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The behavior of preschoolers during and after brief surgical hospitalizations

B E Rossen, P D McKeever

Issues in Comprehensive Pediatric Nursing

|April 1, 1996

Insights

Preschoolers often show distress after tonsillectomy/adenoidectomy hospitalizations, including irritability and anxiety. Preparation programs may slightly reduce immediate post-surgery distress but don't eliminate long-term behavioral changes.

Area of Science:

Pediatric Psychology
Child Health Services Research
Surgical Patient Care

Background:

Tonsillectomies and adenoidectomies are common pediatric surgical procedures.
Understanding preschool children's behavioral responses to brief hospitalizations is crucial for effective care.
Parental preparation methods may influence children's adaptation to surgery.

Purpose of the Study:

To qualitatively describe preschool children's behaviors during and after brief hospitalizations for tonsillectomy/adenoidectomy.
To explore the impact of preadmission teaching programs on children's adjustment.
To identify common behavioral changes observed post-discharge.

Main Methods:

Qualitative study design utilizing structured, open-ended home interviews.
23 parents of preschool children were interviewed 5-7 days post-discharge.
Interviews focused on children's behaviors during hospitalization and the first week at home.

Main Results:

Children's preoperative cooperation varied regardless of attendance at a preadmission program.
Most children separated easily, but some exhibited significant pre-operative anxiety.
Post-discharge, 83% of children showed distress (irritability, nightmares, appetite changes, separation anxiety).
Children who did not attend the preadmission program appeared more distressed immediately after surgery.

Conclusions:

Brief hospitalizations for tonsillectomy/adenoidectomy can lead to significant post-discharge behavioral distress in preschool children.
While preadmission programs may offer some benefits, they do not eliminate distress.
Nursing interventions should address the behavioral and emotional needs of children following pediatric surgery.

Read full analysis

Abstract:

This qualitative study describes the behavior of preschool children during and after very brief hospitalizations for tonsillectomies and/or adenoidectomies. Structured, open-ended home interviews were conducted with 23 parents 5 to 7 days after their children's hospital discharge. Parents were asked to describe their children's behaviors during hospitalization and the first week at home. Approximately half of the parents and children had attended an optional surgical preadmission teaching program. The remaining parents had prepared their children for hospitalization using toy doctor kits and library books. Preoperatively, children who had attended the program behaved similarly to those who had not: They either cooperated fully, resisted initially, or completely refused to cooperate with admission procedures. Most children separated easily from their parents to enter the operating room, whereas some (n = 5) demonstrated great anxiety. However, immediately after surgery, most children who had not attended the program appeared more distressed than those who had attended. Finally, despite their relatively minor surgeries and brief hospitalizations, after discharge the majority of children (83%), regardless of whether they had attended the program, exhibited signs of distress. In comparison with their prehospitalization behavior, parents reported that their children were more irritable, had more nightmares, had appetite changes, and experienced more separation anxiety. Implications for nursing practice and research are discussed.

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