Objective We found a high incidence of negative behaviour changes, eg, anxiety, regression, sleep and eating problems in children following discharge from surgery (73% on day 2 to 33.3% by week 4). Younger age, pain on day 2, current pain and inpatient surgery predicted negative behaviour changes. The aim of this analysis was to examine the influence of parent psychological factors, child temperament and anxiety on negative behaviour changes.

Methods Parents (n  =  111) prospectively reported child negative behaviour changes on the post-hospital behaviour questionnaire at day 2, weeks 1, 2 and 4 after discharge. Developmentally normal children (5.55 ± 2.99 years of age) admitted for urology (34.8%), ENT (29%) or general (36.2%) surgery under general anaesthesia at three hospitals. Psychological factors measured before admission were parent information seeking style, anxiety (PA0), pain catastrophising and beliefs about their role, child temperament. Parent and child anxiety were measured in hospital preoperatively. Postoperatively, parents reported their level of preparedness for their child’s care at home (PP). Factors associated with negative behaviour changes at p<0.10 were added to the previous linear regression model for negative behaviour changes at weeks 1 and 2.

Results PA0, PP, age and current pain were significant predictors of negative behaviour changes at week 1 (R²  =  0.31, F  =  8.69, df 4.77, p<0.001). By week 2, only PA0 and PP remained predictors for negative behaviour changes (R²  =  0.32, F  =  19.71, df 2.87, p<0.01).

Conclusion Interventions are needed to reduce parental anxiety and increase their ability to care for their child postoperatively at home, particularly in relation to managing their child’s pain.