The value of informing Children prior to examination and procedures

Abstract: The value of infoming children about impending medical procedures was investigated, particularly in ægard to possible effects on anxiety, fear, noncooperation and distress in specific clinical situations: urological investigation, heart catheterization, lumbar puncture, acute appendectomy. The use of a preparatory infonnation program was compared with conventional verbal infomation and pharmacological premedication. Pain, anxiety and noncooperative behaviour were measured using establish scales of subjective measurement and analyses of physiological measures: pulse, blood pressure and stress horrnones. The preparation program consisted of a demonstration of the planned procedure to the child using, according to the child's age, a doll, play interaction, a photo album and/or verbal inforrnation. Parents were usually present. Ourstudies demonstrate the following findings: a preparation program reduced the number of anxious children needing premedication befor uroradiological examination; preparation compared favourably to pharmacological premedication; children with acute appendicitis indicated less anxiety after the preparation program and were comparable to controls who had received pharmacological premedication; children who had been prepared prior to heart catheterization also showed less anxiety prior to the procedure; at long terrn follow-up, recollection of the hospitalization apparendy had been effected by the preparation program, possibly due to a more effective handling of anxiety and fear while still in hospital; perception of pain in a prepared group undergoing lumbar punctures showed anxiety reduction during repeated procedures.When the children's anxiety and noncooperation were rated by independent adults, including parents, a surprising degree of agreement was seen. Adults as a group, however, tended consistently to use low ratings for anxiety-noncooperation compared to tie child self rating of pain. Present findings are compared to those of other authors and are generally in agreement where similar questions have been posed. Further research and refinement ofmethods for the delivery ofpreparatory inforrnation to children facing painful or frightening medical procedures is, however, needed.