Preparing children for doctors, dentists and hospital: what video and stories can do

Background: why preparation matters

Injections, blood tests, operations, scans and dental check-ups are some of the hardest moments in childhood, for children, parents and staff. Fear has knock-on costs: many autistic children miss dental care because of fear and often need a general anaesthetic for routine procedures (Isong et al., 2014), and non-drug ways of easing anaesthesia are valued partly because they avoid the side effects of sedation (Manyande et al., 2015).

Research here began with modelling: showing a child someone like them going through the same experience and coping. In the 1970s, Melamed and colleagues tested short films of a child in hospital or at the dentist. The idea runs through today's preparation videos, hospital tours, mock scanners and, for autistic children, picture sequences, social stories and video modelling (see our reviews of video modelling and social stories).

Other approaches work differently. Distraction (cartoons, tablets, games, virtual reality (VR), clowns) acts during the procedure. Environmental changes alter the setting, for example lighting and sound at the dentist. Behavioural desensitisation breaks a procedure into small steps practised with rewards. The evidence for each is different.

How the research has been done

Surgical studies are mostly randomised controlled trials (RCTs) run by anaesthesia teams. Anxiety is usually rated by an observer with the modified Yale Preoperative Anxiety Scale (mYPAS), a behaviour checklist used in the waiting area, at separation from parents and at mask introduction; some trials add pain-relief use, emergence delirium (agitation on waking) and behaviour at home. Needle studies measure pain and distress by self-report, observers and behaviour coding. Dental studies rate cooperation (for example the Frankl scale) and sometimes skin conductance, a physiological stress signal. MRI studies count completed awake scans with usable images.

Research with autistic children relies more on single-case designs, in which a few children are measured repeatedly as an intervention starts, and on small pilot trials (see our glossary of research terms). Observers often know which group a child is in, "usual care" varies, and follow-up is short.

What the reviews and trials found

Filmed modelling: the classic studies

In the best-known study, 60 children admitted for elective surgery saw either a film of a peer being hospitalised and operated on or an unrelated film, alongside usual preparation. The modelling group had lower anxiety on self-report, observation and a palmar sweat measure the night before surgery and 3 to 4 weeks later, and parents reported fewer new behaviour problems (Melamed & Siegel, 1975). In dental studies, children who watched a child model cooperate with treatment were less disruptive and rated less fearful (Melamed, Hawes, et al., 1975); in one, children's own anxiety reports did not match their behaviour in the chair (Melamed, Weinstein, et al., 1975). Later, a modelling slide-tape before day surgery reduced distress in recovery in 26 children with a mean age of 5.5 (Faust et al., 1991).

Surgery: reviews and key trials

A systematic review of 18 studies concluded that audiovisual interventions can reduce preoperative anxiety, with videos, multi-part programmes and interactive games looking most effective; the authors called for adequately powered trials (Chow et al., 2016). The Cochrane review of non-drug help at anaesthetic induction (28 trials, 2,681 children) graded almost all evidence very low certainty. Parental presence did not reduce child anxiety (standardised mean difference 0.03, 95% CI −0.14 to 0.20). Small trials favoured a video of the child's choice during induction, video games and clowns, while cartoon preparation did not differ significantly from verbal preparation (Manyande et al., 2015).

Family-centred preparation has the strongest single trial. In ADVANCE, 408 families were randomised to usual care, parental presence, a family-centred behavioural programme or oral midazolam (a sedative). ADVANCE families were least anxious in the holding area; at induction, children were less anxious than with usual care or parental presence and similar to midazolam, and they had less emergence delirium, needed less pain relief and left recovery sooner (Kain et al., 2007). A web-based tailored preparation programme for children aged 2 to 7 reduced anxiety on entering the operating room (Cohen's d 0.59, a medium effect) (Fortier et al., 2015). Digital does not automatically mean effective: in a Finnish RCT with 70 children aged 2 to 6, a preparation app for day surgery did not reduce children's pain or parents' anxiety, and children's fear did not differ between groups at any time point (Kerimaa et al., 2023). More is not always better: an extensive programme reduced anxiety only in the holding area, not at induction or in recovery (Kain et al., 1998).

Distraction works at a different moment. A meta-analysis of 19 RCTs (1,341 children) found mYPAS scores about 5 points lower in the holding area and 15 points lower in the induction room, with high heterogeneity (Wu et al., 2022). In a trial of 130 children aged 3 to 7, a favourite toy helped most in the holding room but a chosen cartoon helped most in the operating room, where 43% of the cartoon group showed no anxiety against 7% of controls (Lee et al., 2012).

