Calming Children When Drawing Blood Using Breath-based Biofeedback

Blood sampling is a common and necessary procedure in the treatment and diagnosis of a variety of diseases. However, it often results in painful and stressful experiences for children. Designed together with domain experts, ChillFish is a breath-controlled biofeedback game technology with bespoke airflow sensor that aims to calm children during blood sampling procedures. An experimental pilot study was conducted in which 20 children aged 6-11 were assigned to one of two conditions involving either passive distraction (watching a video) or active distraction using the ChillFish prototype. Medical staff rated ChillFish significantly more useful in facilitating the blood sampling procedure compared to passive distraction. Qualitative feedback from patients, parents, and medical staff identified aspects that impact the acceptance of breath-based active distraction. Our study highlights the potential of non-pharmacological assistive technology tools to reduce fear and pain for children undergoing painful or stressful medical treatment.

[1]  L. Ronfani,et al.  Videogame playing as distraction technique in course of venipuncture. , 2012, La Pediatria medica e chirurgica : Medical and surgical pediatrics.

[2]  Aldrik H. Velders,et al.  Simple 3D Printed Scaffold‐Removal Method for the Fabrication of Intricate Microfluidic Devices , 2015, Advanced science.

[3]  Rhonda Winskill,et al.  Minimising the 'Ouch' - A Strategy to Minimise Pain, Fear and Anxiety in Children Presenting to Rural Emergency Departments , 2008 .

[4]  Tanya N. Beran,et al.  Reducing children's pain and distress towards flu vaccinations: a novel and effective application of humanoid robotics. , 2013, Vaccine.

[5]  P. Lehrer,et al.  The Effects of Specific Respiratory Rates on Heart Rate and Heart Rate Variability , 2003, Applied psychophysiology and biofeedback.

[6]  Craig S. Wong,et al.  Needle Phobia and Stress-Reducing Medical Devices in Pediatric and Adult Chemotherapy Patients , 2007, Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses.

[7]  Nirupama Kannikeswaran,et al.  Procedural sedation and analgesia in children , 2008 .

[8]  A. Rizzo,et al.  Effectiveness of virtual reality for pediatric pain distraction during IV placement , 2005 .

[9]  Ellen C Hollon,et al.  Parents’ Positioning and Distracting Children During Venipuncture , 2004, Journal of holistic nursing : official journal of the American Holistic Nurses' Association.

[10]  Aldrik H. Velders,et al.  Microfluidic Devices: Simple 3D Printed Scaffold‐Removal Method for the Fabrication of Intricate Microfluidic Devices (Adv. Sci. 9/2015) , 2015, Advanced Science.

[11]  Ellen Yi-Luen Do,et al.  mediPuppet: an interactive comforting companion for children while visiting a doctor , 2011, C&C '11.

[12]  L Sparks,et al.  Taking the "ouch" out of injections for children. Using distraction to decrease pain. , 2001, MCN. The American journal of maternal child nursing.

[13]  A. Gift,et al.  Visual Analogue Scales: Measurement of Subjective Phenomena , 1989, Nursing research.

[14]  Mads Møller Jensen,et al.  ChillFish: A Respiration Game for Children with ADHD , 2016, TEI.

[15]  Tanya N. Beran,et al.  Humanoid robotics in health care: An exploration of children’s and parents’ emotional reactions , 2015, Journal of health psychology.

[16]  Lindsey L. Cohen,et al.  An Integration of Vibration and Cold Relieves Venipuncture Pain in a Pediatric Emergency Department , 2011, Pediatric emergency care.

[17]  Mikkel Baun Kjærgaard,et al.  Accounting for the Invisible Work of Hospital Orderlies: Designing for Local and Global Coordination , 2016, CSCW.

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

[19]  Jakob E. Bardram,et al.  Applications of context-aware computing in hospital work: examples and design principles , 2004, SAC '04.

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

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

[22]  Ehud Sharlin,et al.  Medi, human robot interaction in pediatric health , 2014, CHI Extended Abstracts.

[23]  Nejla Canbulat Sahiner,et al.  The effects of three different distraction methods on pain and anxiety in children , 2016, Journal of child health care : for professionals working with children in the hospital and community.

[24]  Karen Holtzblatt,et al.  Contextual Design: Evolved , 2014, Contextual Design: Evolved.

