What helps children cope with anxiety before an operation?

Photo of a mother with an anxious child

Children often feel anxious before surgery, and really don’t want to go ahead with it. The time spent waiting before they are given the anesthetic can be particularly distressing for children and their parents. But there are a number of things you can do to help reduce children’s anxiety.

For years now, hospitals have been trying to make the circumstances surrounding surgery as anxiety-free as possible for children, and address parents’ concerns better too. Nowadays children are often not admitted to the hospital until the actual day of the surgery, and are able to go home soon after. They only need to stop drinking two hours before having the anesthetic.

The most important thing is to be there for your child. Parents are usually allowed to stay with their child until he or she is given the anesthetic. They are also often allowed to sit by their child’s bed when they wake up afterwards. If a child has to stay overnight in the hospital, parents can normally stay with them the whole time.

How can parents help their child before an operation?

Different children handle the idea of upcoming surgery differently. So parents can try to find out what helps their child to cope better.

Children are generally very curious and want to learn about things, and surgery is no exception. Parents and doctors might worry that talking to children about the operation could scare them. But avoiding the subject sometimes has the opposite effect: Not knowing what is going to happen might actually make them feel more scared. Children often hear things about surgery and hospitals from other sources – some of which aren’t always very helpful, such as the Internet or television.

You can help children worry less by listening to their concerns and answering any questions they have. For example, children often want to know whether the operation will hurt or whether they will have an injection. Honest answers can help them to be better prepared.

A lot of children want to take a toy along. Things like their favorite soft toy, blanket or pacifier may be comforting.

A number of activities can help children by making it easier for them to understand the procedures and what the different kinds of medical equipment do. For instance, reading to them, telling them stories, drawing pictures, and putting on plays or puppet shows can prepare them for what will happen or offer distraction. Studies have shown that listening to music before surgery can relieve anxiety in children and teenagers. Different people will be able to relax to different types of music, depending on their personal taste in music.

What do hospitals offer?

Initial studies suggest that films, computer games and clowns dressed as doctors can help children feel less anxious before operations. But there isn’t any high-quality research in this area. And different children find different things helpful. There hasn’t been enough research to be able to say whether games or comic strips help too.

Children can be given low doses of sedatives or sleeping medication shortly before the operation. They are used in the form of a syrup, suppositories to be inserted into the anus, or nose drops. The most commonly used drug is called midazolam. The possible side effects include dizziness, headaches and gastrointestinal (stomach and bowel) problems.

Brady MC, Kinn S, Ness V et al. Preoperative fasting for preventing perioperative complications in children. Cochrane Database Syst Rev 2009; (4): CD005285.

Chow CH, van Lieshout RJ, Schmidt LA et al. Systematic Review: Audiovisual Interventions for Reducing Preoperative Anxiety in Children Undergoing Elective Surgery. J Pediatr Psychol 2016; 41(2): 182-203.

Chundamala J, Wright JG, Kemp SM. An evidence-based review of parental presence during anesthesia induction and parent/child anxiety. Can J Anaesth 2009; 56(1): 57-70.

He HG, Zhu L, Chan SW et al. The effectiveness of therapeutic play intervention in reducing perioperative anxiety, negative behaviors, and postoperative pain in children undergoing elective surgery: a systematic review. Pain Manag Nurs 2015; 16(3): 425-439.

Klassen JA, Liang Y, Tjosvold L et al. Music for pain and anxiety in children undergoing medical procedures: a systematic review of randomized controlled trials. Ambul Pediatr 2008; 8(2): 117-128.

Könsgen N, Polus S, Rombey T et al. Clowning in children undergoing potentially anxiety-provoking procedures: a systematic review and meta-analysis. Syst Rev 2019; 8(1): 178.

Manyande A, Cyna AM, Yip P et al. Non-pharmacological interventions for assisting the induction of anaesthesia in children. Cochrane Database Syst Rev 2015; (7): CD006447.

Rantala A, Pikkarainen M, Miettunen J et al. The effectiveness of web-based mobile health interventions in paediatric outpatient surgery: A systematic review and meta-analysis of randomized controlled trials. J Adv Nurs 2020 [Epub ahead of print].

Smith L, Callery P. Children's accounts of their preoperative information needs. J Clin Nurs 2005; 14(2): 230-238.

Wennström B, Hallberg LR, Bergh I. Use of perioperative dialogues with children undergoing day surgery. J Adv Nurs 2008; 62(1): 96-106.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on April 19, 2022

Next planned update: 2025


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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