Puppet Play May Prepare Children For Minor Surgery

Puppet play has been used extensively as a method to prepare children for surgery in hospitals. However, its effectiveness has not been proven experimentally . The primary goal of this study was to develop a structured preparation program using puppet play for children who underwent elective surgery as well as their mothers and examine whether this intervention had a positive effect on the child’s pre- and postoperative distress and behavior. The sample consisted of 91 children, from 4 to 10 years old, and their mothers; the children were admitted for elective ear, nose and throat surgery at the Aghia Sophia Children’s Hospital, Athens, Greece. The sample was divided into two age groups: ages 4–6 years, preschool age, and ages 7–10 years, school age.

All subjects were randomly assigned to either the intervention or control group. Various measures including the Rutter scales for teachers and parents and the Preschool Behavior Questionnaire were used to assess the children’s behavior before and after the operation. The subcategories assessed by the Rutter questionnaire apart from the total score are conduct and emotional disorders while the Preschool Behavior Questionnaire has the following subcategories: total score, aggressive behavior, anxious behavior and behaviors related to hyperactivity and low concentration skills.

In both scales and subscales, a reduction in mean scores denotes an improvement in the behavior of the child. The intervention consisted of two parts: the therapeutic puppet play session for children and the brief counseling session for their mothers. During the play, children are informed in detail regarding hospital stay as well as medical procedures (anesthesia induction and recovery). Furthermore, children are encouraged to express their feelings, fantasies and questions concerning any part of the hospital stay and surgery

At the end of the investigation, the children of the intervention group showed significantly fewer behavioral disturbances after the operation when they were psychologically prepared for it compared to controls. More specifically, younger children (4–6 years old) of the intervention group reduced their aggressiveness and hyperactivity after surgery. This significant difference between the two groups (intervention and control) may imply that the psychological preparation program enabled children to process the clinical procedure in a positive way and be more resilient to emotional or behavioral disturbances postoperatively as other research findings also suggest.

Further research should test the effectiveness of this program even in other age groups and the empirical need for hospitals and medical staff to provide psychological along with medical care.