Needles

The Cochrane review of 59 trials (5,550 participants) found that distraction reduced self-reported pain (standardised mean difference −0.56) and distress, and supported hypnosis, combined cognitive behavioural therapy and breathing. Preparation or information alone, tested in four trials, showed no effect on any outcome. Evidence quality was low to very low (Birnie et al., 2018). Of 82 free online social stories about needles, most showed distraction and the needle step accurately, but their effects have not been studied (Dobson et al., 2025).

The dentist

A meta-analysis of randomised trials in children under 12 (66 articles) found that distraction gave lower self-rated anxiety and better cooperation than "tell-show-do" (explain, demonstrate, then do), except during more invasive procedures; results for modelling, visual pedagogy and VR were inconsistent (Almarzouq et al., 2024).

MRI without sedation

Across 23 studies, 40% to 100% of children completed scans after preparation, and prepared children were more likely to succeed than unprepared ones (odds ratio 1.98) (Suzuki et al., 2023). In an RCT of 122 children aged 3 to 7, 91% completed an awake scan, with no significant difference between mock-scanner training (89%), play-based child-life training (88%) and home book and video (96%); children who failed were younger (Fletcher et al., 2023). For autistic children going to imaging, a small randomised feasibility study of an iPad social-script app (32 parent–child pairs) reported fewer challenging behaviours in children and lower parent anxiety than controls (Johnson et al., 2014). Play with a model scanner and a doll halved sedation use (41% versus 20%) (Bharti et al., 2016), and a VR app matched a manual and in-person preparation in a simulated scan (Stunden et al., 2021). A 174-second animation improved 5- to 11-year-olds' knowledge and worry ratings, though without a control group (Szeszak et al., 2016).

Autistic children at the dentist and in hospital

Single-case studies show steps can be practised gradually: three autistic boys desensitised in a practice setting completed more exam steps in the real clinic (Luscre & Center, 1996), and for participants with severe intellectual disabilities, in vivo desensitisation increased compliance in all five, video modelling in one of three (Conyers et al., 2004).

Screen-media trials are mixed. In an RCT of 80 autistic children aged 7 to 17, scores improved within groups watching a favourite film through video goggles during the visit, but not with a peer-modelling DVD, and no group differed significantly from usual care (Isong et al., 2014). In a 40-child RCT, a modelling video before the visit reduced the appointments needed (da Silva Moro et al., 2024). Emailed toothbrushing videos improved plaque scores in an 18-child pilot, though both groups improved (Popple et al., 2016).

The strongest trial concerns the environment. In a randomised crossover trial, 162 autistic children aged 6 to 12 each had one cleaning in a regular room and one in a room with modified lighting, sounds and touch. Physiological stress and video-coded distress were lower in the adapted room, though questionnaire measures did not differ, and age, IQ and expressive language moderated the effect (Stein Duker et al., 2023), building on an earlier pilot (Cermak et al., 2015) (see sensory sensitivities).

Reviews are cautious. Visual pedagogy results pointed the same way but were too varied for a verdict (Balian et al., 2021). Across 18 studies, about 56% of autistic children cooperated with a mirror examination at a first visit and 64% at a second; visual pedagogy did not raise acceptance, other techniques were inconsistent, and certainty was very low (Lam et al., 2024). A companion review of oral-hygiene outcomes reported improvements but also rated the evidence very low certainty (Lam et al., 2025), video toothbrushing training was no better than social stories or pictures (Tirupathi & Afnan, 2025), and a 2026 review could pool only two VR trials, which suggested better cooperation (Liu et al., 2026). Storytelling in oral-health education, including social stories and video modelling, consistently improved knowledge and habits in the short term (Alwadi et al., 2026). Across 144 studies of neurodivergent children in medical procedures, only 4.2% measured the child's own pain report (Takashima et al., 2026). For scans, gradual exposure to scanner noise, a social stories booklet, rewards and play therapy gave first-attempt success rates of 67% to 87%, depending on the scan type, in 31 children aged 4 to 10 with neurofibromatosis type 1 and autism (Tziraki et al., 2021).

For whom and under what conditions

Before versus during. Preparation seems to act mainly in the waiting period and distraction in the moment, as the holding-area findings above suggest. For needles, information alone did nothing while distraction helped (Birnie et al., 2018).

Timing. In a cross-sectional study of 143 children, those over 6 were least anxious at separation if prepared more than 5 to 7 days before surgery and most anxious if prepared the day before; age, timing, previous hospitalisation and temperament predicted anxiety (Kain et al., 1996). Timing was not randomised, so this suggests rather than shows that older children need time to absorb information.

