• M Karling, H Stenlund, and B Hägglöf.
• Division of Anaesthesia, University of Umeå, Sweden. mats.karling@vll.se
• Acta Paediatr. 2007 May 1;96(5):740-7.

AimTo identify hospital care factors which are associated with problematic behaviours in children after hospitalization.MethodA cohort of 340 children ages 2-13 was studied in connection with elective procedures which included anaesthesia.Data Collectedsociodemographic, type of procedure, anaesthesia induction technique and premedication. Staff and parents assessed child anxiety at induction of anaesthesia, pain, anxiety and nausea in recovery room and hospital ward. Parents assessed their child's pain and nausea and the behaviour measured with the Post Hospital Behavioural Questionnaire two weeks after hospitalization.ResultsOne-third (34.4 %) of the children developed at least one problematic behaviour, measured by the PHBQ subscales. Multiple logistic regression identified the following risk factors: age <5, pain at home but not at hospital, nausea, child anxiety at anaesthesia induction, postoperative nausea, postoperative distress, previous hospitalizations, living in a one adult family and having some previous problematic behaviours. Moderate-to-severe pain at home, but not at hospital, was associated with the greatest risk (OR 6.39 CI: 3.53-11.6). Previous anaesthesia, midazolam use in premedication and living in rural areas seemed to be protective factors.ConclusionPain at home but not in hospital is a strong risk factor for the onset or worsening of problematic behaviour after childhood hospitalization, which included anaesthesia. Proactive interventions are suggested to prevent this by improving pain treatment at home.

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