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A cohort study of the incidence and risk factors for negative behavior changes in children after general anesthesia
Robyn Stargatt1, Andrew J Davidson, Grace H Huang
1Department of Psychology, Royal Children's Hospital, Parkville, VIC, Australia.
Insights
Post-anesthesia, 24% of children showed negative behavior changes by day 3 and 16% by day 30. Parental anxiety and younger age were key risk factors for behavioral changes in children.
Area of Science:
- Pediatric Anesthesiology
- Child Psychology
- Behavioral Science
Background:
- Hospitalization and anesthesia can cause significant psychological distress in children.
- This distress may manifest as negative behavioral changes post-anesthesia.
- Understanding these changes and their predictors is crucial for pediatric care.
Purpose of the Study:
- To determine the incidence of negative behavioral changes in children following anesthesia.
- To identify risk factors associated with these postanesthesia behavioral changes.
Main Methods:
- A cohort of 1250 children (aged 3-12 years) undergoing anesthesia were studied.
- The Vernon Post Hospitalization Behavior Questionnaire (PHBQ) assessed behavior at 3 and 30 days.
- Data on demographics, anesthesia, preparation, procedure, hospitalization, and anxiety levels were collected.
Main Results:
- Significant negative behavior change occurred in 24% of children at 3 days and 16% at 30 days.
- Risk factors at 3 days included parental anxiety, younger age, overnight admission, and discussion-based preparation.
- At 30 days, longer hospitalization, younger age, reading preparation books, and prior difficult anesthesia experiences were associated with negative behavior.
Conclusions:
- Negative behavioral changes are common in children after anesthesia.
- Predicting these changes precisely is challenging, but individual, family, and procedural factors play a role.
- Anesthesia preparation strategies should be tailored to surgical complexity and individual child needs.
Background:
Hospitalization and anesthesia can have a substantial psychological impact on children, which may be manifested by negative behavioral change. The primary aims of this study were to estimate the incidence of negative behavior change postanesthesia in a large cohort of children, and to identify the possible risk factors.
Methods:
One thousand two hundred and fifty children aged from 3 to 12 years scheduled for anesthesia for a variety of procedures were enrolled. The absolute version of the Vernon Post Hospitalization Behavior Questionnaire (PHBQ) was used to assess behavior change at 3 and 30 days postanesthesia. Deterioration in seven or more items of behavior was defined to be a significant negative behavior change. Demographic data, anesthesia details, type and extent of preparation, details of procedure and length of hospitalization were recorded. Child temperament, child anxiety and parental anxiety were also measured.
Results:
Twenty-four percent of children had significant negative behavior change at day 3 and 16% at day 30. After logistic regression, factors associated with significant negative behavior change at 3 days were increased parental state anxiety, younger age, overnight admission, lower birth order and preparation via having a discussion with the anesthetist. At day 30, longer hospitalization, younger age, reading the anesthesia preparation book and a previous difficult anesthesia experience were associated with significant negative behavior change. Also at day 30, reading the anesthesia preparation book was strongly associated with negative behavior change in children having short procedures, but not longer procedures. However, at both 3 and 30 days, the amount of variability explained by factors included in the models was low.
Conclusions:
Significant negative behavior change can occur in children after anesthesia. It is difficult to precisely predict in which children this will occur, however, some individual, family and procedural variables are associated with significant negative behavior change. If used, preparation should be considered according to level of surgical complexity.
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