• N Zech, M Seemann, S Signer-Fischer, and E Hansen.
• Klinik für Anästhesiologie, Universität Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland.
• Anaesthesist. 2015 Mar 1;64(3):197-207.

BackgroundPediatric patients represent a special challenge both for the management of anesthesia and for communication, especially the anxious and screaming child. Children have specific features of fears, cognition, comprehension and skills depending on the stage of development. In addition, behavior and anxiety are strongly shaped by the parents who have to be incorporated.AimThis article presents the special features of children as well as practical strategies and aids for dealing with children in a perioperative setting.Material And MethodsIn children suggestibility and susceptibility to placebo and nocebo effects are increased. This makes them more sensitive to negative factors but can also be utilized for positive, constructive effects. Possibilities are presented which make use of the special characteristics of children. A number of examples from daily clinical routine are given.ResultsA child's imagination, creativity and capability for dissociation in particular allow an effective application of indirect suggestion, metaphors, stories, changes in focus of attention, retreat to an inner or imagined safe place, reframing of disturbing noises and events, pacing and leading in small steps and an activation of inner resources. A hand puppet, a pet toy, a little magic trick, introducing a magic friend, acupoint for palpitations with self-affirmation, stick figure drawings, ceiling pictures or holding hands can be quite helpful. All medical devices and interventions can be explained in a way that children can understand and in positive statements without lying or neglecting the need for information.ConclusionMeeting at eye level, talking to the child instead of just about it, a language appropriate for children but not childish, comprehensible information and explanations, return of control and care more than pure technical distance, all play an important role. A serious look into such communication strategies can help the anesthetist to overcome uncertainties that a child can easily sense.

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