Study examines impact of adult behaviors on children's coping and distress after surgery

A study in the April issue of Anesthesiology found adult behaviors influence children's coping in the recovery room after surgery. In addition, the study from Yale-New Haven Children's Hospital, New Haven, CT, identified specific adult behaviors that increase or decrease the likelihood children will become distressed.

One hundred forty-six children between the ages of 2 and 10 years old were videotaped during their postanesthesia care unit stay after undergoing general anesthesia and elective surgery. Adult and child behaviors were coded from the video, including the onset, duration and order of behaviors. The authors then used a relatively new statistical method, sequential analysis, to determine how the behaviors of children and adults (parents and nurses) influence each other over time.

Findings from the interaction between the children and their parents, as well as the nurses caring for them, revealed:

•Children were significantly less likely to become distressed after an adult used empathy, distraction or coping/assurance talk.

•Children already in distress were significantly more likely to remain distressed if an adult used reassurance.

In addition, findings showed 85 percent of mothers, 88 percent of nurses and 67 percent of fathers used verbal distraction, while 86 percent of mothers, 95 percent of nurses and 57 percent of fathers used reassurance. Criticism was exhibited by only 7 percent of mothers, 2 percent of fathers and none of the nurses.

"Our study was one of the first to examine the impact adult behaviors have on children's coping and distress after surgery," said study author Jill MacLaren Chorney, Ph.D., assistant professor, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada. "We hope to use the findings to educate parents and health care professionals on how to best help children handle the experience of being in the recovery room."

"Similar studies should be continued and expanded to help anesthesiologists, nurses and especially parents understand the most effective ways to interact with children to help them have the best possible experience when they undergo surgery or anesthesia," said ASA Chair of the Committee on Pediatric Anesthesia Mark A. Singleton, M.D.