Effects of balloon inflation and cough trick methods on easing pain in children during the drawing of venous blood samples: a randomized controlled trial

The effects of virtual reality and stress ball distraction on procedure-related emotional appearance, pain, fear, and anxiety during phlebotomy in children: A randomized controlled study

BACKGROUND

Virtual reality (VR) and stress balls can be used during phlebotomy in school-age children.

OBJECTIVES

This randomized controlled study was conducted to evaluate the effect of distraction methods using VR and stress balls on the emotional behavior, pain, fear, and anxiety associated with phlebotomy in children aged 7-12.

METHODS

A parallel trial with a three-arm design approach was adopted for this randomized controlled trial, guided by the CONSORT checklist. The study sample (n = 150) was divided into VR, stress ball, and control group using stratified randomization. The mean scores obtained from the Children's Emotional Manifestation Scale, Wong-Baker FACES Pain Rating Scale, Child Anxiety Scale-State, and Child Fear Scale were compared between the groups. Linear regression analysis and correlation analysis were performed.

RESULTS

Significant differences were found in phlebotomy-related pain, fear, and anxiety. While there was no difference in emotional behavior before the phlebotomy, a significant difference was found after the phlebotomy. Being in the virtual reality group explained 30.8 % of the difference between the before and after phlebotomy-related-emotional behavior scores. A strong, positive, and significant relationship was found between emotional behavior scores after phlebotomy and phlebotomy-related fear, pain, and anxiety scores (p < .01).

CONCLUSION

Virtual reality and stress ball distraction were found to be effective in reducing pain, fear, and anxiety during phlebotomy. Virtual reality distraction is effective in reducing negative emotional behaviors.

APPLICATION TO PRACTICE

The VR distraction can be used in the pediatric population in pain, fear, anxiety, and emotional behavior management during phlebotomy.

CLINICALTRIALS

gov Identifier: NCT05818761.

Non-pharmacological interventions to reduce procedural needle pain in children (6-12 years): A systematic review

PROBLEM

Children of different age groups frequently undergo painful procedures involving needles, which can be a source of significant discomfort. Regrettably, this aspect of care often receives insufficient attention from healthcare professionals. The existing literature proposes several methodologies for managing procedural pain, with nonpharmacological techniques being particularly promising. These techniques should be adapted to the patient's age, but literature predominantly emphasizes their use with infants. Thus, it is necessary to evaluate their effectiveness in diverse age groups. Consequently, the purpose of this systematic review is to identify non-pharmacological interventions used to prevent needle-related procedural pain in children (age group 6-12 years).

ELIGIBILITY CRITERIA

Primary studies in English language on non-pharmacological interventions in children aged 6-12 years undergoing needle-related procedures found on PubMed, CINAHL and Embase.

SAMPLE

A total of 18 studies were included.

RESULTS

The results indicate the potential application of various non-pharmacological techniques, with distraction methods standing out. These techniques include activities like utilizing cards, watching cartoons, employing virtual reality and playing video games.

CONCLUSIONS

Children's procedural pain represents a significant challenge in treatment plans. Literature offers several approaches, including nonpharmacologic methods, to control this problem. Prioritizing procedural pain management is critical both at clinical and organizational levels to improve the quality of pediatric care.

IMPLICATIONS

These findings offer different options to support clinical practice, holding the potential to enhance the quality of patient care.

Virtual Reality Distraction for Needle-Related Pain and Distress in Children: A Multicenter Randomized Controlled Trial

This international multicenter randomized controlled trial aimed to compare the effectiveness of virtual reality (VR) distraction with an identical non-VR game in reducing needle-related pain and anxiety in children undergoing venous blood draw. The study involved 304 children aged 5-9 years undergoing a blood draw procedure, randomly allocated to one of three groups: VR distraction, non-VR distraction, and control group (usual care). The distraction task was based on the Multiple Object Tracking (MOT) paradigm, and the game was identical in design and gameplay for both VR and non-VR distraction groups. The primary outcome was self-reported pain intensity using the Faces Pain Scale-Revised (FPS-R). Secondary outcomes included child distress, attention/distraction to the blood draw, and parent and medical staff satisfaction with procedure. Analyses were conducted using analysis of variance and multivariable linear regression models. The results showed that VR distraction and non-VR distraction performed similarly, showing large effect sizes compared with standard care. There was no significant difference between the two types of distraction. The study's findings suggest that VR and non-VR distraction are similarly effective in reducing needle-related pain and anxiety in children undergoing venous blood draw. This is the first well-powered study comparing modern VR distraction with an identical task displayed on a smartphone or monitor screen. The study's results have important implications for using VR in clinical settings and suggest that investing in expensive VR equipment for acute pain management may not be necessary. The study protocol was pre-registered on Open Science Framework at https://osf.io/frsyc.

