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

Table 6 Author-derived practical considerations for structured parental involvement in pediatric perioperative care

Step	Characteristics
Step 1	Preoperative screening: Consider assessing child’s age, developmental needs, previous healthcare trauma, expected separation anxiety, baseline parental anxiety, language needs, and family preference
Step 2	Eligibility triage: Consider parental involvement for elective, stable, low- to moderate-complexity inductions where the anesthesia team agrees that parental presence will not compromise safety
Step 3	Parent preparation: Provide a short verbal or written script explaining the induction sequence, expected child behavior, parent position, coping-promoting phrases, distraction options, and exit procedure
Step 4	Role prescription: Assign the parent a simple active role, such as maintaining eye contact, holding the child's hand, coaching breathing, telling a story, or assisting with mask familiarization when appropriate
Step 5	Staff coordination: Define who escorts the parent, who observes parent distress, and who has authority to stop the intervention
Step 6	Alternatives: Offer virtual parental presence, preoperative preparation, child-life support, distraction, or pharmacological anxiolysis when physical parental presence is unsuitable
Step 7	Audit and feedback: Collect data on child anxiety, induction cooperation, parental anxiety or satisfaction, induction time, staff workload, adverse events, and protocol adherence

This author-derived framework is intended as a set of expert-informed practical considerations for local adaptation, implementation research, and prospective evaluation. It should not be interpreted as an evidence-based recommendation or validated clinical guideline.