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Behavioral Management of Children

  • Craig SimsEmail author
  • Lisa Khoo
Chapter

Abstract

Children are anxious before anesthesia, and studies show up to 25% may require restraint. Anxiety at induction has many consequences including regression in behavior (or dysfunctional behavior) that may last months, increased pain, and fear of future hospitalization and anesthesia. Pharmacological premedication is the single most effective method of reducing anxiety, and one can be selected from a range of agents according to the level of the child’s anxiety. The behavior of the anesthetist also has a large effect on a child’s anxiety at induction. Some behaviors of the anesthetist and other health care providers focus the child on their anxiety, whereas others distract and calm the child. There are simple and practical methods to distract children at induction or during procedures. Although parental presence in theater does not reduce the child’s anxiety at the moment of induction, it avoids separation, involves the parent and should be included as part of family centered care.

Keywords

Perioperative anxiety Anesthetist behaviors and child anxiety Distraction techniques for anesthesia induction Parental presence at induction Premedication for pediatric anesthesia 

Further Reading

Child Development and Preparation

  1. Adler AC, et al. Preparing your pediatric patients and their families for the operating room: reducing fear of the unknown. Pediatr Rev. 2018;39:13–25.CrossRefGoogle Scholar
  2. Baxter A. Common office procedures and analgesia considerations. Pediatr Clin North Am. 2013;60:1163–83. A very good section about practical distraction and restraint.CrossRefGoogle Scholar
  3. Fortier MA, Kain ZN. Treating perioperative anxiety and pain in children: a tailored and innovative approach. Pediatr Anesth. 2015;25:27–35. A paper from the leading researcher in perioperative anxiety that includes a broad review of perioperative anxiety and its consequences.CrossRefGoogle Scholar
  4. Kain ZN. Anesthesia and surgery in children: reducing pain and fear. Youtube video 2014. https://www.youtube.com/watch?v=ImSBOecUmRY. Accessed July 2019.
  5. Kain ZN, Strom S. Commentaries on ‘Non-pharmacological interventions for assisting the induction of anesthesia in children’. Evid Based Child Health. 2011;6:137–40. A short article giving a concise overview of several behavioral techniques in pediatric anesthesia.CrossRefGoogle Scholar
  6. Laing R, Cyna A. Hypnosis and communication in paediatric peri-operative care. In: Riley R, editor. Australasian anesthesia. Melbourne: Aust NZ College Anesthetists; 2017. p. 273–9.Google Scholar
  7. Duff AJA et al. Management of distressing procedures in children and young people: time to adhere to the guidelines. Arch Dis Child. 2012;97:1–4.CrossRefGoogle Scholar
  8. Royal College of Anaesthetists, UK. Information for children, carers and parents. www.rcoa.ac.uk/node/429. (Cartoon style story books to download for children to read with their parents).

Premedication and Induction

  1. Banchs RJ, Lerman J. Preoperative anxiety management, emergence delirium and postoperative behavior. Anesthesiol Clin. 2014;32:1–23.CrossRefGoogle Scholar
  2. Hearst D. The runaway child: managing anticipatory fear, resistance and distress in children undergoing surgery. Pediatr Anesth. 2009;19:1014–6. A case scenario of a 10y old child, and also a brief review of behavioral stages during growth.CrossRefGoogle Scholar
  3. Lambert P, et al. Clonidine premedication for postoperative analgesia in children. Cochrane Database Syst Rev. 2014;(1):CD009633.  https://doi.org/10.1002/14651858.CD009633.pub2. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009633.pub2/epdf.
  4. Litman RS. Allaying anxiety in children. Anesthesiology. 2011;115:4–5. Editorial accompanying paper about health care provider behaviors and their effect on anxiety at induction.CrossRefGoogle Scholar
  5. Rosenbaum A, Kain ZN, Larsson P, Lonnqvist P. The place of premedication in pediatric practice. Pediatr Anesth. 2009;19:817–28. A debate that discusses the advantages and disadvantages of pharmacological premedication, particularly clonidine.CrossRefGoogle Scholar
  6. While A. Personal view. Br Med J. 1985;291:343. The APRICOT study of 2017 showed parents were present only 50% of inductions in Europe. In this old but still relevant letter, an ophthalmologist describes what happened and how he felt when his child was taken from him into theatre for a traumatic gas induction.CrossRefGoogle Scholar

Hypnosis

  1. Kuttner L. Pediatric hypnosis: pre-, peri, and post-anesthesia. Pediatr Anesth. 2012;22:573–7. A review article giving an introduction to hypnosis, including the ‘magic glove’ technique for IV insertion.CrossRefGoogle Scholar
  2. The ‘magic glove technique’ by Leora Kuttner from Vancouver Children’s Hospital: youtube.com/watch?v=cyApK8Z_SQQ. Accessed July 2019.

Restraint

  1. Homer JR, Bass S. Physically restraining children for induction of anesthesia: survey of consultant pediatric anesthetists. Pediatr Anesth. 2010;20:638–46.CrossRefGoogle Scholar
  2. Walker H. The child who refuses to undergo anesthesia and surgery—a case based scenario-based discussion of the ethical and legal issues. Pediatr Anesth. 2009;19:1017–21.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Anaesthesia and Pain ManagementPerth Children’s HospitalNedlandsAustralia

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