SPECIAL REVIEWS

Over the last decade or more, pediatricians have become increasingly aware that operative procedures can carry with them psychologic trauma for the child. While it is not to be implied that every operation is a life-shaking experience upon which hinges the future happiness and security of the child, we do know that operations and their attendant events are well remembered by all of us, that they are found to be part of the "meaningful content" of psychiatric exploration, and that the onset of night terrors, disobedience, enuresis, excessive dependence reactions and similar disorders often follow operations. Unquestionably, the exact effect of these experiences on children varies both with the type of experience and with the basic security of the child. Although neurotic symptoms may have their origin in traumatic hospital experience, it is more likely that unfavorable reactions to hospitalization are caused by an activation or reinforcement of anxieties or neurotic trends already present. Unfortunately, there has been a wide discrepancy between the acceptance of these ideas and the modification of present presurgical and surgical managment of the child to conform with them. The reasons are not hard to find, for the child patient has paid the price of specialization in medicine by having his pediatrician discover a condition, the surgeon elect to operate, the hospital nurse and physician manage the preoperating room experience, the anesthetist perform the potentially most upsetting procedure of the whole experience, and all these persons and others manage his postoperative hospital course.