Children’s anxiety prior to surgery linked to behavioral changes

A child’s level of anxiety prior to surgery is predictive of whether they will experience post-surgical delirium and maladaptive behavioral changes, including anxiety, nighttime crying, and bedwetting, according to a Yale study published in the journal Anesthesia & Analgesia.

“This finding is of importance to the clinician, who can now better predict the development of adverse postoperative phenomena in children based on the child’s preoperative anxiety,” said Zeev Kain, M.D., professor in the Department of Anesthesiology at Yale School of Medicine and principal investigator of the study.

Kain and his colleagues found children whose anxiety before surgery increased 10 percent based on the Yale Operative Anxiety Scale were 10 percent more likely to experience delirium after surgery. Children with delirium also were more likely to have one or more new maladaptive behavioral changes following surgery when compared to children with no delirium. In addition, children with a 10 percent increase in anxiety scores had a comparable increase in the likelihood that they would have one or more new maladaptive behavioral changes following surgery, among them separation anxiety and temper tantrums.

“We identified characteristics of children who are at high risk of developing all of these clinical issues: they are younger, more emotional, more impulsive, and less social,” Kain said. “In addition, the parents of these children are significantly more anxious in the holding area and more anxious on separation to the operating room. This underscores the importance of finding ways to ease this parental anxiety, for example, by developing preoperative preparation programs directed at parents.”

Co-authors include Alison Caldwell-Andrews, Inna Maranets, M.D., Brenda McClain, M.D., Dorothy Gaal, M.D., Linda Mayes, M.D., Rui Feng, and Heping Zhang, all of Yale.