Psychological Effects of Surgery on Children: Short & Long-Term

Introduction

Pediatric surgery is the branch of surgery that deals with the performance of surgical procedures on children. It encompasses several sub-specialties, including pediatric orthopedic and cardiothoracic surgery, among others. For adults with diseases that originated during childhood, treatment is sometimes provided by a pediatric surgeon in a pediatric hospital, since these specialists and facilities have greater experience managing conditions that begin in childhood compared to general adult facilities. Heart conditions originally identified in childhood, for example, are commonly managed within the pediatric surgical setting.

Surgery on children is usually performed either through day case or inpatient procedures, with most pediatric surgeries conducted as day cases. Since the beginning of the twentieth century, there have been increasing arguments advocating for day case surgeries over inpatient surgeries for children. These arguments have contributed to day case surgical operations rising to approximately fifty percent of pediatric procedures. Additional arguments have supported reducing the costs of day case surgical operations for greater convenience for parents and to minimize psychological effects on the child.

Surgical operations in children result in a range of effects — cognitive, behavioral, physiological, emotional, and psychological. These psychological effects are classified as either short-term or long-term, with severe cases producing effects that last for months or even years. Research indicates that children experience various psychological effects after surgery, though these typically diminish significantly over time and can disappear within two weeks in some cases.

Children who undergo inpatient surgical operations tend to experience more psychological effects than those who undergo day case operations, largely because of the hospital environment itself. Prior to surgery, children frequently show negative psychological reactions that can sometimes be severe, persistent, and harmful (Justus et al., 2006). It is therefore important to provide children with honest preliminary explanations before surgery, without conveying false information, since a negative surgical experience can affect a child's confidence, emotional stability, and overall sense of well-being. Children who undergo inpatient surgical operations are also at risk of experiencing a re-emergence of post-hospital distress at a later time or in a different form.

Short-Term Psychological Effects of Pediatric Surgery

There are two broad categories of psychological effects of surgery on children: short-term and long-term effects. These categories are generally determined by the kind of surgery conducted and the condition the child was being treated for. Whether the surgery was performed as an inpatient or day case procedure also plays a significant role — in most cases, inpatient surgical operations are associated with longer-lasting or more severe psychological effects. Short-term psychological effects typically disappear within weeks or a few months.

Emotional Stress

Emotional stress is one of the most common short-term psychological effects that a child experiences after undergoing surgery. Regardless of the type of surgical procedure, emotional stress is usually the first psychological effect to appear. Breastfeeding children who have undergone heart transplant surgery are among the most vulnerable patients, since such operations often require restricted breastfeeding and increased reliance on feeding tubes. Children who receive nutrition via feeding tube or intravenously experience additional emotional stress as a result (Cadena, 2007).

Emotional stress is also closely associated with other types of pediatric surgery and is typically indicated by eating difficulties, sleeping problems, anxiety, and regression to earlier levels of functioning. The severity of emotional stress differs between children who receive preoperative preparation and those who receive no explanations before surgery. Preliminary preparation helps reduce the intensity of emotional stress experienced after the procedure.

Need for Extra Attention

The need for extra attention is the second major short-term psychological effect of surgery on children, and it occurs most prominently in patients who have undergone inpatient surgery. While children who undergo day case surgery also experience this need, it is more pronounced in inpatient cases because of the disruptive hospital environment. Research indicates that the degree to which children who have undergone inpatient surgery require extra attention after discharge is related to their length of stay in the hospital — the longer the stay, the greater their need for attention upon returning home. Separation from parents during hospitalization further intensifies this need.

The need for extra attention may disappear after a few weeks, but it sometimes takes up to three months to resolve following discharge from hospital (Campbell, Scaife & Johnstone, n.d.). The severity of emotional stress experienced during and after surgery is also a determining factor in how intense this need for attention becomes.

Conclusion

It is important for children who undergo surgery to receive preliminary preparations and explanations prior to the procedure. While these preparations do not entirely eliminate the psychological effects of surgery, they help reduce their severity and prevent short-term impacts from developing into long-term conditions. Surgery performed on children without any preliminary preparation risks leaving them feeling betrayed and frightened — outcomes that can have lasting consequences for their psychological well-being and their future relationship with medical care.

References

Cadena, C. (2007, May 11). The psychological impact of organ transplants in children. Associated Content.

Campbell, I. R., Scaife, J. M., & Johnstone, J. M. (n.d.). Psychological effects of day case surgery compared with inpatient surgery. Retrieved from National Center for Biotechnology Information — U.S. National Library of Medicine website: PubMed (NCBI)

Justus, R., et al. (2006). Preparing children and families for surgery: Psychological responses to surgery. Pediatric Nursing Journal, 32(1), 35–43.

Todaro, J. F., et al. (n.d.). Cognitive and psychological outcomes in pediatric heart transplantation. Journal of Pediatric Psychology, 25(8), 567–576.