The impact of different methods of distraction on pain of venipuncture: a case study in children 6-3 years old

Document Type : Research Paper


1 Anesthesiology, Critical Care and Pain Management Research Center, Jahrom University of Medical Sciences, Jahrom, Iran.

2 Anesthesiology Department, Shiraz University of Medical Sciences, Shiraz, Iran.

3 Research center for social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran.

4 Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran.


 Introduction: Children become irritable, restless, and excited in response to excruciating pain. Most children anticipate the pain caused by the injection and are prevented from doing so by non-adaptive anxious behaviors prior to the injection, so the aim of this study was to investigate the effect of different methods of thinking on the pain caused by venous thrombosis. In children 6-3 years old.
Methods: This quasi-experimental study was performed on 110 children admitted to the pediatric ward of Peymaniyeh Hospital in Jahrom city by available and random sampling method. The data collection tools in this study included three demographic information questionnaires, children's behavioral pain scale and numerical pain measurement scale. Data analysis was performed using SPSS software version 21 and descriptive and inferential statistical tests.

Results: Comparison of research groups in terms of scale of behavioral pain analysis using test Mann Whitney showed that there was a significant difference between all groups of musical balls, inflating balloons, in the mother's arms, the musical ball + the mother's arms, and controlling (p-value <0.05). The "control" group had the highest and the "musical ball + mother embrace" group had the lowest average pain behavior and pain measurement.

 Conclusion: Implementing a mindfulness program has reduced the pain caused by sprains in children. Therefore, it is possible to reduce the effects of destructive and stressful procedures in children who experience a lot of pain during painful procedures when diagnosing, treating and controlling their disease with various deviant methods.


