Understanding of parent anxiety and its effect on infant postoperative pain is limited. We sought to identify psychological factors associated with preoperative anxiety for parents of infants and toddlers undergoing elective surgery and to determine whether parent anxiety is associated with child postoperative pain.


This was a prospective cohort study of consecutively eligible patients aged ≤18 months undergoing craniofacial surgery and their parents. Preoperative parent assessment included anxiety, coping, parent health locus of control, and self-efficacy. Postoperative inpatient child pain scores and medication use were collected. Analyses included hierarchical multivariable logistic and linear regression models.


Parents (n = 71, 90% female) of young children (mean age 6.6 months) undergoing cleft lip or palate (n = 59) or cranial vault repair (n = 13) were enrolled. Maladaptive coping (odds ratio 1.3; 95% confidence interval, 1.1–1.6), low parent self-efficacy (odds ratio 2.4; 95% confidence interval, 1.3–4.5), and external locus of control (odds ratio 1.74; 95% confidence interval, 1.1–2.9) were independently associated with high parental anxiety. The adjusted odds of moderate/severe parent anxiety was 3.6 (95% confidence interval, 1.5–9.1) higher with each SD increase in maladaptive coping. High parental anxiety was correlated with significantly higher hospital mean child pain scores (1.87 points on 0–10 scale; 95% confidence interval, 0.42–3.70; P = .045).


Coping and self-efficacy are modifiable factors that contribute to parent anxiety before and during hospitalization and may be targets for intervention. Infants and toddlers undergoing elective craniofacial surgery with highly anxious parents may be at greater risk for higher postoperative pain.

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