• Ursula Lopez, Jennifer Martin, Mitsouko van Assche, Aline Fleury Schubert, Maryll Fournet, Vincent Quartier, Walid Habre, and Martial Van der Linden.
• Department of Neurology, University Hospitals of Geneva, Geneva, Switzerland.
• Paediatr Anaesth. 2019 Jul 1; 29 (7): 712-720.

Background/AimNegative postoperative changes in children are frequent and have been described for decades. However, there is currently no theoretical framework, nor any consensual operational criteria for identifying them. This study aims at characterizing the many dimensions involved in postoperative behavioral disturbances in early childhood, using a qualitative analysis applied for the first time to these symptoms.MethodFifty-seven parents of preschool children (1-5 years old; 38 boys), who underwent general anesthesia, were interviewed 10 days after surgery. Semi-structured interviews investigated behavioral disturbances classically described in preschool children. Qualitative analysis of the transcripts allied both deductive and inductive reasoning, and inductive coding was carried out using constant comparison method with dedicated qualitative software.ResultsParents reported both positive and negative postoperative changes. Negative changes were classified in four main categories: (a) Externalizing and (b) Internalizing problems behaviors, (c) Feeding sleeping disruption and (d) Somatic problems, each comprising different sub-categories. Importantly within these categories, the symptoms distribution changed in 5 years old children, compared to younger children. Finally, our method allowed defining whether these (negative or positive) changes were significant or not, that is, the importance of postoperative behavioral changes.ConclusionThe results of this study highlight the heterogeneity of postoperative disturbances in preschool children. These results are of primary importance for the definition and measurement of postoperative behavioral disturbances.© 2019 John Wiley & Sons Ltd.

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