Preoperative anxiety affects roughly 60% of children undergoing surgery and is associated with poorer cooperation at anesthesia induction, greater postoperative pain, and maladaptive behavioral changes. Many proven interventions rely on digital platforms or virtual reality, which can be costly and difficult to implement in busy wards with limited staff and space. A new single-center trial offers preliminary evidence that a structured, non-digital alternative may help fill that gap.
Researchers at Children's Hospital, Zhejiang University School of Medicine in China reported (DOI: 10.1007/s12519-026-01097-4) the findings online on 19 September 2026 in the World Journal of Pediatrics. The trial randomized 164 children, with 162 included in the final analysis after two in the intervention group did not complete the game protocol.
In the intervention, a trained nurse led a child-life-informed session on the evening before surgery, individually or in groups of up to three children, lasting 40 minutes. Two modules were used: "Time-limited Treasure Hunting," in which children matched medical equipment tokens while receiving brief explanations, and "Surgical Adventure," a board game introducing the ward, operating room, and perioperative procedures. The authors describe the approach as the nurse-led Medical Vanguard card game.
The study's main outcome was anxiety at operating-room entry. Children in the card-game group appeared less anxious at that point than controls, were more likely to cooperate during anesthesia induction, and showed fewer post-discharge behavioral problems, particularly generalized anxiety, according to caregiver reports. Heart rate and blood pressure changed over time but did not differ between groups. Caregiver anxiety scores were similar between groups, although they rose in both groups when children separated from caregivers.
The authors said the benefit was most evident at operating-room entry, a particularly stressful moment when children separate from caregivers and face the clinical environment directly. They suggested the effect may reflect distraction, greater familiarity with procedures, improved predictability, and a stronger sense of control, and noted that the group format may have encouraged emotional sharing and positive peer modeling.
The implications matter for hospital administrators and pediatric surgical teams weighing scalable preparation programs. Because the game uses simple materials and can be delivered by trained nurses in small groups, it may be easier to incorporate into routine pediatric surgical pathways than digital or virtual-reality programs. The authors cautioned, however, that the trial was single-center, restricted to otolaryngology inpatients, unable to blind children and providers, used weekly randomization, and lacked long-term follow-up. The intervention did not reduce caregiver anxiety, suggesting future preparation should pair child-focused play with support for parents and caregivers.
Multicenter studies with longer follow-up are needed to test generalizability, examine whether behavioral benefits persist, and evaluate integrated child-caregiver models. If replicated, the approach could be considered for routine preoperative preparation and future quality-improvement programs, according to the authors. The study was supported by Medical Technology and Education of Zhejiang Province of China (Grant No. Y202352389). Additional information is available through http://chuanlink-innovations.com.
