Introduction

As a result of major advances in all branches of pediatric care there have been considerable improvements in survival and physical health of children following pediatric surgery. Follow-up of pediatric surgical patients has, understandably, concentrated on physical or functional outcome, whereas interest in psychological and social sequelae is relatively recent. Conditions requiring pediatric surgery vary along a continuum from acute short-term problems requiring minor surgery, to those requiring major life-threatening surgery. This chapter is primarily concerned with the long-term psychological and social sequelae of conditions requiring major surgery.

The chapter is divided into four sections. The first focuses briefly on methodological issues in psychological research. The second addresses the effects of hospitalization and children's responses to hospitalization. The third section reviews studies of long-term psychological outcomes and the relationship to chronic health problems. Finally, issues arising from the previous sections are discussed.

Methodological issues

Study design

Good psychosocial adjustment in children has been described as being “reflected in behavior that is age-appropriate, normative and healthy and that follows a trajectory towards positive adult functioning”. The ideal way to assess long-term psychosocial outcomes is by prospective longitudinal studies. They are unique in their ability to determine the best causal relationship between early and later behavior, and they offer the possibility of studying whether specific risk factors lead to different outcomes, whether the effects are immediate or delayed, whether the effects persist over time and whether they are modified by intervening variables.