Effectiveness of Child Life Service in the Management of Pediatric Anxiety During the Perioperative Period: A Systematic Review and Meta-analysis.

PURPOSE: Pediatric patients are vulnerable to perioperative anxiety, while pharmacological and routine nursing approaches may be constrained by adverse effects and insufficient developmental support. Child Life Service (CLS) offers structured, developmentally appropriate psychosocial care, but its overall effectiveness and optimal application remain unclear. This systematic review and meta-analysis synthesized the effects of CLS compared with traditional nursing care and examined variations across study characteristics. DESIGN: Systematic review and meta-analysis. METHODS: This study was conducted in accordance with PRISMA guidelines. CNKI, Wanfang, PubMed, Embase, Scopus, and Web of Science were searched from inception to December 1, 2025, for Chinese- and English-language randomized or quasi--randomized controlled trials. Risk of bias was assessed using the Cochrane RoB Tool. Standardized mean differences with 95% confidence intervals were pooled using a random-effects model. FINDINGS: Eighteen studies involving 1863 pediatric patients were included. Across 25 post-intervention measurement time points, CLS was associated with significantly lower anxiety in the preoperative phase (SMD = -1.06, 95% CI [-1.53, -0.60]), during anesthesia induction (SMD = -1.87, 95% CI [-2.88, -0.86]), and in the postoperative phase (SMD = -1.38, 95% CI [-1.84, -0.92]). Substantial heterogeneity was observed across all phase-specific analyses. Subgroup analyses by types of surgery, anxiety assessment tools, and age groups supported a greater effect of CLS, but did not explain the heterogeneity. According to the GRADE framework, the certainty of evidence was low. CONCLUSIONS: This review suggests that CLS may reduce perioperative anxiety across different perioperative time points, surgical contexts, and age groups, supporting its integration into multidisciplinary perioperative care for pediatric patients and their caregivers.