Effects of Perioperative Music Interventions on Emotional Outcomes in Children and Adolescents: A Systematic Review and Meta‐Analysis Integrating Developmental Psychology and Music Education Perspectives

ABSTRACT Objective To evaluate the effects of perioperative music interventions on emotional outcomes (preoperative anxiety, postoperative fear, emergence delirium) and related physiological parameters in children and adolescents undergoing surgery, and to examine potential effect modifiers. Methods Nine databases were searched from inception to February 2026. Randomized controlled trials comparing music versus no‐music control in pediatric surgical patients (≤ 18 years) were included. Risk of bias was assessed with RoB 2.0. Random‐effects meta‐analyzes were performed for preoperative anxiety, postoperative pain, heart rate, and blood pressure. Subgroup analyzes were conducted for age, music selection method, intervention timing, and surgery type. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Results Seventeen RCTs (1871 children) were included. Music significantly reduced preoperative anxiety (SMD = −2.03; 95% CI −3.19 to −0.86; I 2 = 97%), postoperative pain (SMD = −0.64; 95% CI −1.01 to −0.27; I 2 = 62%), heart rate (MD = −12.92 bpm; 95% CI −19.07 to −6.77; I 2 = 88%), and mean arterial pressure (MD = −8.41 mmHg; 95% CI −10.07 to −6.76; I 2 = 66%). Effects on systolic blood pressure were not significant. Anxiolytic effects were significant in both children (≤ 12 years) and adolescents (≥ 13 years) with no subgroup difference. Self‐selected and pre‐selected music were both effective. Sensitivity analyzes confirmed robustness. GRADE assessment indicated very low to low certainty of evidence for all outcomes, primarily due to high heterogeneity, risk of bias, and imprecision. Conclusions Perioperative music was associated with reduced anxiety and pain, but evidence certainty was very low to low. Pending stronger evidence, music may be considered a low‐risk adjunct to standard care.