Learning Objective #1: Understand the advantages and limitations of different approaches on measuring children's emotional responses to stressful medical procedures

Learning Objective #2: Understand the interrelationship of different approaches (physiological, subjective, and behavioural) on measuring children's emotional responses to stressful medical procedures

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Abstract Background. Psychological upset has been described as a multidimensional phenomenon, which includes behavioural, subjective, and physiological components. Nevertheless, a majority of the previous studies employed only one or two measures of psychological upset. Besides, the interrelationship among these three components of psychological upset has seldom been explored. Aims. To discuss the three different approaches: physiological measure of children's heart rates and blood pressure, subjective measure of children's level of anxiety, and direct behavioural observation, that frequently used in previous studies, and to explore its interrelationship on measuring the psychological upset of children having surgery. Methods. A cross-sectional study was employed. Eighty-two Chinese children admitted in a day surgery unit were invited to participate the study. Children were then asked to respond to the Chinese version of State Anxiety Scale for Children. The Children's mean arterial blood pressure and heart rates were recorded inside the theatre after transferring to the operating table and before the procedure of anaesthesia induction. A research nurse used the Children's Emotional Manifestation Scale to assess the children's emotional behaviours during anaesthesia induction. Results. Children with high pre-operative anxiety levels were associated with more negative emotional behaviour manifested during anaesthesia induction. Results also revealed that children with more negative emotional behaviour or high levels of state anxiety were associated with faster heart rate and higher mean arterial blood pressure. Conclusion. A child's response to stressful medical procedures can be varied. Different approaches in measuring or documenting children's emotional responses have its advantages and limitations. To have a thorough understanding of how children respond to stressful medical procedures, it is recommended that assessment strategies used should reflect the multidimensional phenomenon of the psychological upset.