Efficacy and safety of the Valsalva maneuver in relieving venipuncture pain in children and adults: A systematic review and meta-analysis

Venipuncture is a common invasive clinical procedure, and pain management during puncture has been of interest to healthcare professionals. The purpose of this systematic review and meta-analysis was to evaluate the efficacy and safety of the Valsalva maneuver (VM) for the relief of venipuncture pain in children and adults. PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, VIP database, and CBM were searched from inception to December 2023 for all available randomized controlled trials (RCTs) that evaluated the impact of VM on venipuncture. Two reviewers independently performed study selection, data extraction, and risk of bias assessment. Continuous variables were analyzed by mean differences (MD) or standardized mean differences (SMD), whereas dichotomous variables were analyzed by risk ratios (RR). A total of 22 studies involving 1740 participants were included. The pooled results showed that VM relieved pain intensity during venipuncture in children (SMD = -0.89, 95% CI = -1.47 to -0.30, p = 0.003) and adults (SMD = -1.11, 95% CI = -1.46 to -0.77, p < 0.00001), reduced anxiety intensity (SMD = -1.07, 95% CI = -1.68 to -0.47, p = 0.0005), and shortened puncture time (MD = -13.52, 95% CI = -21.14 to -5.90, p = 0.0005). There was no significant difference in the success rate of venous cannulation, MAP, HR, or incidence of adverse events in subjects who performed VM compared to controls. VM was an effective and safe method of pain management that reduced pain intensity during venipuncture in children and adults without significant adverse effects. The results of this meta-analysis need to be further validated by more rigorous and larger RCTs.

The effect of two different methods on reducing the pain and fear during phlebotomy to children: A randomized controlled trial

INTRODUCTION

Reducing pain and fear during painful medical procedures in children is important since mismanagement of pain causes the child and parent to feel anxious, which can have negative long-term consequences. This study aimed to evaluate the effects of two different distraction methods in reducing pain and fear during the phlebotomy procedure in children.

METHOD

The study, which has a randomized controlled experimental design was conducted between July and October 2020 with 111 children aged 6-12 years who underwent phlebotomy in the emergency department of a public hospital and their parents. The children were randomly assigned to soap bubble blowing (n:37), ball squeezing (n:37) and control (n:37) groups. During the phlebotomy, soap bubble blowing, and ball squeezing methods were used as active distraction methods. Data were collected using the Wong Baker Faces Pain Rating Scale, and the Children's Fear Scale.

RESULTS

The pain scores of the soap bubble blowing group and the ball squeezing group during the phlebotomy procedure were found to be lower than the control group (p < 0.001). In addition, the soap bubble blowing group had lower fear scores than the ball squeezing and control groups (p < 0.001).

CONCLUSION

The active distraction methods used in the study reduced pain and fear during the phlebotomy procedure. In addition, the method of soap bubble blowing was found to be a more effective method in reducing fear. Distraction methods should be used as a nursing intervention to reduce pain and fear during the phlebotomy procedure in children.

Comparison of trace image colors for kids-book with two active distractions in reducing pain and fear of children during the venipuncture procedure

