The effects of three different distraction methods on pain and anxiety in children

This study aims to investigate of three different distraction methods (distraction cards, listening to the music of cartoon and balloon inflation) on pain and anxiety relief of children during phlebotomy. This study is a prospective, randomized, and controlled trial. The sample consisted of 6 to 12 years old children who require blood tests. Children were randomized into four groups as the distraction cards, the music, the balloon inflation, and the control. Data were obtained by conducting interviews with the children, their parents, and the observer before and after the procedure. The pain levels of the children were assessed by the parent and observer reports as well as self-report using the Wong-Baker FACES. The anxiety levels of children were assessed by parent and observer reports using Children Fear Scale. One hundred and twenty children (mean age: 9.1 ± 1.6 years) were included. The self-reported procedural pain levels showed significant differences among the study groups (p = .040). The distraction card group (2.33 ± 3.24) had significantly lower pain levels (p = .057) than the control group (4.53 ± 3.23). The procedural child anxiety levels reported by the observer showed a significant difference among the study groups (p = .032). All the forms of distraction significantly reduced pain and anxiety perception.

[1]  S. Wente Nonpharmacologic pediatric pain management in emergency departments: a systematic review of the literature. , 2013, Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association.

[2]  A. Çelebioğlu,et al.  Turkish children loved distraction: using kaleidoscope to reduce perceived pain during venipuncture. , 2009, Journal of clinical nursing.

[3]  B. Rapkin,et al.  Behavioral intervention to reduce child and parent distress during venipuncture. , 1990, Journal of consulting and clinical psychology.

[4]  A. Taddio,et al.  Psychological interventions for needle-related procedural pain and distress in children and adolescents. , 2015, Paediatrics & child health.

[5]  O. Kristjansdottir,et al.  Randomized clinical trial of musical distraction with and without headphones for adolescents' immunization pain. , 2011, Scandinavian journal of caring sciences.

[6]  P. McGrath,et al.  Cochrane review: Psychological interventions for needle‐related procedural pain and distress in children and adolescents , 2008 .

[7]  P. McGrath,et al.  Pain Reduction During Pediatric Immunizations: Evidence-Based Review and Recommendations , 2007, Pediatrics.

[8]  Y. Gidron,et al.  Effects of active distraction on pain of children undergoing venipuncture: Who benefits from it? , 2003 .

[9]  G. Champion,et al.  Age-related response to lidocaine-prilocaine (EMLA) emulsion and effect of music distraction on the pain of intravenous cannulation. , 1994, Pediatrics.

[10]  G. Kostopanagiotou,et al.  Music's use for anesthesia and analgesia. , 2013, Journal of alternative and complementary medicine.

[11]  R. Goldman,et al.  Distraction techniques for children undergoing procedures: a critical review of pediatric research. , 2012, Journal of pediatric nursing.

[12]  A. Roth-Isigkeit,et al.  Pain Among Children and Adolescents: Restrictions in Daily Living and Triggering Factors , 2005, Pediatrics.

[13]  C. Chambers,et al.  Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline , 2010, Canadian Medical Association Journal.

[14]  Q. Razzaq The underuse of analgesia and sedation in pediatric emergency medicine , 2006, Annals of Saudi medicine.

[15]  Devendra Gupta,et al.  An Evaluation of Efficacy of Balloon Inflation on Venous Cannulation Pain in Children: A Prospective, Randomized, Controlled Study , 2006, Anesthesia and analgesia.

[16]  W. Chaplin,et al.  Training children to cope and parents to coach themduring routine immunizations: Effects on child, parent, and staff behaviors , 1992 .

[17]  Lisa Hartling,et al.  Music for pain and anxiety in children undergoing medical procedures: a systematic review of randomized controlled trials. , 2008, Ambulatory pediatrics : the official journal of the Ambulatory Pediatric Association.

[18]  C. McClellan,et al.  Topical Anesthesia Versus Distraction for Infants' Immunization Distress: Evaluation With 6-Month Follow-Up , 2006 .

[19]  R. Kennedy,et al.  On the Front Lines: Lessons Learned in Implementing Multidisciplinary Peripheral Venous Access Pain-Management Programs in Pediatric Hospitals , 2008 .

[20]  C. Chambers,et al.  Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline (summary) , 2010, Canadian Medical Association Journal.

[21]  Hong-gu He,et al.  Chinese nurses' use of non-pharmacological methods in children's postoperative pain relief. , 2005, Journal of Advanced Nursing.

[22]  S. Bavdekar,et al.  Can Indian classical instrumental music reduce pain felt during venepuncture? , 2010, Indian journal of pediatrics.

[23]  D. Coury,et al.  Blowing away shot pain: a technique for pain management during immunization. , 1994, Pediatrics.

[24]  Natalie K. Bradford,et al.  Psychological interventions for needle-related procedural pain and distress in children and adolescents , 2018 .

[25]  G. Finley,et al.  A randomized double‐blind, placebo‐controlled trial of the EMLA® patch for the reduction of pain associated with intramuscular injection in four to six‐year‐old children , 2001, Acta paediatrica.

[26]  Elaine Lau,et al.  Pain Management in Children: Part 1 — Pain Assessment Tools and a Brief Review of Nonpharmacological and Pharmacological Treatment Options , 2012, Canadian pharmacists journal : CPJ = Revue des pharmaciens du Canada : RPC.

[27]  Sevil Inal,et al.  Efficacy of distraction methods on procedural pain and anxiety by applying distraction cards and kaleidoscope in children. , 2014, Asian nursing research.

[28]  Lisa Hartling,et al.  Music to reduce pain and distress in the pediatric emergency department: a randomized clinical trial. , 2013, JAMA pediatrics.

[29]  S. Caprilli,et al.  Interactive Music as a Treatment for Pain and Stress in Children During Venipuncture: A Randomized Prospective Study , 2007, Journal of developmental and behavioral pediatrics : JDBP.

[30]  M. Kelleci,et al.  Distracting children during blood draw: looking through distraction cards is effective in pain relief of children during blood draw. , 2012, International journal of nursing practice.

[31]  Malcolm H. Johnson,et al.  A Comparison of Distractors for Controlling Distress in Young Children During Medical Procedures , 1999, Journal of Clinical Psychology in Medical Settings.

[32]  P. McGrath,et al.  Watch needle, watch TV: Audiovisual distraction in preschool immunization. , 2002, Pain medicine.