WELCOME TO ALL

Psychological evaluation of the

paediatric patients and their parents.

Presented by:Dr. Mohammed Saiful Islam

Phase A, Year 2.Department of Paediatric Surgery, BSMMU.

Objectives:Overview the psychological

problems of pediatric patients, mostly in surgical perspective.

Overview the pshychological problems of patient’s parents.

How to overcome these problems.

Introduction:In last few decades tremendous

improvement has occured in paediatric surgical field.

Despite the impovements, many children and parents still experience high level of distress when children are awaiting for invasive surgical procedures.

Introduction cntd....... Psychological evaluation is

defined as a way of testing people about their behavior, personality, and capabilities to draw conclusions using combinations of techniques.

Why psychological evaluation is needed?

Better understanding of the impact of procedures on children & families.

User perspective : psychological issues are as important as medical and surgical issues.

Improve treatment outcome.More research to validate the role of

psychological interventions.Cost reductions.

Psychological assesment tools :

Interview : hypnotic or collaborating.Observations.Role play.Assessment scales.

ANXIETY & FEAR

Sources of anxiety & fear for children:

1.Physical harm or injury, resulting in discomfort, pain, mutilation or death.

2.Separation from parents and dealing with strangers in absence of a familiar faces.

Sources (Continued…..)

3.Fear of unknown.4.Uncertainty about limits and

acceptable behaviour.5.Loss of control, autonomy, &

competence.

Infant◦Separation

(highest age risk)

◦Stranger Anxiety (6-18 months)

Toddler◦Separation

anxiety◦Loss of self-

control

Developmental Considerations of anxiety & fear:

Preschooler Regression

(highest age risk) Separation

anxiety and fear of abandonment

Inability to distinguish fact/ fiction

Unable to understand reason for hospitalization

◦School age Loss of control/ privacy Pain Bodily Injury Death

◦Adolescent Aware of the

physiologic, psychologic and behavioral causes of illness

Concerned with appearance

Separation from peer group

Developmental Considerations…..

Sources of anxiety & fear for parents:

1. Concern about the possibility of physical harm or injury resulting in discomfort, pain, mutilation or death of the child.

2. Alterations in the parenting role.3. Lack of information.4. New environment e.g. ICU, HDU etc.

Sources (Continued…..)

5. Post operative changes in child’s behaviour, appearance,or emotional responses.

6. Cost of procedure.7. Accessibility of surgical services.8. Discrimination and stigmatization.

Chart :

Interpretation of Hamilton anxiety scale:

Total score ranges from 0 to 56.Score Indicates

≤ 17 Mild anxiety.

18 to 24 Moderate anxiety.

25 to 30 Severe anxiety.

≥31 Very severe anxiety.

What you would like to know about children’s anxiety:

Presence of strong association between preoperative anxiety and negative post surgical outcomes.

Childs are uncooperative during anaesthesia,making the procedure pronounced and prolonged.

Preoperative anxiety has linked to disturbance at recovery.

What you would like to know (Continued…..)

Greatest risk of uncooperative behaviour is done by 2 to 6 yrs.

Increased post operative pain and delirium.

Disturbance in child’s postsurgical behaviour.

Postsurgical maladaptive behavioural changes.

Parents anxiety:Level of anxiety

affected by various factors.

Mother experience a greater degree of anxiety.

24%

29%

45%

35%

0%

10%

20%

30%

40%

50%

Teens Siblings Mothers Fathers

Moderate tosevere PTSDsymptoms

Parents anxiety (Continued…...)

Anxiety is also related to the coping style adopted. Two types of coping:

1)Problem focused strategy.2)Emotion focused strategy.

Why preoperative evaluation is needed?

Preoperative stress and anxiety can lead to :

1.Need for increased anesthesia.2.Need for increased postoperative pain management.

3.Speed of recovery is decreased.

Psychological preparation of children & parents for surgery:

Giving information to child.Encouraging emotional expression.Establishing a relationship of trust &

confidence between the hospital staffs and parents.

Preparing parents.Providing or teaching coping

strategies to parents & children.

Giving information to child:Accurate information in a formate

that child could understand.Childs are predominants for

emotion focused stratrgy for coping.

Better to help the child with refocusing techniques.

Timing of providing information:

Earlier the child & parents are provided with the information, the outcome is better.

Children < 6yrs: its optimal to start 1-5 days prior to procedure.

Child > 6yrs : start before 1 week.

Using a variety of channels in the provision of information:

Written information with enhanced visual images, leaflets.

Multimedia .Tour of hospital,OT.Discussion with pediatrician or

health care professionals.Engaging children in play sessions

or puppet.

Offering play therapy:Child express their emotion.Provide information in a format

that is easy for child.Help to build the confidence of

child & establish a trusting relation between child & hospital personnel.

Play specialists can be deployed.

Providing psychological interventions:Teaching the child & parents actual

techniques that help them to anticipate, recognise and manage stress related surgical experiences.

Child is taught actual life coping skill—prograssive muscle relaxation technique, conscious breathing exercises.

Providing models and counseling:

Models are known by the children.

The people who have the same experience.

Vedio, internet.Group discussion.

Preparation for parents:Informed consent with sufficient

information is ethically and legally required.

Appropriate empathic provision of information about surgery.

Group disscussion with peer group patients.

Counselling by psychotherapist.Sometimes medications.

Take home massage : I would be happy to be treated this way if this patient was me or member of my family.

Thank you all.......