This study investigated the effectiveness of trace image and coloring for kids-book (TICK-B), cough trick, and balloon inflation techniques in reducing pain and fear in children during venipuncture. The current study is a prospective, controlled, and randomized trial (RCT). School-aged children who required venipuncture were involved in the study. Pediatric patients were randomly assigned to four groups: the TICK-B group, the cough trick group, the inflation of balloons, and the control groups. Before and after the procedure, the children and their parents were interviewed. Wong-Baker (FACES) Pain Rating Scale was applied to measure the severity of pain. Children's Fear Scale was applied to measure children's fear. This study involved the 160 children (mean age, 8.39-2.18 years). The severity of pain and fear levels among the children during and after the procedure were significantly different (p = 0.001). Pain and fear were significantly decreased in children in the intervention groups compared with those in the control group (p < 0.05). In the TICK-B group, participants reported significantly less pain and fear during the venipuncture procedure than in the cough trick, balloon inflation, and control groups (P = 0.001, p = 0.001, p = 0.001) and after the procedure (p = 0.001, p = 0.002, p = 0.002). There was a similar significance found in the level of fear during the procedure (p = 0.001, p = 0.002, p = 0.006), and after the procedure (p = 0.001, p = 0.008, p = 0.015).    Conclusion: TICK-B was the most effective method for decreasing the pain and fear of children associated with venipuncture procedures. Furthermore, the distraction technique of coughing and inflating balloons also proved efficacious in decreasing the pain and fear of children during venipuncture.    Trial registration: The study has been registered with ClinicalTrials.org under the number NCT04983303. It was retrospectively registered on July 26, 2021. What is Known: • Venipuncture, one of the most painful and uncomfortable procedures for children, caused great fear and discomfort during the procedure. What is New: • The TICK-B technique, music listening, and cartoon watching techniques are effective, simple, and safe ways to reduce children's fear and pain. These interventions provide a good way for children and their parents to collaborate during painful medical procedures. • No studies have compared the impact of TICK-B during venipuncture.

The Effect of Stress Ball Use Applied by Emergency Nurses During Swabbing Procedure on the Pain and Fear Levels of Children Admitted to the Pediatric Emergency Service With the Suspicion of COVID-19: A Randomized Controlled Trial

INTRODUCTION

This study aimed to determine the effect of stress ball use during the swabbing procedure on the pain and fear levels of children admitted to the pediatric emergency department with the suspicion of coronavirus disease 2019. Children with suspected coronavirus disease 2019 were recruited by convenience sampling from the pediatric emergency department of a university hospital in a city in Turkey.

METHODS

This study used a random controlled experimental design and had a calculated sample size of 60. There were 30 participants in both the control and experimental groups. The stress ball intervention was applied to the children in the experimental group during the swabbing process, and no intervention was made to the children in the control group during the procedure. The pain and fear levels of the children in the control and experimental groups were measured during the swabbing process. "Descriptive Characteristics Form for Parents and Children," "Wong-Baker Faces Pain Rating Scale," "Children's Fear Scale," and "Stress Ball" were used in data collection. Chi-square, Mann-Whitney U, and Friedman tests were used in the analysis.

RESULTS

Although there was no statistically significant difference between the groups in terms of pain and fear level mean scores before the procedure, a statistically significant difference was found between the groups during and after the procedures (P < .05).

DISCUSSION

Giving a stress ball to children aged 4 to 10 years during the swabbing procedure was determined to reduce the pain and fear levels during and after the procedures. It is recommended that stress ball use be applied during the swabbing procedure for children.

The Effect of 2 Different Distraction Methods on Pain, Fear, and Anxiety Levels During Venous Blood Draw in Children in a Pediatric Emergency Unit: A Randomized Controlled Study

BACKGROUND

Blood draw procedures can cause pain, fear, and anxiety in the pediatric population.

PURPOSE

To compare the effects of watching cartoons either with virtual reality (VR) or via a tablet on pain, fear, and anxiety during venous blood draw procedures in children.

METHODS

A randomized controlled study was conducted with 159 children aged 5 to 12 years in the pediatric emergency unit. The 3 groups included cartoons with VR (n = 53) or a tablet (n = 53), and a control group (n = 53).

RESULTS

Children in the 2 intervention groups had lower perceptions of pain, fear, and anxiety, with those watching cartoons via VR having the lowest perceptions.

CONCLUSIONS

Findings from this study showed a reduction in the perception of pain, fear, and anxiety in children who watched cartoons with VR or tablets during blood draw procedures. Nurses should consider using these nonpharmacological methods to reduce pain, fear, and anxiety, among pediatric patients.

The effect of a hand puppet-based therapeutic play for preschool children on the fear and pain associated with blood collection procedure

PURPOSE

The aim of this study was to determine the effects of a therapeutic play involving a hand puppet on the fear and pain associated with blood collection procedure in preschool children.