Age and past experience. Hospital information helped children aged 4 to 17 overall, but children under 8 who had had surgery before reported more medical worries after it (Melamed et al., 1983). Younger children were also more likely to fail an awake MRI (Fletcher et al., 2023).

Coping style. Some children cope by seeking information and others by limiting it. Information-seeking children watched procedures, asked questions and protested more, yet needed fewer hours of intensive care after minor surgery (Field et al., 1988). Before tonsil surgery, consistent seekers and consistent limiters both had low anxiety, while children who sought information about only some aspects were most anxious (Thompson, 1994). Most children aged 7 to 17 want comprehensive information, especially about pain, and more anxious children want more pain information (Fortier et al., 2009).

Who is involved. Preparing the whole family can work well (Kain et al., 2007), whereas a parent simply being present at induction does not reduce anxiety (Manyande et al., 2015). In one small study, physiological arousal fell only in children who watched a modelling slide-tape without their mother (Faust et al., 1991).

Autistic children. Adapting the environment and practising steps gradually have more consistent support than video alone, and benefit varied with age, IQ and expressive language (Stein Duker et al., 2023).

What this means in practice

• Make two plans. A "before" plan (what will happen, a model who copes, a little practice) and a "during" plan (a favourite cartoon, game or toy, slow breathing).
• Ask how much your child wants to know. Some children want every step; others cope by not knowing. Follow their lead, and answer pain questions honestly.
• Start early for school-age children. Prepare several days ahead, with a short reminder on the day.
• Be gentle with young children who had a hard time before. Emphasise comfort, coping and who will be there rather than technical detail.
• Show what is true. Include the real steps, even the needle, alongside what helps.
• For scans, ask about awake-scan preparation. For many young children, home materials work as well as hospital training.
• For autistic children, ask the dental team about adjustments (lighting, sounds, order of steps) and practise steps in short visits or at home, with rewards.
• Seek specialist help (a child-life specialist, psychologist or special-care dentist) if fear repeatedly prevents necessary care or leads to restraint or sedation.

What this means for short personalised cartoons

A short cartoon in which a child-like character goes through a procedure is a preparation tool, closer to the modelling films and home videos above than to in-the-moment distraction. Peer-modelling films reduced fear (Melamed & Siegel, 1975), home video supported awake scans (Fletcher et al., 2023) and a modelling video reduced dental appointments for autistic children (da Silva Moro et al., 2024), so some benefit plausibly transfers.

The cautions matter as much. A peer-modelling video did not beat usual care in one autistic dental trial (Isong et al., 2014), information alone did not help with needles (Birnie et al., 2018), and detail can worry some young children (Melamed et al., 1983). A cartoon should show a character who feels worried and uses coping strategies, show accurate steps, let parents choose how much detail to share, and be paired with real practice and an in-the-moment plan. No study has tested personalised animated preparation, including the personalised cartoons we make; their effects are unknown.

Limits of the evidence

• Cochrane reviews grade most findings low or very low certainty, mainly because of high risk of bias and small trials.
• The classic filmed-modelling studies are 50 years old and small, and many modern trials test packages, so the video's own contribution is unclear.
• Outcomes are mostly observer ratings by staff who know the allocation; children's own reports are rare.
• Studies of autistic children are small, often uncontrolled, and many measure toothbrushing rather than fear or cooperation.
• Follow-up is short, and gains in a practice setting do not always carry over to the real clinic.
• Most trials come from high-income settings; in the Cochrane review of anaesthetic induction, all of them did.

Open questions for research

1. Does a personalised preparation video, with the child as the model, reduce anxiety more than a generic peer video for the same procedure? A three-arm RCT with mYPAS or needle-distress outcomes could answer this.
2. What are the best timing and dose: how many viewings, how many days before, and does this differ for children under and over 6?
3. Can a brief measure of coping style (seeking or avoiding information) be used to tailor how much detail preparation gives, and does tailoring help?
4. Do preparation and distraction add together? Factorial trials could test each alone and combined.
5. For autistic children, does video modelling add benefit on top of a sensory-adapted environment, measured with the child's own report?
6. Are animated models as effective as filmed ones for medical and dental preparation?
7. Does a better first experience reduce later dental or medical avoidance over years?

Frequently asked questions

References

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Spotted an error, or know a study we should add? Email hello@calalunakids.com. Every study we draw on is in the research library; research terms are explained in our methods glossary.