Preoperative anxiety in children. Predictors and outcomes

Arch Pediatr Adolesc Med. 1996 Dec;150(12):1238-45. doi: 10.1001/archpedi.1996.02170370016002.


Objective: To determine predictors and behavioral outcomes of preoperative anxiety in children undergoing surgery.

Design: A prospective, longitudinal study.

Setting: A university children's hospital.

Participants: One hundred sixty-three children, 2 to 10 years of age (and their parents), who underwent general anesthesia and elective surgery.

Main outcome measures: In the preoperative holding area, anxiety level of the child and parents was determined using self-reported and independent observational measures. At separation to the operating room, the anxiety level of the child and parents was rated again. Postoperative behavioral responses were evaluated 3 times (at 2 weeks, 6 months, and 1 year).

Results: A multiple regression model (R2 = 0.58, F = 6.4, P = .007) revealed that older children and children of anxious parents, who received low Emotionality, Activity, Sociability, and Impulsivity (EASI) ratings for activity, and with a history of poor-quality medical encounters demonstrated higher levels of anxiety in the preoperative holding area. A similar model (R2 = 0.42, F = 8.6, P = .001) revealed that children who received low EASI ratings for activity, with a previous hospitalization, who were not enrolled in day care, and who did not undergo premedication were more anxious at separation to the operating room. Overall, 54% of children exhibited some negative behavioral responses at the 2-week follow-up. Twenty percent of the children continued to demonstrate negative behavior changes at 6-month follow-up, and, in 7.3% of the children, these behaviors persisted at 1-year follow-up. Nightmares, separation anxiety, eating problems, and increased fear of physicians were the most common problems at 2-week follow-up. Multivariate analysis demonstrated that child's age, number of siblings, and immediate preoperative anxiety of the child and mother predicted later behavioral problems.

Conclusions: Variables such as situational anxiety of the mother, temperament of the child, age of the child, and quality of previous medical encounters predict a child's preoperative anxiety. Although immediate negative behavioral responses develop in a relatively large number of young children following surgery, the magnitude of these changes is limited, and long-term maladaptive behavioral responses develop in only a small minority.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Distribution
  • Anxiety / psychology*
  • Child
  • Child Behavior Disorders / psychology
  • Child, Hospitalized / psychology*
  • Child, Preschool
  • Female
  • Humans
  • Male
  • Multivariate Analysis
  • Parents / psychology
  • Predictive Value of Tests
  • Preoperative Care / psychology*
  • Prognosis
  • Prospective Studies
  • Regression Analysis
  • Risk Factors