# A nurse is caring for a 4-year-old child who is scheduled for surgery tomorrow. The child appears anxious and keeps asking "When is mommy coming back?" What is the most appropriate communication approach for this preschool-aged child?

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> language: ko  
> subject: Growth & Development

## 문제

A nurse is caring for a 4-year-old child who is scheduled for surgery tomorrow. The child appears anxious and keeps asking "When is mommy coming back?" What is the most appropriate communication approach for this preschool-aged child?

## 보기

1. Explain the surgical procedure in detail using medical terminology to help the child understand what will happen.
2. Tell the child that everything will be fine and there is nothing to worry about
3. Ignore the child's questions about the mother and redirect attention to toys in the room
4. Use simple, concrete language and acknowledge the child's feelings while providing reassurance about the mother's return. **✔ 정답**

**정답: 4**

## 해설

Preschoolers think concretely and have separation anxiety. Using simple, concrete language and acknowledging feelings addresses their developmental needs. Detailed explanations or false reassurance can increase anxiety.

## 심화 해설

Understanding the Preschool-Aged Child in the Perioperative Setting

When communicating with a 4-year-old child facing surgery, it is essential to match the intervention to their developmental stage. Preschool-aged children are in Piaget's preoperational stage, characterized by magical thinking, egocentrism, and a limited understanding of time and bodily integrity. They process information literally and cannot grasp abstract medical terminology or complex future-oriented explanations. Their anxiety often manifests as separation anxiety, which is a primary stressor during hospitalization. The child’s repeated question, "When is mommy coming back?", is not a request for a clock time but an expression of fear of abandonment and a need for emotional safety.

Analysis of Communication Options

- Option 1 is incorrect. Using detailed medical terminology with a preschooler is developmentally inappropriate. A child in the preoperational stage lacks the cognitive ability to process abstract concepts like "anesthesia" or "surgical incision." This approach can increase fear and misunderstanding, potentially leading to higher levels of preoperative anxiety. Research on perioperative preparation programs emphasizes the need for developmentally tailored, concrete explanations, not clinical jargon .

- Option 2 is incorrect. False reassurance ("everything will be fine") dismisses the child's valid emotional experience. This blocks the development of a trusting nurse-patient relationship because the child learns that their fears are not being heard or taken seriously. Effective non-pharmacological interventions for preoperative anxiety focus on acknowledging and managing the emotion, not minimizing it .

- Option 3 is incorrect. Ignoring the child's direct questions about their mother is counter-therapeutic. It invalidates their primary source of distress and can intensify separation anxiety. While distraction is a key component of anxiety-reduction models, it should be used in conjunction with emotional validation, not as a replacement for addressing a direct fear . The goal is to help the child cope, not to avoid the topic.

- Option 4 is correct. This approach directly applies principles of therapeutic communication for the preschool age group. Using simple, concrete language aligns with their cognitive level. Acknowledging feelings ("I see you are worried about where your mommy is") validates their emotional state and builds trust. Providing concrete reassurance about the mother's return ("Your mommy will be right here in this chair when you wake up") addresses the core fear of separation. This strategy is supported by evidence showing that maintaining a connection with the family significantly reduces negative psychological outcomes. A randomized controlled trial demonstrated that family presence during the perioperative period is effective in reducing negative postoperative behavioral changes in preschool children, highlighting the critical importance of addressing the child's attachment needs directly .

## 임상 시나리오

Communicating with a Preschooler Before SurgeryAddressing Separation Anxiety with Concrete Reassurance
Acknowledge the child's feelings directly using simple, concrete language. For a question like "When is mommy coming back?", validate the fear of abandonment by saying, "I see you miss your mommy. She will be here when you wake up."

Avoid abstract time concepts. Instead of giving a clock time (2:00 PM), anchor the parent's return to a tangible event in the child's routine, such as after the procedure or when you wake up.

CautionNever use false reassurance like "everything will be fine" or detailed medical terminology. These approaches dismiss the child's valid emotional state or are cognitively incomprehensible, increasing perioperative anxiety.

## 핵심 개념

- **Preoperational Stage** — Piaget's stage (ages 2-7) where children think literally and symbolically, characterized by egocentrism and magical thinking, making abstract medical explanations ineffective.
- **Separation Anxiety** — A primary stressor for hospitalized preschoolers, manifesting as an intense fear of abandonment when separated from primary caregivers.
- **Magical Thinking** — A preschooler's belief that their thoughts, wishes, or unrelated actions can cause external events, often leading to irrational fears about illness or procedures.

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