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Anesthesiology. 2013 Apr;118(4):834-41. doi: 10.1097/ALN.0b013e31827e501b.

Adult-child interactions in the postanesthesia care unit: behavior matters.

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Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.



Many children experience significant distress before and after surgery. Previous studies indicate that healthcare providers' and parents' behaviors may influence children's outcomes. This study examines the influence of adults' behaviors on children's distress and coping in the postanesthesia care unit.


Children aged 2-10 yr were videotaped during their postanesthesia care unit stay (n = 146). Adult and child behaviors were coded from video, including the onset, duration, and order of behaviors. Correlations were used to examine relations between behaviors, and time-window sequential statistical analyses were used to examine whether adult behaviors cued or followed children's distress and coping.


Sequential analysis demonstrated that children were significantly less likely to become distressed after an adult used empathy, distraction, or coping/assurance talk than they were at any other time. Conversely, if a child was already distressed, children were significantly more likely to remain distressed if an adult used reassurance or empathy than they were at any other time. Children were more likely to display coping behavior (e.g., distraction, nonprocedural talk) after an adult used this behavior.


Adults can influence children's distress and coping in the postanesthesia care unit. Empathy, distraction, and assurance talk may be helpful in keeping a child from becoming distressed, and nonprocedural talk and distraction may cue children to cope. Reassurance should be avoided when a child is already distressed.

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