Emotional and behavioural changes after surgery

Most people coming to hospital for a procedure will feel anxious. For some people this anxiety may be more significant and can lead to noticeable emotional and psychological changes. Between 40- 60% of patients will experience changes in their emotions and behaviour in the three weeks following surgery.

The following changes can be common after surgery. Most people only experience one or a few of these:

• Nightmares.
• Night terrors – waking in the night disorientated and upset.
• Bed wetting.
• Anger or feeling generally upset.
• Changes in eating habits.
• Anxiety at separation from parents or loved ones.
• More general or non-specific anxiety.
• Resistance to being told what to do.
• Fear of strangers.
• Specific dislike of any aspect of care they experienced before.
• Specific fears that someone will perform further unwanted medical procedures.

For most people, changes are usually relatively mild and resolve quickly with support and reassurance from family members. However, a few people may continue to experience some changes in behaviour for more than a year following surgery.

It is more common for this to happen if someone:

• Experiences more extreme anxiety around the time of their procedure.
• Has had multiple experiences of extreme anxiety - either on the same admission or during multiple admissions.
• Is less than 6 years old when they have their surgery.

These emotional and behavioural changes are thought to be caused by the experience of being in hospital, rather than the anaesthetic itself.

This is because hospital can be an unfamiliar environment with potentially unpleasant experiences, where normal routines are disturbed, and people are away from usual support networks such as family and friends.

Siblings of children and young people in hospital may also show many of the same emotional and behavioural disturbances.

Very young children (under twelve months old) are likely to be less impacted by the hospital experience than older children. This is because they are in an early stage of developing their awareness, perception and understanding.

Children between one and five years old are more aware of their surroundings. They have begun to understand what should be expected as part of normal day-to-day life and develop likes, dislikes and anxiety towards things of which they are unsure.

They may also have only just started to develop coping strategies to help them manage the feelings and emotions they experience in difficult, challenging or unpredictable situations. This is why children aged between one and five are more likely to feel anxious, and experience emotional and behavioural disturbances as a result.

If you are a young person about to have a procedure, please let us know if the following apply to you:

• If you feel very anxious about the upcoming procedure.

• If you have experienced significant anxiety when having procedures in the past.

• If you have asked for or needed medicine (a ‘pre-med’) in the past to help manage anxiety about a procedure.

• If you have not been able to take this medicine/pre-med in the past. For example, if you couldn’t cope with the taste/ refused to take it/ spat it out.

• If you have experienced significant anxiety during any procedure and were physically restrained so the procedure could be completed.

• If you developed or are still experiencing emotional or behavioural disturbances following a procedure in the past.

If you are a parent/carer and your child is having a procedure, please let us know if any of the above apply for your child.

You can tell the anaesthetic pre-assessment team or the medical team looking after you/ your child.

After the procedure most patients will also have a follow up appointment. You can also share any concerns or questions in this appointment, so we can offer further support.

We are very aware of the impact procedure-induced anxiety can have.

We have a specialist multi-disciplinary team whose role it is to offer expert input and support for anxious patients who are likely to find medical interventions disturbing, and to help those who have developed emotional and behavioural disturbances following surgery.

Anaesthetists, play specialists and psychologists are all part of this wider medical team, and are happy to discuss the risks and consequences of behaviour disturbances following medical interventions. They can also offer information and support to help manage any issues your child might experience.

If you have any concerns or questions regarding behaviour changes that relate to surgery or hospital admission, please ask us at your appointment with the Anaesthetic Pre-Operative Assessment clinic (APOA). We can also discuss any other worries or concerns you may have. If you have not been sent an appointment with APOA but would like one, then please contact us to arrange it:

Telephone: 020 7829 8686

Email: anaesthetic.pre-op@gosh.nhs.uk