My Alveolar Bone Graft Plan

It can also be somewhere for you to write down any worries you have about the operation or brace treatment and any questions you have for your Cleft team.

There is also a page at the back of the booklet that you can use to make notes when you have appointments with any of your Cleft team. This is so that you don’t forget what you talked about.

Worries about your operation

Having an operation might feel scary, even adults can feel scared about operations. If you are having any worries, it is completely normal. Lots of children might have worries about their ABG operation and treatment, like:

• My mouth might feel too sore with braces in
• My mouth or hip will hurt after my operation
• Having my stitches removed will be really painful

If you have any worries about your brace treatment or the operation, you can write them down to bring with you in your printed copy of your action plan.

If you are having any worries, remember it is completely normal!

With an adult you trust, it might be helpful to think of any questions you have for your cleft team about your operation. You can use the in your leaflet to write down any questions you have. Then you can have this plan with you in your appointment so you don’t forget what questions you want to ask. If you don’t want to ask the questions, the adult with you at your appointment can ask for you.

What is anxiety?

You might have heard of the word anxiety before. Anxiety is another way of explaining how we feel when we have worries. Anxiety is the human body’s normal reaction to danger. We all need to have an amount of anxiety or arousal to help keep us safe.

Millions of years ago when we were cave people, we developed an ’anxiety response’ to protect us from danger. It was so clever that when we came across danger our bodies knew how to respond to keep us safe. We knew to fight or run away.

This response is called ‘fight or flight’ and it is something all humans have now.

Imagine you are a cave man who has just bumped into a scary animal, like a saber-toothed tiger or mammoth! The fight or flight response will help you when you need to run away. We don’t have saber-toothed tigers or mammoths to be scared of anymore, but our bodies still have the same response to anything that we find scary. Even when it might not be dangerous, like taking a test.

Changes in the body

Fight or Flight response

• More blood gets to the muscles so they can work harder
• Pupils get bigger so you can see better
• More blood gets pumped to the brain so you can think faster
• Digestion of food slows down
• Body releases cortisol

Lots of changes can happen in the body when we feel anxious. Circle the changes that happen in your body when you feel anxious:

• Feeling dizzy
• Difficult to swallow
• Tense muscles
• Shaking
• Feeling sick
• Aches and pains
• Legs feel weak
• Feeling hot
• Hard to breathe
• Pounding heart
• Stomach flutters
• Tingling in arms or legs
• Sweating
• Anything else?

People who feel worried and anxious tend to have tricky thoughts and share some similar behaviours. These thoughts and behaviours may happen when you are feeling worried about your operation. Here is an example of how someone who is worried about their ABG operation might think, act, and feel in their body. It is laid out as a Cognitive Behavioural Therapy (CBT) picture which shows how thoughts, emotions, behaviours and sensations in our body are linked. Each part can be changed if we do something different.

The nurse can give you lots of helpful information about your operation. You can also tell the nurse how you are feeling about it. If you don’t talk about your operation you might miss out on this and become even more worried about your operation as it draws closer.

Here is an example of how someone who is thinking differently about their ABG operation might act, and feel in their body.

Talking with the nurse means that you get to find out more about your operation. You can also ask the nurse questions and share any worries you have with them.

Here is an example of how someone who is worried about brushing their teeth after their ABG operation might think, act, and feel in their body.

Brushing your teeth after the operation might feel a little scary. You might be worried about any pain you feel as you brush. Not brushing your teeth may lead to an infection, which might mean more visits to the hospital. In turn, this could lead to even more soreness and new worries.

Here is an example of how someone who is thinking differently after their ABG operation might act, and feel in their body.

Giving brushing a go after your operation might not be an easy thing to do, but it will help your mouth heal better. Try your best and have a go. Using a soft bristle toothbrush will be more gentle on your gums.

These are examples of some of the things others find helpful when feeling worried. Have a try and see if these might help you:

• Do things you find relaxing for your body and mind, e.g: reading or listening to music
• Have time with an adult you trust to talk about your worries
• Ask someone you feel comfortable and safe with for a hug
• Distract yourself by doing things you enjoy

You could also ask your parent/carer for other ideas on what to do if you are feeling worried. Fears and worries can almost always be dealt with by your cleft team answering any questions you have. If you are still very worried about your operation after talking to a parent/carer and your cleft team, it might help to talk to a Clinical Psychologist who works in your cleft team. A parent/carer can help you do this.

My ABG operation plan

Would I like to see the ward I will be staying in before my operation?

Some children like to see the ward they will be staying in before they have their operation so they know where it is and what it looks like. Would you like to see the ward where you’ll be staying? Then please let us know.

If you would like to go on a virtual tour of the ward you will be staying in, you can watch a tour of the ward on the Leeds Children’s Hospital TV website. Ask an adult to help you to watch this.

What can I take to the hospital with me?

There are things you could take with you which might help you to feel more relaxed like your favourite blanket or teddy. Remember to check with the ward if you are thinking of bringing things with you. Make a list of anything you would like to bring?

Remember to also check with your family that it is OK for you to take these things to the hospital!

What can I eat and use to brush my teeth after my operation?

To help your mouth heal as best as it can, you need to only eat soft foods for the first four weeks after your operation. So unfortunately, you can’t eat any hard foods like toast, crisps, or biscuits. It is important that you continue brushing your teeth as this helps with healing. Using a toothbrush with soft bristles will feel much better than using one with harder bristles.

You can think with your parent or carer about what soft foods you would like to eat after your operation.

Make a list of soft foods you would like to eat whilst my mouth is recovering from the operation.

What am I going to do to stop being bored while I am at home?

You might be excited to have time off from school or you might be worried you’ll get bored without having friends around.

Have a think about what you would like to do while you are at home after your operation.

What is it going to be like when I go back to school?

Most children go back to school a week after their operation.

It is expected that I will go back to school on.

After your operation, you shouldn’t do any physical or contact sports, like rugby, football or gymnastics for about 8 weeks.. This might feel hard if you are normally sporty!

What other things can you do instead? Some ideas could be drawing, reading, gaming or spending time with a friend. Write your ideas down in your leaflet.

Lots of children having ABG operation also have worries about going back to school, like:

• I might not be able to catch up with my schoolwork
• I might have to tell my classmates why I was off
• My classmates might ask me lots of questions about my operation

You might find it helpful to write down any worries you have in your leaflet. It might also be helpful to talk about them to someone you feel safe with, like an adult at home or a teacher.

If you are worried about children (or adults) asking lots of questions about your cleft or operation, the EXPLAIN, REASSURE, DISTRACT technique is an easy way to answer confidently. It also allows you to move the conversation onto something else. Here is how it works:

It might be helpful to think of some examples of things you can say when you go back to school. That way, you will be ready if anyone asks you about why you have been off. An adult can help you do this. You can write some examples in your leaflet.

Talking to a Clinical Psychologist

Remember, if after talking to your parents and your Cleft Team you are still very worried about your operation or anything else to do with your cleft, you can talk to a Clinical Psychologist. They work with lots of children and young people who are worried about having an operation. They can help you think through your worries and give you tips on how to manage some of them. They can also talk to other adults in the hospital and those who look after you at home, about how they can help you.