DESIGN AND METHODS

The research was conducted as a randomised controlled experiment. The sample included children aged 3-6 years who attended the blood collection unit between July and October 2022 and met the study's inclusion criteria. The research was completed with a total of 120 children, divided evenly into one of two groups. The nursing intervention of the research was a therapeutic play applied with a hand puppet. Data were collected through face-to-face interviews using a Questionnaire Form, the Child Fear Scale and the Wong-Baker Faces Pain Rating Scale. Ethical principles were followed in the research.

RESULTS

Differences between mean fear and pain level scores between the groups were statistically significant (p < 0.05).

CONCLUSIONS

The therapeutic play applied with a hand puppet reduced the level of fear and pain associated with the blood collection process.

PRACTICE IMPLICATIONS

Health professionals working in units related to paediatrics can use hand puppets, which are easy to use, inexpensive and practical, to reduce the fear and pain associated with blood collection from pre-school children.

The Effect of 3 Methods (Buzzy, ShotBlocker, and DistrACTION Cards) Used While Taking Blood Samples From Children with Pain and Anxiety: A Randomized Controlled Trial

OBJECTIVES

The aim of this study was to compare the effectiveness of 3 methods (Buzzy, ShotBlocker, and DistrACTION Cards) in reducing pain and anxiety while taking venous blood samples in children.

METHODS

The study population consisted of children aged 9 to 12 years admitted to the Child Health and Diseases Department in a Faculty of Medicine in Turkey. The sample of the study consisted of 242 children (Buzzy = 60, ShotBlocker = 61, DistrACTION Cards = 60, control = 61) who met the patient selection criteria and agreed to participate in the study. The data were obtained using an Information Form, the State-Trait Anxiety Inventory for Children, visual analog scale, and the Faces Pain Scale-Revised.

DESIGN

This article is an experimental randomized controlled study.

RESULTS

During venous blood collection, the scores of visual analog scale were significantly lower in ShotBlocker, Buzzy, and DistrACTION Cards groups than the control group. It was also observed that the control group experienced more anxiety than the other groups.

CONCLUSIONS

Methods such as Buzzy, ShotBlocker, and DistrACTION Cards can be used to reduce the anxiety and pain of children during painful procedures such as blood collection and vascular access. Among these methods, "Buzzy" and "DistrACTION Cards" can be preferred as it is equally effective, and then ShotBlocker can be preferred.

Effect of soap bubbles technique, coughing and distraction cards on reducing pain and anxiety during phlebotomy in children

This study aims to compare three techniques (soap bubbles, distraction cards, coughing) to reduce pain and anxiety in children during phlebotomy and collection with the use of a control group. Pain levels of children were assessed with the Wong-Baker FACES Pain Rating Scale and anxiety levels of children were assessed with the Children's Fear Scale. This randomized controlled study involved intervention groups and a control group. The population of this study consisted of 120 Turkish children (30 subjects in each of the four groups soap bubbles technique, distraction cards, coughing, and control groups) between the ages of 6 and 12. The study found that pain and anxiety levels of the children in intervention groups were lower than those of the children in the control group during phlebotomy procedure and this difference was statistically significant (P < .05). No difference was found among the three techniques (Soap bubbles, distraction cards, and coughing) to reduce pain and anxiety in children during the phlebotomy procedure (P > .05). Soap bubbles, distraction cards and coughing techniques were found to reduce pain and anxiety in children during phlebotomy. Nurses can play an effective role in reducing pain and anxiety by using these techniques.

Effect of the coughing technique during subcutaneous heparin injection on pain severity and individual satisfaction

to examine the effect of the medium intensity coughing technique during subcutaneous low molecular weight heparin injection on pain severity and individual satisfaction in general surgery patients. the prospective, quasi-experimental study included 100 patients who had been prescribed a subcutaneous low molecular weight heparin injection once in 24 hours. Each patient received two injections by the same researcher, one using the standard injection technique with medium intensity coughing technique and the other only the standard injection technique. there was a statistically significant difference between patients' mean scores on pain severity and satisfaction levels after injections administered by the two techniques (p= 0.000). Also, it was found that gender affected pain severity relating to the injection but did not affect the level of individual satisfaction. the medium intensity coughing technique was found to reduce pain severity and increase patient satisfaction in general surgery patients receiving subcutaneous low molecular weight heparin injections. Trial registration: NCT05681338.

