This prospective observational study aims to evaluate whether daily screen exposure duration is associated with preoperative anxiety levels in children aged 2-5 years undergoing elective surgery.
Screen exposure in early childhood has been associated with emotional and behavioral outcomes, including increased anxiety. However, its potential impact on anxiety in acute stress situations such as surgery has not been previously investigated. Preoperative anxiety in children is associated with difficult anesthetic induction, increased postoperative agitation, prolonged recovery, and behavioral disturbances.
In this study, parents will complete a structured questionnaire assessing their child's daily screen exposure duration and related factors. Children will be categorized into three groups according to reported daily screen time: less than 1 hour per day, 1-2 hours per day, and more than 2 hours per day.
Preoperative anxiety will be assessed immediately before anesthesia induction using the Modified Yale Preoperative Anxiety Scale (mYPAS), a validated observational tool for measuring anxiety in young children.
No additional medical interventions will be performed beyond routine clinical care. The study seeks to determine whether higher screen exposure is associated with increased preoperative anxiety levels and to identify potential risk factors contributing to anxiety in preschool children undergoing surgery.
Children aged 2 to 5 years
Scheduled for elective surgical procedures under general anesthesia
American Society of Anesthesiologists (ASA) physical status I-III
Parent or legal guardian able to provide written informed consent
Premedication administered or planned prior to anxiety assessment
Emergency surgical procedures
Known developmental delay or neurodevelopmental disorder
Known psychiatric disorder
The study population consists of children aged 2-5 years scheduled for elective surgical procedures under general anesthesia at Kanuni Sultan Süleyman Training and Research Hospital. Participants will be enrolled prospectively after written informed consent is obtained from a parent or legal guardian. Children will be categorized based on parent-reported daily screen exposure duration. Preoperative anxiety will be assessed immediately before anesthesia induction using the Modified Yale Preoperative Anxiety Scale (mYPAS).
Cohort
Prospective
Not listed
Preoperative Anxiety Level Assessed by mYPAS Total Score
Preoperative anxiety will be measured using the Modified Yale Preoperative Anxiety Scale (mYPAS), a validated observational tool for children aged 2-12 years. The total score ranges from 23.3 to 100, with higher scores indicating greater anxiety. The primary analysis will compare mYPAS total scores among three daily screen exposure groups (\<1 hour/day, 1-2 hours/day, \>2 hours/day).
Association Between Screen Content Type and Preoperative Anxiety (mYPAS)
Association between the predominant content type watched during screen time (educational, non-violent cartoon/entertainment, adult content, action/violent content, YouTuber videos) and mYPAS total score.
Association Between Parental Monitoring of Screen Content and Preoperative Anxiety (mYPAS)
Association between parental supervision of viewed content (always selects content, sometimes checks, usually does not check) and mYPAS total score.
Association Between Passive Screen Exposure and Preoperative Anxiety (mYPAS)
Association between passive screen exposure (TV on in the background for most of the day vs turned off when not watched) and mYPAS total score.
Association Between Reasons for Providing Screen and Preoperative Anxiety (mYPAS)
Association between reported situations in which parents provide a screen (feeding difficulties, during housework, to calm tantrums, to facilitate sleep, as reward, for entertainment, never allowed) and mYPAS total score
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