Objective To design a role-playing card game program and explore its application effect in the perioperative period of pediatric tonsillectomy patients. Methods Based on the tabletop card game of “Medical Little Team” developed by our hospital，a role-playing card game program was formulated through literature review. A convenience sampling method was used to recruit 126 pediatric patients undergoing tonsillectomy in a tertiary pediatric hospital in Zhejiang Province as study participates. The patients were divided into a control group （admitted from March to June 2023，n=60） or an intervention group（admitted from July to October 2023，n=66） depending on the order of admission. The control group received routine perioperative nursing，while the intervention group received role-playing card game intervention in addition to routine perioperative nursing. Medical fear，postoperative delirium occurrence，postoperative medication adherence，and parental readiness for discharge were assessed and compared between the two groups. Results Finally, 63 cases in the experimental group completed the study, and all the cases in the control group completed the study. On the first postoperative day，the medical fear score in the intervention group was（21.02±1.90），lower than that in the control group of （22.30±3.34）（P=0.011）. The incidence of delirium within 2 hours from entering the recovery room to returning to the ward after surgery was lower in the intervention group[5%（3/63） vs. 17%（10/60），P=0.032]. The medication adherence score on the first postoperative day was （3.11±0.70） in the intervention group，higher than that in the control group of （2.53±0.60）（P<0.001）. The parental readiness for discharge score was （239.21±28.15） in the intervention group，higher than that in the control group of （211.55±29.38）（P<0.001）. Conclusion The application of role-playing card game can alleviate perioperative medical fear in pediatric tonsillectomy patients，reduce postoperative delirium，improve medication adherence，and enhance parental readiness for discharge.