[25]  L. Cohen,et al.  Distraction for Pediatric Immunization Pain: A Critical Review , 2005, Journal of Clinical Psychology in Medical Settings.

[26]  L. Peterson,et al.  Coping by children undergoing stressful medical procedures: some conceptual, methodological, and therapeutic issues. , 1989, Journal of consulting and clinical psychology.

[27]  Sam Bucolo,et al.  The efficacy of an augmented virtual reality system to alleviate pain in children undergoing burns dressing changes: a randomised controlled trial. , 2008, Burns : journal of the International Society for Burn Injuries.

[28]  Hana Yoo,et al.  The effects of an animation distraction intervention on pain response of preschool children during venipuncture. , 2011, Applied nursing research : ANR.

[29]  D. Fanurik,et al.  Distraction Techniques Combined With EMLA: Effects on IV Insertion Pain and Distress in Children , 2000 .

[30]  Holger Schnädelbach,et al.  ExoPranayama: a biofeedback-driven actuated environment for supporting yoga breathing practices , 2016, Personal and Ubiquitous Computing.

[31]  K. Slifer,et al.  Distraction for Children of Different Ages Who Undergo Repeated Needle Sticks , 2002, Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses.

[32]  Robyn Fivush,et al.  Effectiveness of virtual reality distraction during a painful medical procedure in pediatric oncology patients , 2005 .

[33]  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.

[34]  Claire Thurgate,et al.  Needle phobia--changing venepuncture practice in ambulatory care. , 2005, Paediatric nursing.

[35]  Sam Bucolo,et al.  Multi-modal distraction: Using technology to combat pain in young children with burn injuries , 2010 .

[36]  Jenny Ziviani,et al.  A Prospective Randomized Controlled Trial of Nonpharmacological Pain Management During Intravenous Cannulation in a Pediatric Emergency Department , 2016, Pediatric emergency care.

[37]  Sam Bucolo,et al.  The design of a tangible interaction device to alleviate anxiety and pain in paediatric burns patients , 2006, CHI Extended Abstracts.

[38]  Andreas Butz,et al.  Murphy Miserable Robot: A Companion to Support Children's Well-being in Emotionally Difficult Situations , 2016, CHI Extended Abstracts.

[39]  Mads Møller Jensen,et al.  Evaluating the ChillFish Biofeedback Game with Children with ADHD , 2016, IDC.

[40]  Ricardo Gutierrez-Osuna,et al.  Chill-Out: Relaxation Training through Respiratory Biofeedback in a Mobile Casual Game , 2013, MobiCASE.

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

[42]  Ravinder Jerath,et al.  Physiology of long pranayamic breathing: neural respiratory elements may provide a mechanism that explains how slow deep breathing shifts the autonomic nervous system. , 2016, Medical hypotheses.

[43]  Gail M. Sullivan,et al.  Using Effect Size-or Why the P Value Is Not Enough. , 2012, Journal of graduate medical education.

[44]  Ricardo Gutierrez-Osuna,et al.  Sonic respiration: controlling respiration rate through auditory biofeedback , 2014, CHI Extended Abstracts.

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

[46]  Cynthia Breazeal,et al.  A Social Robot to Mitigate Stress, Anxiety, and Pain in Hospital Pediatric Care , 2015, HRI.

[47]  R. Aitken Measurement of feelings using visual analogue scales. , 1969, Proceedings of the Royal Society of Medicine.

[48]  Mary Czerwinski,et al.  MoodWings: a wearable biofeedback device for real-time stress intervention , 2013, PETRA '13.

[49]  Albert A. Rizzo,et al.  Effectiveness of Virtual Reality for Pediatric Pain Distraction during IV Placement , 2006, Cyberpsychology Behav. Soc. Netw..

[50]  R. Saatchi,et al.  Respiration rate monitoring methods: A review , 2011, Pediatric pulmonology.

[51]  C. Kleiber,et al.  Effects of distraction on children's pain and distress during medical procedures: a meta-analysis. , 1999, Nursing research.

[52]  Leon Sterling,et al.  Robots in Rehab: Towards socially assistive robots for paediatric rehabilitation , 2015, OZCHI.

[53]  Jeffrey Heer,et al.  Peripheral paced respiration: influencing user physiology during information work , 2011, UIST.

[54]  Robert S. Ware,et al.  Mock MRI: reducing the need for anaesthesia in children , 2010, Pediatric Radiology.