**1. Introduction**

164 Complementary Pediatrics

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In this chapter we aim to present a model of comprehensive care for hospitalized children in a public Brazilian university hospital. This service is provided by a team of pediatric surgeons, psychologists, nurses and social workers, all of who specialize either in pediatrics or in the surgical procedures of the pediatric surgical clinic.

As part of their continuing education, these professionals regularly participate in conferences and courses specific to developments in maternal/pediatric care, therapeutic coping techniques in the realm of maternal/pediatric care, and the major diseases that affect children in this age group.

The team is responsible for the care of children and adolescents aged 0-18 years, of both sexes, who require either outpatient or inpatient medical and surgical care. In this chapter we will discuss the provided surgical care and the specific details of its treatment, care, and guidance, for both the child and the child's family, in bio-psycho-social aspects.

The interdisciplinary approach has been emphasized in recent years by promoting a broader understanding of the patient, his or her medical condition, and its context, demonstrating that this joint service improves the diagnosis, prognosis and quality of life of the patient.

The main objectives of this interdisciplinary model of care are:


Interdisciplinary Model of Attention for Children Undergoing Hospitalized Surgical Procedures 167

The child's exposure to the risks of a hospitalization or surgery may induce negative fantasies and fearful reactions in both the parents and the child, exacerbating a natural reaction of anxiety and possibly causing a dysfunctional or pathological reaction of anxiety,

The difficulty in understanding the procedure to be performed on the child, or even the hospital context to which the child will be exposed, the possibility of injury, loss or separation from the child, the anesthetic risk, and especially the fear of prognosis are some

For the infant, who is still in full development of its impressions, the principal sentiment is fear of the unknown, the pain, and the risk of separation from its attached adults, such as

Upon admission, everything surrounding the child is new and often scary. The child finds itself in a new routine with environmental and social restrictions and is often exposed to

These potentially anxiety-inducing changes are more intense during hospitalization due to the environmental restrictions, the hospital routine, and the prognosis, among other factors. However, the process becomes more complex during surgery. There will also be an invasive intervention that includes anesthetic procedures, being that various studies show that surgery, and anesthesia in particular, are stimuli that trigger stress and anxiety because they

These factors may lead to behavioral changes in the child during and after hospitalization, such changes being more frequent in children who have not constructively addressed and

In pediatric surgery, anxiety can be observed both in the child and in the parents, so that parental coping techniques, the representation of their anxiety and consequently the manner in which they deal with the child, can help or hinder the team's work and the child's

Very anxious parents exacerbate their child's inappropriate behavior, often hampering treatment and even the child's prognosis. For this group, with greater difficulty in coping with fear and anxiety, the child's behavior often changes during and after hospitalization, encouraging behaviors that are disturbing, such as nail biting and enuresis, and emotional,

Note that empowering both children and adults to face and cope with the illness and proposed surgical procedure provides a way to deal with the information and can reduce fears and the implicit risks of a hospitalization. It is known that the quantity and quality of information received by the family and by the patient influence their trust in the team and consequently reduce anxiety and behavioral changes, which improves adherence to

In this way, we emphasize the idea that when information and psycho-emotional support are provided to patients and their families there is often an improvement in the acceptance

of the proposed procedures and, especially, an increased confidence in the team.

such as tantrums and night terrors. The same changes can also occur in the parents.

and consequently a possible behavioral disruption.

of the reasons these parental feelings are evoked.

procedures that cause pain and/or discomfort.

can be symbolically associated with the fear of loss.

coped with the stress they experienced.

the mother.

recovery.

treatment.


Based on these objectives, the Pediatric Surgery Team of the University Hospital of the Faculty of Medicine of Ribeirão Preto of the University of São Paulo (HCFMRPUSP) developed a protocol of integrated care for patients and their families. Through this protocol, all children and families who will experience a surgical procedure are treated in consultation with an interdisciplinary team composed of surgeons and psychologists in order to provide guidance and explanation of the possible conflicts related to the surgery for both the child and the family.

This model was developed from concepts described in several papers cited in the international literature, especially Canada, USA, France and China, which aimed specifically at the orientation of these patients for the procedures they will be undergoing, desensitization to invasive procedures, child-parent coping strategies, treatment and prognosis, as well as interdisciplinary interaction.