1- Marlow D. Pediatric nursing. Tehran: Boshra Pub;2009. p. 25.
2- Harkreader HR. Fundamentals of nursing. 4th edition. Philadelphia: Saunders Co; 2008. p. 104.
3- Alavi A, Zargham A, Abde Yazdan Z, Namnabat M. Study of distraction and Emla cream on
the pain intensity catheter insertion in children with thalassemic age 5- 8 years old]. Shahrekord Uni
Med Sci J .2005;7(3) : 9-15.
4- Uman LS, Chambers CT, McGrath PJ, Kisely S. Psychological interventions for needle related
Procedural pain and distress in children and adolescents. Cochrane Database Syst Rev.
5. Fried LN, Qmryvsfy R, Nmazyan M, Namdar F, Nezami M. Comparison of EMLA
Cream Versus Local Refrigeration for Reducing Venipuncture-Related Pain in Pediatric
Patients of Children’s Medical Center, 2008. Iranian Journal of Nursing Research.
2010;5 (16):32-7 (Persian)
6. Allahyari I, Alhany F. Evaluation of The Nurses’ Problems in Using Methods to Reduce
Injection Pain in Children. Iran J Pediatr. 2006;16 (2):183-8
7. Frotan R, Saadaty A, Wafaie SM, Reiecy F. A Comparative Study on Impact of Topical
Cooling and Manual Pressure Before Intramuscular Injection on Pain Severity in 5-12
Years Old Children. KAUMS Journal (FEYZ). 2006;10 (3):52-5.
 8. Elahi F. Treatment and experience chronic pain. Tehran, Iran: Tabib Publication; 2011.
9. Fox J. Primary Health Care of Infants, Children and Adolescents. 2nd ed, St. Louis: Mosby; 2002.
10. Wang ZX, Sun LH, Chen AP. The efficacy of non-pharmacological methods of pain
Management in school-age children receiving venepuncture in a paediatric department: a randomized controlled trial of audiovisual distraction and routine psychological intervention. Swiss Med Wkly. 2008 Oct 4;138(39-40):579-84.
11. Sinha M, Christopher NC, Fenn R, Reeves L. Evaluation of nonpharmacologic methods of pain and anxiety management for laceration repair in the pediatric emergency department. Pediatr 2006;117(4):1162-8.
12. Dahlquist LM1, Busby SM, Slifer KJ, Tucker CL, Eischen S, Hilley L, Sulc W. Distraction for children of different ages who undergo repeated needle sticks. J Pediatr Oncol Nurs. 2002;19(1):22-34.
13. Vosoghi N, Chehrzad M, Abotalebi G, Atrkar Roshan Z. Effects of Distraction on Physiologic Indices and Pain Intensity in children aged 3-6 Undergoing IV Injection. Hayat. 2011; 16 (3 and 4) :39-47.
14. Ashwill JW, Droke SC. Nursing care of Children: Princioles and practice, second ed, saunders co, 2001; U.S.A.
16. Rostami M, Abazari F, Pouraboli B, Jahani Y, Shirzadi F. The effects of huko point massage with ice on intensity of pain due of Phlebotomy in children with thalassemia in Kerman Samen Alhojaj Medical Center, Iran. Medical - Surgical Nursing Journal 2014; 3(3): 157-162.
17. Mahdipour Raberi R, Nematollahi M, Ismaielzadeh Nighabi F.  Effect of Distraction Techniques on Pain Intensity Catheter Insertion in Children with Strabismus. Avicenna J Nurs Midwifery Care. 2010; 18 (1):18-28.
18. Nematollahi M, Mehdipoor- Raberi R, Esmailzadeh- Noghani F. omparing the Effects of Distraction Techniques and Routine Care on Intensity of Fear of IV Insertion in Children with Strabismus. JHC. 2011; 13 (4):20-24.
19. Vosoghi N, Chehrzad M, Abotalebi G, Atrkar Roshan Z. Effects of Distraction on Physiologic Indices and Pain Intensity in children aged 3-6 Undergoing IV Injection. Hayat. 2011; 16 (3 and 4):39-47.
20. Potter PA, Perry AG. Fundamentals of Nursing: Concepts, Process and Practice. 5th ed. St. Louis: Mosby; 2005.
21. Urden LD, Stacy KM, Lough ME. Thelan's Critical Care Nursing: Diagnosis and Management. 5th ed. St. Louis: Mosby; 2005.
22. Pourmovahed Z, Salimie T, Dehghani KH, Yassinie M, Shakiba M, Tavangar H, et al. Comparative Study of the Effect of Music Distraction and Emla Cream on Pain of the Children During Intravenous annulation. Iran J Nurs 2008; 21(55): 47-53.
23. Arts SE, Abu-Saad HH, Champion GD,Crawford MR, Fisher RJ, Juniper KH, et al. Agerelated response to lidocaine-prilocaine (EMLA) emulsion and effect of music distraction on the pain of intravenous  cannulation. Pediatrics 1994;93(5): 797-801.
24. Pouraboli B, Abazari F, Rostami M, Jahani Y. Comparison the effect of two methods of acupressure and massage with ice on Huko point on pain intensity during IV insertion in pediatrics with thalassemia. JPEN. 2015; 2 (2) :20-27.
25. Safari  A, Behnam Vashani H, Rehani  T, Atai Nakhaee A. Effect of Touch on the Intensity and Duration of Venipuncture Pain in the School-age Children. EBCJ.2014;4(11): 18-23.
26. Sparkes L. Taking touch of injection for children. 100. MCN 2001; 26(2):76-77.
27. Kleiber C, Craft-Rosenberg M, Harper DC. Parents as distraction coaches during i.v. insertion: a randomized study. J Pain Symptom Manage. 2001 Oct; 22(4): 851-61.
28. Tanabe P, Ferket K, Thomas R, Paice J, Marcantonio R. The effect of standard care, ibuprofen, and distraction on pain relief and patient satisfaction in children with musculoskeletal trauma. J Emerg Nurs. 2002 Apr;28(2):118-25.
29. Hasanpour M, Tootoonchi M, Aein F, Yadegarfar Gh. The effects of two non-pharmacologic pain management methods for intramuscular injection pain in children. Acute Pain. 2006 Mar; 8(1): 7-12.
30. Kalani-Tehrani D. [Comparison of EMLA topical anesthetic cream and music on pain intensity caused by catheter insertion]. MSc. Dissertation, Shahid Beheshti University of Medical Sciences. 2007.
31. Aein F. [Effect of distraction and relaxation on pain-intensity during the postoperative 24 hours in children]. Shahrekord University of Medical Sciences Journal. 2003; 4(4): 24-30.
32. Cohen LL. Comparative study of distraction versus topical anesthesia for pediatric pain management during immunizations. Health Psychol 1999; 18(6): 591.
33. Dahlquist LM1, Busby SM, Slifer KJ, Tucker CL, Eischen S, Hilley L, Sulc W. Distraction for children of different ages who undergo repeated needle sticks. J Pediatr Oncol Nurs. 2002;19(1):22-34.
34. Huth MM, Broome ME, Good M. Imagery reduces children's post-operative pain. Pain 2004; 110(1-2): 439-448.
35. Manne SL, Bakeman R, Jacobsen PB, Gorfinkle K, Redd WH. An analysis of a behavioral intervention for children undergoing venipuncture. Health Psychol 1994; 13(6):556-66.
36. Winskill R, Andrews D. Minimizing the ‘ouch’—–A strategy to minimize pain, fear and anxiety in children presenting to the emergency department. AENJ 2008; 11:184-188.
37. Windich-Biermeier A, Sjoberg I, Dale JC, Eshelman D, Guzzetta CE. Effects of Distraction on Pain, Fear and Distress during Venous Port Access and Venipuncture in Children and Adolescents with Cancer. J pediatr oncol nurs 2007; 24(1): 8-19.
38. DeMore M. Cohen L .Distraction for Pediatric Immunization Pain: A Critical Review. J Clin Psychol 2005; 12(4):281-291.
39. Lal MK, McClelland J, Phillips J, Taub NA, Beattie RM. Comparison of EMLA cream versus placebo in children receiving distraction therapy for venepuncture. Acta  aediatr. 2001 Feb; 90(2):154-9.