Introduction: Reducing Distress in Pediatric Procedures
In pediatric care, invasive procedures like venipuncture and peripheral cannulation are common yet can trigger significant pain, fear, and anxiety in young children. Non-pharmacological strategies, including distraction, offer a safe and cost-effective way to ease distress and improve procedural cooperation. This article synthesizes findings from a randomized controlled trial comparing two distraction modalities—active distraction via video games and passive distraction via cartoons—against routine care in children aged 3–7 years.
Two Distraction Paths: Active versus Passive
Active distraction requires the child’s engagement and interaction, such as playing video games. Passive distraction involves watching cartoons or absorbing calming visuals. Both approaches aim to shift attention away from needles and procedural stress, but their cognitive load and engagement levels differ, potentially shaping their effectiveness in reducing pain, fear, and anxiety.
In the study, children in three groups—control (routine care), cartoon (passive), and video game (active)—were assessed before, during, and after the procedures using age-appropriate scales for pain, fear, and anxiety. The interventions began two minutes before the procedure and continued through its completion.
Key Findings: Video Games Lead to Greater and Longer-Lasting Relief
The trial found that both distraction methods significantly reduced pain, fear, and anxiety compared with routine care. However, active distraction via video games produced the strongest and most sustained benefits. Across the board, children in the video game group reported lower pain, fear, and anxiety levels before, during, and after the procedure. The effects were not only statistically significant but also clinically meaningful, with pain reductions exceeding commonly cited minimum clinically important differences for pediatric scales.
Cartoon-based distraction also reduced distress relative to control, though its effects were less pronounced and tended to diminish after the procedure. These results align with prior literature suggesting that active engagement can offer superior relief by absorbing cognitive resources more fully and providing a more immersive experience than passive viewing.
Clinical Implications: Practical, Safe, and Scalable
From a clinical standpoint, both distraction strategies are practical and low-cost, requiring minimal training for staff. The video game approach, in particular, can foster greater cooperation during venipuncture or IV access, potentially shortening procedure times and reducing the need for pharmacological alternatives in some cases. Importantly, the study ensured safety by using age-appropriate, non-violent games and by having trained nurses monitor use and safety throughout the procedure.
Institutions considering implementation should plan for equipment readiness (charged devices, age-appropriate games) and allocate time for staff to supervise the distraction without compromising procedural flow. Parental presence remained standard across groups, reinforcing the role of family in supporting a child’s coping strategies.
Limitations and Considerations for Future Research
While the findings favor active distraction, several limitations merit consideration. Variability in video game duration and content, potential baseline emotional differences among groups, and the focus on a specific age range (3–7 years) may affect generalizability. Future work could explore personalized distraction plans, including a broader age spectrum and additional distraction modalities, to determine optimal combinations for different procedures and clinical settings.
Conclusion: Embrace Active Distraction When Possible
For pediatric care teams, the evidence supports incorporating active distraction—video games—into routine procedural care when feasible. While passive distraction like cartoons remains beneficial, the more immersive, interactive approach offers greater reductions in pain, fear, and anxiety, with effects lasting beyond the procedure itself. This simple, scalable strategy holds promise for improving the pediatric patient experience and enhancing procedural efficiency.
About the Study Context
The randomized controlled trial was conducted in a Turkish pediatric unit with children ages 3–7 undergoing venipuncture or IV cannulation. Participants were allocated to three groups and assessed with validated pediatric scales, including age-appropriate pain and anxiety measures. The study emphasized safety, parental involvement, and practical integration into everyday nursing practice, highlighting a feasible pathway for hospitals seeking to reduce procedural distress in young patients.
