Background: Anxiety disorders are common in children and among the most prevalent psychiatric issues. Untreated preoperative anxiety can lead to increased complications and a higher risk for future anxiety disorders and major depression. Therefore, addressing preoperative anxiety in children is crucial to prevent perioperative and long-term adverse effects.

Objective: This review aimed to evaluate various articles and develop a management plan based on evidence for the prevention of preoperative anxiety in children using non-pharmacological approaches in areas with limited resources.

Methods: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Databases, such as PubMed, Cochrane Library, and Google Scholar, were searched for high-quality evidence to draw appropriate conclusions.

Result: A total of 7669 articles were retrieved from the search engines. These articles were then filtered based on intervention, outcome, population data, inclusion and exclusion criteria, and methodological quality. After the filtration process, only 35 studies met the inclusion criteria for comprehensive review.

Conclusion: The Children's Emotional Manifestation Scale (CEMS) effectively assesses preoperative anxiety in children. Evidence suggests that non-pharmacological interventions such as clowning, music therapy, audiovisuals, virtual reality, and cognitive-behavioral therapy are effective in preventing preoperative anxiety. Practitioners can choose a suitable non-pharmacological approach based on availability and cost.

Keywords: audiovisual; clowning; music therapy; pediatric surgery; preoperative anxiety; virtual reality.

Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc.