Pre-operative anxiety and the effect of soft toys in children at an academic hospital in Johannesburg, South Africa

Background: Paediatric pre-operative anxiety is common. Pharmacological and non-pharmacological methods can reduce pre-operative anxiety. Low- and middle-income countries require safe, affordable, accessible methods such as soft toys to minimise anxiety. Aim: This study aimed to describe pre-operative anxiety in children and the effect of soft toys in managing anxiety. Setting: The study involved children ages 2–17 years receiving general anaesthesia for elective surgery at a South African academic hospital. Methods: This prospective, cross-sectional observational study assessed 114 children using the modified Yale Pre-operative Anxiety Scale (mYPAS) at three points: Waiting area (T1); after being offered a soft toy (T2); and at mask introduction (T3). Scores of 30 or greater indicated high anxiety. Results: At baseline, 54% of children displayed high anxiety (T1 median mYPAS = 30). Those who refused a toy were more anxious than those who accepted a toy (median mYPAS = 37 vs 30; p = 0.10). Anxiety decreased after toy introduction (T2 median mYPAS = 28) with significantly lower scores in children who chose a toy (p = 0.006). Anxiety spiked at mask introduction (T3 median mYPAS = 41) with 93% showing high anxiety regardless of toy presence (p = 0.63). Toys were associated with lower anxiety at T2 (p = 0.039) but not at T3 (p = 0.61). Older age correlated with lower anxiety at T3 only (p < 0.001). Caregiver presence approached statistical significance at T3 (p = 0.054). Conclusion: Soft toys help reduce anxiety initially, but not during mask introduction. Combining low-cost, non-pharmacological strategies may improve outcomes in resource-limited settings. Contribution: Soft toys are safe, affordable, and accessible for peri-operative anxiolysis in low- and middle-income countries.