Congenital heart disease (congenital heart disease) is the most common heart disease in childhood, with 8-10 out of every 1000 live births suffering from congenital heart disease. It not only affects the physical health of children, but also has a significant impact on the psychological behavior of children. In the past 20 years, with the advancement of diagnostic techniques and surgical treatment, the death rate of precocious heart disease has been greatly reduced, and most children can survive for a long time through treatment. Therefore, it is more important to explore and study the psychological behavior of children with precocious heart disease. Zheng Xiaozhou, Department of Cardiovascular Surgery, Jinan General Hospital, Jinan Military District, China 1 Intelligent development of children with precocious heart disease The intelligent development of children is determined by many factors such as genetic, environmental, nutritional and physical disease conditions, etc. Previous studies have shown that children with precocious heart disease can be developmentally delayed as early as 2 months of age, especially those with cyanosis, and their intelligent development often lags behind that of healthy children of the same age, mainly in gross motor skills, perceptual motor skills, visual reaction time and total IQ. The main features are low gross motor skills, perceptual-motor skills, visual reaction time, and total intelligence quotient (0Q). The majority of children have an IQ at the low end of normal, with no significant correlation between the IQ and the specific disease diagnosis. Children with preoperative predilection have a significant reduction in motor, personal/social functioning, listening/speaking scale scores and total IQ compared to normal children, although the mean values of all factors are within the normative range. However, the 1-year postoperative follow-up showed no significant difference between non-cyanotic heart disease and normal controls. However, cyanotic preconditioning still had impairment in intellectual development, except for an increase in the listening/speaking scale score, and no significant change in other scale scores compared with preoperative scores, suggesting that surgical treatment can eliminate and improve the impairment of intellectual development. Therefore, early surgical treatment is generally considered appropriate. However, some studies have shown that short-term delays in surgery due to economic reasons do not exacerbate the intellectual impairment. It is controversial whether the persistent intellectual impairment in cyanotic children is due solely to the effects of hypoxemia on the brain. Because hypoxemia is often accompanied by restriction of normal activities, children with severe clinical disease also have more impaired intelligence and more pronounced hypoxemia and activity restriction, so that the degree of impaired intelligence in children with precocious disease is positively correlated with the severity of clinical disease. There are two contrasting views on the effect of the surgical approach on the intelligence of the child. Some studies have reported that the use of hypothermic circulatory block during cardiac surgery is associated with poorer motor and language function compared with extracorporeal circulation, neither of which is significantly associated with lower total IQ. However, a recent study asked reported that extracorporeal circulation can lead to delayed intellectual development, while deep hypothermic circulatory block and duration of block were not associated with clinical outcomes. Therefore, the effect of both procedures on intelligence remains to be studied in more depth. Bloom et al. controlled a study of the functional status of children with precordial disease who had cardiac arrest versus those who did not and found significant impairment in general cognitive function, motor and adaptive behavior in those who had cardiac arrest. Seizures and EEG abnormalities in the early postoperative period also suggested the onset of later intellectual impairment. Thus, factors contributing to intellectual impairment in children with precardiac disease should include the type, severity, complications, and surgical approach of the disease, but more importantly, the impact of precardiac disease on the child’s daily life as an early diagnosable, chronic, life-threatening disease that limits the child’s intellectual development, and these limitations include mobility restrictions, parental overprotection, prolonged illness and hospitalization, and early feeding difficulties on the child’s nutritional intake and parent-child relationship. Children with CHD have more hospitalizations and specific disease experiences than healthy children, and even when surgically corrected, they may have more emotional and behavioral problems than normal children. These emotional and behavioral problems often manifest themselves in the preschool years, and internalized behavioral problems are more common. Gasey reported that children with surgically treated complex precardiac disease in school-aged children were more withdrawn, had more social problems, and participated in fewer group activities than normal children. Sometimes “hidden” emotional and behavioral problems can be found in children who do not appear to have obvious psychosocial problems when assessed. In Canada, Gupta et al. used the Children’s Fear Inventory, the Children’s Anxiety Inventory, the Children’s Depression Questionnaire, and the Children’s Behavioral Screening Inventory to assess the psychological behavior of 39 seemingly normal children with predilection for medical fears and physical anxiety, including inexplicable fears, anxiety, depression, and disciplinary behavior, more often than in normal children with predilection. Other studies have similarly found that children with precocious disease can have both internalized behavioral problems, such as depressive fears, and externalized behavioral problems, such as aggression and disciplinary infractions. To investigate the risk factors for the development of behavioral problems in children with prediabetes, Goldberg et al. followed up the relationship between child health status, child temperament, parent-child relationship and family environment and the development of behavioral problems in children with prediabetes and found that parental stress index reflecting the family environment was positively associated with the subsequent development of behavioral problems in children. Other studies have also confirmed that maternal anxiety status exacerbates children’s emotional and behavioral problems. utens et al. studied biological factors in the development of behavioral problems in children with precordial disease and found that internalized behavioral problems were associated with multiple cardiac surgeries, deep hypothermic circulatory blockade, prematurity, hypoxic state, and older age at the time of surgery. Externalized behaviors were only associated with multiple cardiac surgeries. Thus, the risk factors for the development of behavioral problems in children with precardiac disease include both biological and psychosocial aspects. Since the severity of the disease is often accompanied by increased parental anxiety, the impact of excessive parental anxiety, especially in mothers, on children with precordial disease should be taken more seriously. 