The Effect of Buzzy Application on Pain Level During Vaccine Injection in Infants

BACKGROUND

Nonpharmacological interventions are needed to reduce pain during vaccine administration in infants.

PURPOSE

To determine the effect of the Buzzy device, which is a combination of cold and vibration, on pain during measles-mumps-rubella (MMR) vaccine administration in 12-month-old infants.

METHODS

A prospective randomized controlled experimental research design was used.

RESULTS

A total of 60 infants were included in the study. During and after vaccine injection, pain scores of infants who had the Buzzy device were significantly lower than those of infants in the control group ( P = .001).

CONCLUSIONS

Buzzy application may be an effective method in reducing pain during MMR vaccine administration. Use of the device is recommended for infants receiving vaccinations.

The comparative effects of ball squeezing and cartoon watching in pain management in children during intramuscular injection: A randomized control trial

This study was designed as a randomized controlled trial to investigate the comparative effect of ball squeezing and watching cartoons on pain management in children during intramuscular injection. The population of the study was comprised of 6-12 years old children who came to emergency for intramuscular injection. Power analysis was performed by G*Power program. Approximately 147 protocols completed with 6-12 years old children (each group 49 children). In the study, a questionnaire including child and socio-demographic characteristics their experiences of hospitalization data and Facial Pain Scale- Revised (FPS-R), Visual Analog Scale (VAS), and ball (for squeezing) were used. According to the results of the study, the FPS-R score during the procedure was the lowest in the stress ball group and was statistically significant (p˂0.05). The lowest VAS scores during the procedure the lowest score was in the stress ball group and the differences between the relevant groups were statistically significant (p˂0.05). It was determined that squeezing the ball and watching cartoons were effective in reducing pain during injection, however, the ball squeezing group had the lowest pain level. Among non-pharmacological methods, ball squeezing can be preferred as a practical and effective method, especially by pediatric nurses, in reducing pain during intramuscular injection in children.

Effect of using vacutainers with cartoon characters on the pain and fear levels of preschoolers during bloodletting

AIM

Our study aims to analyse the effect of using a vacutainer with cartoon characters on preschoolers' pain and fear levels during the bloodletting process.

METHODS

The experimental, randomised controlled clinical trial was conducted with 102 children aged 3-6 years, randomised into control and experimental groups. The bloodletting routine was applied to the control group. The vacutainer of each child in the experimental group was covered with the illustration of their chosen cartoon character and blood was drawn with it. The fear and pain levels during the bloodletting procedure were examined in both groups.

RESULTS

Pain and fear levels were significantly lower in the experimental group than in the experimental group (P < 0.05).

CONCLUSIONS

Our research highlighted that using a cartoon character sticker with a vacutainer can reduce preschoolers' pain and fear during bloodletting.

Efficacy of Distraction for Reducing Pain and Distress Associated With Venipuncture in the Pediatric Posttransplant Population: A Randomized Controlled Trial

OBJECTIVE

Distraction can reduce pain and distress associated with painful procedures but has never been studied in children with solid organ transplants. We aimed to determine whether there is a difference in pain and distress associated with venipuncture in pediatric posttransplant patients who receive distraction compared with those who do not.

METHODS

Randomized controlled trial of children aged 4 to 17 years with solid organ transplants undergoing venipuncture in the outpatient setting. Patients were randomized to receive distraction or no distraction. The primary outcome was the Faces Pain Scale-Revised. Secondary outcomes were the Observational Scale of Behavioral Distress-Revised; Faces, Leg, Activity, Cry, Consolability; and Children's Hospital of Eastern Ontario Pain Scale. Exploratory outcomes included the number of venipuncture attempts, time to successful venipuncture, and satisfaction of phlebotomists and parents.

