Introduction: Reducing distress in the pediatric procedure room
Invasive procedures like venipuncture and peripheral intravenous cannulation are routine yet distressing for young children. Pain, fear, and anxiety not only affect the immediate experience but can also influence future medical encounters, cooperation, and long-term emotional well-being. Distraction techniques—non-pharmacological, low-risk approaches—are increasingly recommended to complement standard care. This article summarizes a randomized controlled trial that directly compared active distraction (video games) with passive distraction (watching cartoons) in children aged 3–7 years during invasive procedures.
Methods: How the study was designed
Three groups of 35 children each were randomized in a single-center trial: a control group receiving routine nursing care, a passive distraction group watching age-appropriate cartoons, and an active distraction group playing age-appropriate video games. Both distraction interventions were initiated two minutes before the procedure and continued through its completion, with one parent present for all groups. Outcome measures included pain, fear, and anxiety, assessed using age-appropriate scales (Oucher Pain Scale, CSAS, and CFS) at three time points: before, during, and after the procedure. A blinded observer collected data to minimize bias, and data analyses used ANOVA and repeated measures approaches to evaluate changes over time and between groups.
Key findings: Active distraction led to the strongest relief
The trial consistently showed that both distraction methods reduced pain, fear, and anxiety compared with routine care. However, active distraction (video games) produced the most pronounced and sustained benefits. Notably:
- Video games yielded the lowest pain scores at all time points and demonstrated a maintained reduction after the procedure.
- Fear and anxiety were significantly lower in the video game group before and during the procedure, with effects persisting post-procedure.
- Cartoon viewing also reduced distress compared with control, but its effects were generally smaller and less durable than those of video games.
Effect sizes ranged from medium to large, underscoring the clinical relevance of the findings. Importantly, the benefits of distraction persisted even after accounting for baseline physiological differences in pulse and respiration rates among groups, suggesting a robust effect of the interventions themselves.
Clinical implications: What this means for pediatric care
The results support integrating active distraction, particularly child-friendly video games, into routine care for short invasive procedures in early childhood. Key implications include:
- Active distraction can improve cooperation, reduce procedure time, and diminish the need for pharmacologic anxiolytics in some cases.
- Passive distraction remains a valuable, low-cost option, especially in settings where interactive technology is limited or when a child prefers a calmer activity.
- Implementation is feasible: nurses can offer age-appropriate options, with devices prepared and charged in advance, minimizing disruption to workflow.
These findings align with broader evidence suggesting that engaging cognitive and motor processes through interactive tools can more effectively divert attention away from pain and threat, thereby easing the child’s emotional response during medical procedures.
Practical considerations for adoption
When deploying distraction strategies, clinicians should consider:
- Age-appropriate content: Select non-violent, engaging games that can be played with one hand to avoid interference with the procedure.
- Parental involvement: Maintain supportive presence while respecting the child’s autonomy and choice of distraction modality.
- Device logistics: Have backup devices and pre-installed, child-friendly content to prevent delays.
- Safety and monitoring: Ensure devices are securely handled and monitored by trained staff throughout the procedure.
Limitations and future directions
The study focused on a narrow age range (3–7 years) and short invasive procedures, which may limit generalizability to older children or longer or more painful interventions. Variability in video game exposure duration was noted, and real-world settings may present different workflow challenges. Future research could explore longer-term outcomes, different clinical environments, and a broader age spectrum, as well as cost-effectiveness analyses of distraction strategies.
Conclusion: Active distraction wins for pediatric procedural pain
Both active and passive distraction methods effectively reduce pain, fear, and anxiety during invasive pediatric procedures, but active distraction through video games provides the most robust and lasting relief for children aged 3–7 years. Incorporating these strategies into standard care can enhance the patient experience, support families, and improve procedural efficiency in pediatric settings.