3 Self-awareness and social adjustment About 1/3 of children with prediabetes are unable to attend classes normally during their school years because of health problems. Frequent absences from school or suspensions from school make the affected children usually have to have individual tutors at home, which makes the affected children feel isolated. In addition, short stature, surgical scars, cyanosis, and low energy levels make children feel different and abnormal from other children, making it difficult for them to interact with peers. Boys have difficulty joining peer activities because they are often teased by their peers and feel low self-esteem. Girls have the same problem but interact well with their peers. As they enter adolescence, girls become more concerned about their bodies and scars, trying to hide them and cyanosis through makeup and fashion; boys vary, with some not caring about scars, some trying to hide them, and some showing them off as scars from fights. Although surgical scars have a significant impact on the child’s sense of self, there is a significant improvement in the child’s sense of self and psychological development after surgery. Early surgery will benefit the child’s psychological well-being and quality of life. In the face of isolation and rejection during the school years, children with predilection often bury their feelings and act as if nothing is wrong. Thus, although the study concluded that children with cyanotic precocious heart disease had significantly lower academic skills, including reading, spelling and arithmetic, than controls, 27 of the 29 adults with precocious heart disease reported by Horner completed high school and 18 reached college graduation. This suggests that the “denial mechanism” helps children with prediabetes maintain normal social functioning. However, denial also hides emotional and psychiatric disorders in children and affects the veracity of the self-rating scale, making it difficult to identify emotional and psychiatric disorders. Therefore, the use of self-assessment scales should be avoided as much as possible in the study of the psychological behavior of children with prediabetes, and objective assessment by other means is appropriate. 4 Parent-child relationship and impact on the family Children with prediabetes have a great impact on the parent-child relationship since birth. Due to the disease, the child is usually isolated from the mother in early life and it is difficult to breastfeed, which affects the normal establishment of the parent-child relationship.Gardner et al. conducted a controlled study of the differences in parent-child relationships between children with prediabetes and normal children of the same age at around 6 months of age and found that in parent-child interactions. The children had lower levels of affinity and positive emotions, and their mothers had lower levels of affinity and positive emotions than normal controls, both of which were not related to the severity of the disease, and there was no significant correlation between the children and their mothers. Most mothers tried their best to adapt to the child’s behavior, but often had difficulties in parent-child interactions. Approximately 3/4 of the mothers were psychologically disturbed and had more anxiety, depression, frustration and frustration than the control group. Although the children’s affinity and the mothers’ moods improved after surgery, they were still lower than normal children. This was related to factors such as the child’s condition and the mother’s lack of skills to interact with the affected child. Factors that predispose children to parent-child interaction difficulties include low birth weight, slow growth due to precocious heart disease, breathing and feeding difficulties especially in children with cyanosis, and lack of physical strength, all of which can contribute to low levels of affection in infancy. If the mother lacks adequate interaction skills and knowledge, this situation will persist in early childhood, severely affecting the child’s emotional development and leading to the development of emotional and behavioral problems. In the family, the father of the child also suffers from the loss and frustration associated with the precocious disease, but he usually tries to control his emotions in order to maintain his image as the breadwinner of the family. The results of a questionnaire survey on the psychological status of parents of children with precordial disease before surgery showed that parents of children with precordial disease had more psychological distress in the form of anxiety, insomnia and social dysfunction than the control group. And the problems of mothers were especially obvious. Therefore, interventions for families of children with precocious heart disease are necessary for the development of psychological health and the maintenance of normal family functions of the children. 5. Current status and outlook of prevention interventions Psycho-behavioral interventions for children with precocious heart disease should be guided by the bio-psycho-social medicine model. Interventions can be directed to the medical treatment, the child and the family. Medical interventions should include early diagnosis, early surgery, selection of appropriate surgical procedures, prevention of complications, and surgical rehabilitation training. Interventions for children and families should include understanding the emotional reactions of children and parents, educating parents and children on how to cope with the difficulties caused by the disease, identifying psychological and behavioral problems of parents and children, and strengthening various support systems. At present, few studies have been reported on interventions for psychological-behavioral problems in children with precocious heart disease. The literature reports that guided systematic physical training for children and adolescents with preexisting heart disease reduces withdrawal and somatization complaints. It is suggested that guided systematic physical training can promote normal physical and psychological development in children with predilection. The remaining interventions were mainly directed at parents of children with newly diagnosed precardiac disease and pre- and postoperative coping guidance, but there is a lack of in-depth systematic studies, so there is extensive scope for future research on the psychological behavior of children with precardiac disease, including the normal establishment of parent-child relationships early in life, the adequate application of various support system resources for the child and family, the effective control and integrated intervention of early factors that impair intelligence, and the influence of family and The long-term impact of disease factors on the personality formation and psychological and behavioral problems of the child, as well as cross-cultural studies between different regions and countries. Comprehensive interventions will certainly contribute to the overall recovery and quality of life of children with prediabetes and improve their family and social functioning.