Parental involvement for pediatric perioperative anxiety: A systematic review and implementation framework

Table 2 Author-derived taxonomy of parental-involvement strategies and implementation considerations

Strategy	Definition	Likely clinical value	Implementation implications
Passive physical presence	Parent is physically present but has no clearly defined therapeutic role	May reduce separation distress in selected children, but effects at induction are inconsistent	Low resource, but vulnerable to anxiety transmission and staff distraction
Active parental participation	Parent provides touch, eye contact, calm verbal reassurance, distraction, or helps with mask acceptance	More plausible mechanism; active participation outperformed passive presence in one RCT	Requires brief training, role scripting, and staff agreement
Coached or prepared presence	Parent receives behavioral guidance before induction and is instructed in coping-promoting behaviors	Appears more promising than unstructured presence; aligns with ADVANCE and virtual coaching evidence	Requires standardized preoperative education and staff time
Multimodal parental involvement	Presence combined with sedative premedication, dexmedetomidine, clown therapy, preparation, or distraction	May be useful as part of individualized pathways; not consistently additive to midazolam	Should be protocolized to avoid duplicative or unnecessary interventions
Virtual parental presence	Parent provides real-time or recorded audiovisual presence without entering the OR	Feasible and potentially useful when physical presence is impractical; evidence remains pilot-level	May reduce infection-control and workflow barriers; needs technology reliability

RCT: Randomized controlled trial; OR: Operating room.