RESULTS

Median age of the 40 children enrolled was 11.5 years. Type of transplants included the heart (67.5%), kidney (22.5%), liver (7.5%), and more than 1 organ (2.5%). There was no difference between the Faces Pain Scale-Revised scores in distraction and no distraction groups (1.4; 95% confidence interval, 0.9-1.9; and 1.3, 95% confidence interval, 0.5-2.1, respectively). There was also no difference in the Observational Scale of Behavioral Distress-Revised; Faces, Leg, Activity, Cry, Consolability; and Children's Hospital of Eastern Ontario Pain Scale scores, number of venipuncture attempts, or time to successful venipuncture. Phlebotomists were more satisfied with the venipuncture when distraction was implemented.

CONCLUSIONS

In children with solid organ transplants, there was no difference in pain and distress associated with venipuncture between those who did and did not receive distraction. There was also no difference in other procedure-related outcomes except for greater phlebotomist satisfaction when distraction was implemented.

Salivary C-reactive protein-a possible predictor of serum levels in pediatric acute respiratory illness

Identifying the etiology of an acute respiratory infection in children is a well-known challenge. In this study, we evaluated the correlation between salivary C-reactive protein (CRP) and its serum counterpart, which is known to be higher in bacterial infections but necessitates a venipuncture. Salivary and serum CRPs were measured in children with an acute respiratory illness, aged 2 months to 18 years. Pearson's correlation coefficients were used to measure correlation. Discrimination of the salivary CRP levels for predicting serum levels above 100 mg/L was calculated and compared to serum CRP levels. Sensitivity and specificity were similarly calculated. Salivary CRP was measured in 104 samples. Levels correlated significantly and positively with serum CRP levels (r = 0.670, p<0.001). Area under the curve for predicting serum CRP levels of 100 mg/L was 0.848. For a salivary CRP concentration above 32,610 ng/L, the sensitivity and specificity were 69% and 93%, respectively, for accurately predicting a serum CRP level ≥100 mg/L.Conclusions: Salivary CRP can be used in the pediatric acute setting due to its high specificity for predicting elevated serum levels without the need for venipuncture. Further studies are required to achieve higher sensitivity rates. What is known: • Salivary C-reactive protein has shown correlation to its serum counterpart, mainly in healthy children, adults, and ill neonates. What is new: • In a large population of children with acute respiratory illness, aged 2 months to 18 years, salivary C-reactive protein showed high specificity for predicting elevated serum levels, thus indicating its potential as a diagnostic tool.

The effect of playing games with toys made with medical materials in children with cancer on pain during intravenous treatment

OBJECTIVE

This research aims to examine the effect of playing games with toys made of medical materials in children with cancer on pain that occurs during intravenous (IV) treatment.

METHODS

The randomized controlled clinical trial was conducted between May 2016 and February 2018. The study sample comprised 110 children (experimental group 55; control group 55), determined using power analysis from the study population. The data were collected by the researcher, using face-to-face interview techniques, the Information Form, and Wong-Baker FACES Pain Rating Scale (WBS).

RESULTS

The pre- and post-test pain mean scores of patients in the experimental group were 2.27 ± 0.91 and 0.43 ± 0.66, respectively (p = 0.0001). The pre- and post-test pain mean scores of patients in the control group were 1.72 ± 0.82 and 3.34 ± 0.77, respectively (p = 0.0001).

SIGNIFICANCE OF RESULTS

The experience of playing with toys made from materials used for invasive procedures relieves pain the during IV treatment.

The Effect of Cartoon Watching and Distraction Card on Physiologic Parameters and Fear Levels During Inhalation Therapy in Children: A Randomized Controlled Study

OBJECTIVE

The study was conducted as a randomized controlled study to investigate the effect of cartoon watching and distraction cards on physiologic parameters and fear levels in children with acute bronchitis in the emergency department.

METHODS

Ninety-nine children with acute bronchitis aged 3-6 years were randomized in the emergency department. The study was conducted with three groups: cartoon group, distraction card group, and the control group. Data were collected using a follow-up form and the Children's Fear Scale.

RESULTS

The difference between the mean pulse rates of the groups evaluated by an observer nurse was found to be statistically significant. The pulse rates of the cartoon and distraction card groups were lower than in the control group during inhalation therapy (p < 0.05). The difference between the mean fear scores in the cartoon and control groups as evaluated by the observer nurse and the accompanying parent was found to be statistically significant during after inhalation therapy (p < 0.01).

