Psychological preparation of children for surgery

Research shows that 40 % to 60 % of children, especially of pre-school and early school age, experience anxiety and stress before a surgery requiring general anaesthesia. Subsequently, some of them show post-traumatic stress symptoms, which continue to affect the child’s overall condition, recovery, and compliance with any other medical care. Children under seven years of age are considered to be the most endangered group. Several preventive measures can be taken that reduce the risk of developing a post-traumatic stress response. This algorithm endeavours to draw healthcare professionals’ attention to the critical points of the entire procedure of preparing a child for the surgery under general anaesthesia in terms of psychology, that can help children better manage medical intervention.

Posttraumatic stress disorder
psychological preparation
Published at: 1.6.2021


Assoc. Prof. Radko Obereignerů, MSc, PhD
Psychologist, Department of Psychology, Faculty of Arts, Palacký university Olomouc, Czech Republic

Medical procedures can be mentally exhausting for a child. In the presented algorithm, the basic idea of a sensitive approach and the need to let the child’s emotions and expressions flow (fear, anxiety, crying), which belong to a healthy mental function, repeatedly appears. Following the procedure in the prepared example, doctors can become aware of the tendencies towards their own reactions, or revise them with feedback in the correct answers. The algorithm of the Psychological preparation of children for surgery is based on erudite foundations, offering the basic principles of preparation and behaviour of the doctor in relation to the child in the given situation without unnecessary “ballast”.


COTÉ, Charles J., Jerrold LERMAN a Brian J. ANDERSON. A practice of anesthesia for infants and children. Sixth edition. Philadelphia, PA: Elsevier, [2019], 1256 pp. ISBN 978-0-323-42974-0.

LEVINE, Peter A. a Maggie KLINE. Trauma očima dítěte: probouzení obyčejného zázraku léčení : od raného dětství po dospívání. Praha: Maitrea, 2012. ISBN 978-80-87249-27-7.

LEVINE, Peter A. a Maggie KLINE. Prevence traumatu u dětí: průvodce k obnovení důvěry, vitality a odolnosti. Praha: Maitrea, 2014. ISBN 978-80-87249-61-1.

GARCIA-MARCINKIEWICZ, A. G., T. R. LONG, D. R. DANIELSON a S. H. ROSE. Health literacy and anesthesia: patients' knowledge of anesthesiologist roles and information desired in the preoperative visit. Journal of clinical anesthesia [online]. 2014, 26(5), 375-82 [cit. 2021-03-21]. ISSN 18734529. Available at: doi:10.1016/j.jclinane.2014.01.013

ARI, Amichai Ben, Tuvia PERI, Daniella MARGALIT, Esti GALILI-WEISSTUB, Raphael UDASSIN a Fortu BENARROCH. Surgical procedures and pediatric medical traumatic stress (PMTS) syndrome: Assessment and future directions. Journal of Pediatric Surgery [online]. 2018, 53(8), 1526-1531 [cit. 2021-03-21]. ISSN 00223468. Available at: doi:10.1016/j.jpedsurg.2017.10.043

BELLEW, M., K. R. ATKINSON, G. DIXON a A. YATES. The introduction of a paediatric anaesthesia information leaflet: an audit of its impact on parental anxiety and satisfaction. Paediatric anaesthesia [online]. 2002, 12(2), 124-30 [cit. 2021-03-21]. ISSN 11555645. Available at: doi:10.1046/j.1460-9592.2002.00788.x

GLENN, Jennifer, Kayln WOLFE a Katherine BORGMANN. THE EVALUATION OF VIDEO TEACHING ON PREOPERATIVE ANXIETY IN THE OUTPATIENT PEDIATRIC SURGICAL PATIENT. JOURNAL OF PERIANESTHESIA NURSING [online]. 2020, 35(4), E3 [cit. 2021-03-21]. ISSN 10899472. Available at: doi:10.1016/j.jopan.2020.06.008

VAGNOLI, L., S. CAPRILLI, A. ROBIGLIO a A. MESSERI. Clown doctors as a treatment for preoperative anxiety in children: a randomized, prospective study. Pediatrics [online]. 2005, 116(4), e563-7 [cit. 2021-03-21]. ISSN 10984275. Available at: doi:10.1542/peds.2005-0466

LI, H. C., V. LOPEZ a T. L. LEE. Psychoeducational preparation of children for surgery: the importance of parental involvement. Patient education and counseling [online]. 2007, 65(1), 34-41 [cit. 2021-03-21]. ISSN 07383991. Available at: doi:10.1016/j.pec.2006.04.009

DWAIREJ, D. A., H. M. OBEIDAT a A. S. ALOWEIDI. Video game distraction and anesthesia mask practice reduces children's preoperative anxiety: A randomized clinical trial. Journal for specialists in pediatric nursing: JSPN [online]. 2020, 25(1), e12272 [cit. 2021-03-21]. ISSN 17446155. Available at: doi:10.1111/jspn.12272

KAIN, Zeev. Family-centered Preparation for Surgery Improves Perioperative Outcomes in Children: A Randomized Controlled Trial. Anesthesiology [online]. 2007, 106(1), 65-74 [cit. 2021-03-21]. ISSN 00033022. Available at: doi:10.1097/00000542-200701000-00013

KUMAR, A., S. DAS, S. CHAUHAN, U. KIRAN a S. SATAPATHY. Perioperative Anxiety and Stress in Children Undergoing Congenital Cardiac Surgery and Their Parents: Effect of Brief Intervention-A Randomized Control Trial. Journal of cardiothoracic and vascular anesthesia [online]. 2019, 33(5), 1244-1250 [cit. 2021-03-21]. ISSN 15328422. Available at: doi:10.1053/j.jvca.2018.08.187

FORGEY, M. a B. BURSCH. Assessment and management of pediatric iatrogenic medical trauma. Current psychiatry reports [online]. 2013, 15(2), 340 [cit. 2021-03-21]. ISSN 15351645. Available at: doi:10.1007/s11920-012-0340-5

VOJTÍŠEK, P. Premedikace u dětí. Pediatr. praxi, [online] 2015, vol. 16, iss. 6, p. 375-378. [cit. 2021-03-21] Available at:

Related algorithms