A dramatic increase in the number of surgical and medical procedures performed on children has caused a spike in extreme anxiety among young patients, a leading pediatric anaesthetist has warned.
Alexandra Donaldson, who founded Australia’s first pre-surgery anxiety clinic at the Queensland Children’s Hospital in 2018, says some children can be so distressed the hospital has to cancel at least one surgical procedure a day.
The more upset children are at the start of a procedure the higher the incidence of nausea, delirium and pain levels after surgery, as well as longer stays in hospitals, Dr Donaldson said.
“The trauma can continue in children for up to 12 months with separation anxiety, bed wetting nightmares and temper tantrums,” she said.
Dr Donaldson said medical advances meant more children were being subjected to multiple procedures like MRI’s and lumbar punctures.
Unlike adults, they had to be anaesthetised to keep them still.
For some children that could mean having a general anaesthetic every day for up to a month, and just the sight of a canula, or putting on an oxygen mask can alarm them.
“For kids I often sing songs, tell stories, it’s really about calming them, distracting them and absorbing them in the moment,” Dr Donaldson said.
“Babies may experience separation anxiety before a procedure so sometimes all that is needed is for a parent or carer to hold them close on their lap and cuddle them before their anaesthetic instead of placing them directly on the operating theatre bed.”
The clinic is run by a multi-disciplinary team of anaesthetists, nurses and allied health workers, including occupational therapists.
The children’s families are also involved given their critical role in reassuring their child.
“We tell the parents calm is contagious, even though they are feeling worried in the moment and they are inwardly distressed just keep a smile on your face for your child,” Dr Donaldson said.
Anxiety around blood tests, vaccinations and even a visit to the local GP were all red flags for parents and health practitioners that some help may be needed.
Children and young adults with special needs are also cared for by the clinic, with 40 per cent of patients diagnosed with an autism spectrum disorder.
Dr Donaldson said when a child is so distraught the hospital has to cancel a procedure the clinic offers a range of techniques to help calm them, including a tour of the hospital and operating theatre beforehand so they know what to expect.
She said doctors had been aware for decades children were often deeply traumatised by the hospital experience, but the higher rate of treatments and “generalised anxiety” in children meant health services had reached a tipping point.
Dr Donaldson will present the results of the QCH clinic’s work at the Australian and New Zealand College of Anaesthetists’ Annual Scientific Meeting in Brisbane on Sunday.
She said the clinic had proved such an effective service, children’s hospitals in Perth and Sydney were now in the process of establishing their own and there was interest across the country.
The clinic is complemented by the publicly accessible EPIC website (Effective Peri-Procedural Communication), developed by the Society for Paediatric Anaesthesia in New Zealand and Australia.
* The Australian and New Zealand College of Anaesthetists has facilitated AAP’s coverage of the 2024 meeting.
By Deborah Cornwall in Brisbane
