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Perioperative psychosocial interventions for autistic children undergoing ENT surgery
1Center for Child Health Outcomes, Children's Hospital, San Diego, CA 92123, USA.
Insights
Pediatric tonsillectomy/adenoidectomy for autistic children requires specialized care. Psychosocial and medical interventions can improve their operative course.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Developmental Pediatrics
Background:
- Tonsillectomy/adenoidectomy is a common pediatric procedure.
- Autistic children present unique challenges due to sensory sensitivities and communication deficits.
- Managing these children requires adapting standard surgical practices.
Observation:
- Autistic children exhibit distinct characteristics including language/social deficits and abnormal sensory reactions.
- Rigid routines and attachment to objects are common.
- Mental retardation can also be present.
Findings:
- Specific interventions can optimize the surgical experience for autistic children.
- Key strategies include parental involvement, minimizing separation, pre-operative role-playing, tailored anesthesia, and post-operative distraction.
Implications:
- These techniques can enhance the management of autistic and developmentally delayed children undergoing surgery.
- Improved care for this population aligns with quality improvement initiatives.
- Educating surgeons on these interventions is crucial for effective practice.
Abstract:
Tonsillectomy/adenoidectomy is one of the most frequently performed operations in the United States. It is therefore likely that pediatric ENG surgeons will encounter autistic and developmentally delayed children in routine practice. Autistic children differ from normal children in that they exhibit severe deficits in language and social functioning; abnormal reaction to stimuli such as light, sound, touch, and pain; attachments to particular unusual objects and rigidly stereotyped routines. They are often mentally retarded. With the increasing importance of managed care and continuous quality improvement, knowledge of how to manage the operative course of such children is crucial for the practising surgeon. Based on research and clinical knowledge of these children, certain psychosocial and medical interventions are presented which may improve the operative course of this population. Using the parent as a consultant; decreasing separation from familiar caretakers, objects, and routines; pre-operative role-playing; tailoring anesthetic induction; and using post-operative distractors are suggested techniques.