A Practical Approach to Preparing Children for Dermatologic Surgery

Abstract

This paper presents a series of stratagems designed to minimize the potential psychological problems of children who require dermatological surgery. After discussing the "normal" critical periods of childhood, the selective approaches to children at different ages are presented. General and specific suggestions are made for pre- and postoperative management for both office and hospital surgical procedures.

The Role of the Family in Children's Responses to Stressful Medical Procedures

“…The way in which a parent prepares the child for a medical procedure also will play a part in the child's reaction to the procedure (Gabriel, 1977). For example, Heffernan and Azarnoff (1 971) interviewed mothers and children who had come to a medical clinic for treatment.…”

Iatrogenic Effects of General Anesthesia in Children: Considerations in Treating Large Congenital Nevocytic Nevi

“…Psychoanalytic theory and clinical experience suggest that one might expect some long‐lasting effects related to anesthesia. It is expected that children will experience some level of psychic trauma as a result of hospitalization and administration of anesthesia 19 . Whether this trauma will result in pathological formations depends upon the child's constitution, age and stage of development, as well as past and present experiences.…”

“…Since anesthesia can be experienced as traumatic at any age, it is important for the physician recommending surgery to be aware of the particular needs and vulnerabilities of children at specific stages of development, bearing in mind that all children do not progress at exactly the same rate. Although cut‐off marks for developmental stages vary somewhat from author to author, the literature suggests that psychologically children can tolerate surgery most easily under 1 year of age or over 8 years of age 19,20 …”

“…Typically, fear of separation from the mother or primary caretaker begins early in infancy, peaks about age 3, and becomes less of a problem by age 7. Gabriel 19 feels that children under 9 months of age handle this separation reasonably well. Steward 20 suggests an even earlier cut‐off, i.e., the first 6 months as the psychological optimal time for surgery; at this early age these infants “do not appear unduly upset by separation from the mother and admission to the hospital.”…”

“…After age 3, children begin to communicate coherently and have more awareness of themselves and their environment. However, with this comes the development of fearful fantasies, particularly about physical mutilation for being “bad.” Once a child is able to communicate, it becomes important to talk directly to him, informing him in simple terms what is going to happen 19–21 …”