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More than 5 million children in the United States undergo surgery annually. Of those 5 million children, 50% to 75% experience considerable fear and anxiety preoperatively. Preoperative anxiety in children is associated with a number of adverse postoperative outcomes, such as increased distress in the recovery phase, and postoperative regressive behavioral disturbances, such as nightmares, separation anxiety, eating disorders, and bedwetting. Preparing the pediatric patient adequately for surgery can prevent many behavioral and physiological manifestations of anxiety. Children are most susceptible to the stress of surgery owing to their limited cognitive capabilities, greater dependence on others, lack of self-control, limited life experience, and poor understanding of the health care system. This article will review the literature on preoperative interventional teaching strategies to reduce preoperative anxiety in children and discuss the methods available for evidence-based preparation of children undergoing surgery.