the UK, all anaesthetists with a Certificate of Completion of Training (CCT) or equivalent will have completed higher paediatric anaesthetic training or equivalent.²¹² There will be anaesthetists who have acquired more advanced competencies, thus allowing provision of a more extensive anaesthetic service, and...

Each hospital should have a written definition of age thresholds and the types of procedure for elective and emergency work, including imaging, which can be provided locally. Children undergoing complex surgical procedures or with significant comorbidity should be discussed with the carers and referred to a tertiary centre if the local infrastructure cannot meet their needs.^213,214

Children should be separated from and not managed directly alongside adults throughout the patient pathway, including in waiting rooms, preassessment clinic rooms and theatre areas, including anaesthetic and recovery areas, as far as possible.²¹⁵ These areas should be child-friendly and should be staffed by suitably trained and qualified practitioners within recovery.²⁰¹

Children undergoing surgery should be grouped into paediatric lists, or together at the start of mixed lists.^213,214

Preoperative fasting should be minimised as much as possible, especially for infants and younger children.²¹⁶