JAMA. 1954;154(6):509. doi:10.1001/jama.1954.02940400047014.
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The reactions of children who become surgical patients in a hospital for the first time vary considerably. Older children, especially those over 5 years of age, seem to forget the stay in a hospital quickly, while those under 5 years are more likely to show transient behavior changes—fear of the dark, fear of being left alone, and such regressive behavior phenomena as bed wetting, wanting to be fed, and fear of doctors and nurses. Disobedience, temper tantrums, increasing dependency, and spiteful, defiant behavior are more likely to occur in older children.

According to Mac Keith,1 the three principal anxieties that concern children who are admitted to a hospital for the first time deal with separation from the home, the nature of the anesthetic, and the operation itself. While older children usually regard separation from a home environment to be temporary, younger children occasionally react in a highly charged manner.


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