ABSTRACT
The purpose of this prospective multicentre survey was to evaluate the occurrence and the type of changes in children's behaviour during the first 4 weeks following the day of surgery, and to assess the significance of some patient-related factors on the incidence. Pre- and postoperative questionnaires were completed by the parents of 551 children aged 4 months to 13.4 years in five hospitals incorporating nine operative units in Northern Finland. The overall incidence of problematical behavioural changes was 47% and that of beneficial changes 17%. Problematical changes were most common in the 1.0 to 2.9 year olds and the incidence decreased significantly from 46% on the day of the operation to 9% 4 weeks later (p < 0.0001). Predictors by multiple logistic regression analysis were age, mild pain at home following surgery, severe pain and a previous bad experience of health care which had adversely affected the attitude of the child towards doctors or nurses. Hospital influenced playing was a significant factor 3 and 4 weeks after the operation. By the 4th week, beneficial and problematical changes were equally common (9%). Gender, previous operations and experience of repeated paracenteses (for treatment of middle ear infection) did not have a significant effect on the incidence. Pain on the day of the operation predicted the occurrence of behavioural problems up to the 4th week, 2-4 weeks longer than the duration of pain itself. The results emphasise the importance of effective prevention of postoperative pain as well as the importance of avoiding unpleasant experiences in all contacts children have with health care. Playing could perhaps be used to help children cope with a short hospital experience.
Subject(s)
Ambulatory Surgical Procedures/psychology , Child Behavior , Adolescent , Age Factors , Anesthesia, General , Child , Child Behavior Disorders/etiology , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Male , Pain, Postoperative/psychology , Play and Playthings , Postoperative Complications , Preanesthetic Medication/psychology , Prospective Studies , Risk FactorsABSTRACT
Behavioural changes in 85 two-to-ten-year-old children were evaluated by the parents one day, one week and one month after a routine ENT operation. Twenty (23%) children showed no changes. Behavioural problems at least once during the observation time were seen in 52 (61%) and improvements in 28 (33%) children, 15 (17%) had both. There was no statistically significant difference between the children treated as day cases and those hospitalized for one or two nights, or between the girls and the boys. The proportion of children showing behavioural problems decreased from 59% at 1 day to 32% at 1 month after the operation. The highest incidence of problematic changes occurred in children aged 3, 5 years or younger (79%), and the incidence was lowest in the 5.0-6.9-year-olds (43%). The most common changes were an increase in seeking attention from the parents (in 34% of the children), temper tantrums (25%), waking up at nights (16%) and problems in eating (16%).
Subject(s)
Adenoidectomy/psychology , Child Behavior , Middle Ear Ventilation/psychology , Tonsillectomy/psychology , Age Factors , Ambulatory Surgical Procedures/psychology , Child , Child Behavior Disorders/etiology , Child Reactive Disorders/etiology , Child, Preschool , Feeding and Eating Disorders/etiology , Female , Hospitalization , Humans , Male , Parent-Child Relations , Postoperative Period , Sex Factors , Sleep Wake Disorders/etiology , TemperamentABSTRACT
Adapting the paradigm developed by Richard Lazarus, parenting stress and coping were studied among mothers of 6-9-year-old children (n = 42) with different symptoms of Minimal Brain Dysfunction (MBD) (hyperkinesis, perceptual or motor deficits, learning disabilities or speech disorders) and among mothers of non-disabled children (n = 42) matched for age, sex, social status of the family and marital status. Mothers of children with MBD were found to experience more parenting difficulties and more negative cognitive appraisals of their stakes in parenting than their matched controls. The mothers of children with hyperkinesis and perceptual or motor deficits considered their mastery lower and experienced less positive affects than their matched controls. The mothers of children with speech disorders experienced less positive affects than their matched controls. Mothers of children with both few and several symptoms experienced more parenting difficulties in the child domain than their matched controls. Mothers of children with several symptoms considered their mastery lower and experienced less positive affects; mothers of children with few symptoms appraised their stakes in parenting more negatively than their matched controls. No significant differences were found between mothers of children with MBD with few and several symptoms.
