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Department: Pearls

Calming pediatric surgery patients and parents

Dziuba-Pallotta, Jennifer BSN, RN, CNOR

Author Information
doi: 10.1097/01.CCN.0000471010.24826.c9
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In Brief

Reducing preoperative anxiety is one of the most important considerations in pediatric surgery. Usually, one parent is invited into the OR suite to comfort the child during the induction process. Increased preoperative anxiety in young children is associated with increased postoperative pain and increased analgesic requirements.1

High anxiety

A child's ability to cope with stress depends on his or her developmental age. For example, infants and younger children tend to experience separation anxiety from their parents and stranger anxiety, especially during the perioperative experience. To decrease this anxiety, parents should learn to physically and verbally soothe their child by maintaining their composure and calmly and reassuringly speak to him or her.

Wearing a face mask

In most cases, children are induced with an inhaled anesthetic agent via face mask before an I.V. is started. It's a good idea to introduce a child to the face mask in the preoperative area showing the child how to hold it up to his or her face. This technique is helpful during induction because the child will know what to expect and may feel more in control of the process.

Because older children and teenagers have more developed verbal communication skills, perioperative nurses can speak to them about their concerns.

Weighty issue

When administering medication, the child's weight is more important than age because medication dosages and I.V. fluids are based on the child's weight in kilograms. Adding the child's weight to the “time out” checklist is a useful way to ensure the entire surgical team is aware of the correct weight for medication dosing during the intraoperative period. These medications would include antibiotics as well as local anesthetics.

Parents are also patients

It's important to remember that parents are also patients. They're the keys to the initial assessment, as they know the child's entire medical history. They can also describe their child's temperament and personality, and are powerful allies in implementing a nursing care plan. However, sending a child into surgery is a stressful time for them also, and therefore, their psychosocial needs are important. Allowing parents ample time to have their concerns addressed is crucial to establishing their trust in the surgical team and creates an overall sense of satisfaction with their child's care. A composed parent can help a child stay calm in an otherwise emotionally tense environment.


1. Kain ZN, Mayes LC, Caldwell-Andrews AA, Karas DE, McClain BC. Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. Pediatrics. 2006;118(2):651–658.
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