Risk factors for preoperative anxiety in holding area:
(1) history of poor quality in previous medical encounters
(2) maternal anxiety in holding area
(3) lower activity ratings (shy or inhibited, tending to be anxious in novel situations)
(4) age > 7 years
Risk factors for separation anxiety before surgery:
(1) history of poor quality in previous medical encounters
(2) history of previous surgery
(3) maternal anxiety in holding area
(4) maternal anxiety at separation
(5) age < 5 years of age and not enrolled in day care
(6) no or small number of siblings
(7) no premedication
where:
• A small child enrolled in day care has probably dealt with some separation anxiety.
• Premedication reduced anxiety levels (negative risk factor).
Maladaptive behavioral responses are common after surgery and usually are transient. They include:
(1) general anxiety
(2) crying at night
(3) enuresis
(4) separation anxiety
(5) temper tantrums
(6) apathy and withdrawal
(7) eating problems
(8) bad dreams or nightmares
(9) dislike of hospitals or physicians
Risk factors for behavioral problems at 2 weeks after surgery:
(1) no siblings
(2) child very anxious at separation
Additional risk factors included:
(3) age < 4 years
(4) not enrolled in day care center
(5) mother very anxious in holding area
(6) child very impulsive
Risk factors for behavioral problems at 6 months after surgery:
(1) age < 4 years
(2) mother very anxious in holding area
Additional risk factors included:
(3) no siblings
