Pre-operative anxiety and the effect of soft toys in children at an academic hospital in Johannesburg, South Africa

Abstract

Background: Paediatric pre-operative anxiety is common. Pharmacological and non-pharmacological methods can reduce pre-operative anxiety. Low- and middle-income countries require safe, affordable, accessible methods such as soft toys to minimise anxiety.
Aim: This study aimed to describe pre-operative anxiety in children and the effect of soft toys in managing anxiety.
Setting: The study involved children ages 2–17 years receiving general anaesthesia for elective surgery at a South African academic hospital.
Methods: This prospective, cross-sectional observational study assessed 114 children using the modified Yale Pre-operative Anxiety Scale (mYPAS) at three points: Waiting area (T₁); after being offered a soft toy (T₂); and at mask introduction (T₃). Scores of 30 or greater indicated high anxiety.
Results: At baseline, 54% of children displayed high anxiety (T₁ median mYPAS = 30). Those who refused a toy were more anxious than those who accepted a toy (median mYPAS = 37 vs 30; p = 0.10). Anxiety decreased after toy introduction (T₂ median mYPAS = 28) with significantly lower scores in children who chose a toy (p = 0.006). Anxiety spiked at mask introduction (T₃ median mYPAS = 41) with 93% showing high anxiety regardless of toy presence (p = 0.63). Toys were associated with lower anxiety at T₂ (p = 0.039) but not at T₃ (p = 0.61). Older age correlated with lower anxiety at T₃ only (p < 0.001). Caregiver presence approached statistical significance at T₃ (p = 0.054).
Conclusion: Soft toys help reduce anxiety initially, but not during mask introduction. Combining low-cost, non-pharmacological strategies may improve outcomes in resource-limited settings.
Contribution: Soft toys are safe, affordable, and accessible for peri-operative anxiolysis in low- and middle-income countries.