CONCLUSION

It was observed that watching cartoons during inhalation therapy was more effective in reducing the level of fear in children that distraction card.

The Effect of a Cartoon and an Information Video About Intravenous Insertion on Pain and Fear in Children Aged 6 to 12 Years in the Pediatric Emergency Unit: A Randomized Controlled Trial

INTRODUCTION

Intravenous insertion is the most common invasive procedure made for administering intravascular fluid and medicine. Peripheral venous catheterization may cause pain, fear, and stress in children. This study aimed to compare the effects of watching a cartoon and an information video about intravenous insertion on the pain and fear levels of children aged 6-12 years.

METHODS

The study was an experimental, randomized controlled clinical trial. It was conducted with 477 children aged 6-12 years randomized into 3 groups: the informative animated video group, the cartoon group, and the control group. Fear and pain perception were evaluated on the basis of the feedback from the child, observer nurse, and parents. The Children's Fear Scale was used to evaluate the fear level and the Wong-Baker FACES Scale was used to assess pain levels. Data were analyzed using one-way analysis of variance, the chi-square test, and the intraclass correlation coefficient test.

RESULTS

The children who watched the information video before the intravenous insertion procedure and those who watched a cartoon during the procedure had lower mean pain and fear scores as evaluated by the child (pain: F = 278.67, P = 0.001; fear: F = 294.88, P = 0.001), parent (pain: F = 279.53, P = 0.001; fear: F = 294.47, P = 0.001), and nurse (pain: F = 286.88, P = 0.001; fear: F = 300.81, P = 0.001) than children in the control group.

DISCUSSION

This study showed that watching an animation video or a cartoon was effective in lowering children's perceived level of pain and fear during an intravenous insertion intervention.

Squeezing a squishy object effectively controls pain in children during intravenous catheter insertion

This study aimed to identify the effect of distraction technique involving squeezing a squishy object on pain in children during intravenous catheter insertion. In this work, the control group posttest-only quasiexperimental design was used. This study involved 50 participants aged 3-15 years and was assigned into either intervention or control group. The intervention group was provided with a squishy object to squeeze as a form of distraction during intravenous catheter insertion, whereas the control group received the standard intervention. The pain was measured by using the Wong- Baker Faces Scale for 3-8 years old and the Visual Analog Scale or Numeric Rating Scale for children older than 8 years. Mann-Whitney analysis reveals significant difference in pain level between the intervention and control groups (P<0,001; α=0.05). The distraction technique involving squeezing a squishy object effectively reduced pain in children during intravenous catheter insertion and is recommended for pain management in nursing care in the pediatric ward.

Children's Pain, Fear, and Anxiety During Invasive Procedures

This study was conducted to find out the effects of different means of games used during pediatric blood draw on the levels of procedure-induced fear and anxiety. Patient descriptive information form and selected scales were completed for both the experimental and control group before the blood drawing procedure. During the blood draw procedure, the children in the experimental group listened to music and watched video games. Following the blood draw procedure, the children were given the Fear of Medical Procedure Scale and State Anxiety Inventory for a second time. The results of the study showed that differences between pre- and postprocedure average total scores of Fear of Medical Procedure Scale were statistically significant for all groups (p < .05). As a conclusion, it was found that making children listen to music or watch a video during blood draw was effective in decreasing their medical procedure fear levels and state anxiety.

The Efficacy of Distraction Cards and Kaleidoscope for Reducing Pain During Phlebotomy: A Randomized Controlled Trial

PURPOSE

The purpose of this study was to determine the efficacy of distraction cards and a kaleidoscope in reducing pain during phlebotomy procedures among children aged 6 to 12.

DESIGN

This randomized controlled study involved intervention groups and a control group.

METHODS

Data were obtained by the use of an information form and the visual analog scale. Data were analyzed with descriptive statistics as well as Kruskal-Wallis, Wilcoxon, and post hoc tests.

FINDINGS

During the phlebotomy, children in the control group experienced more pain than children in the distraction cards group and kaleidoscope group (P < .001). There was no significant difference between pain scores of the two intervention groups (P > .05). Both methods were found to be effective in reducing pain.

CONCLUSIONS

It may be helpful to inform children and parents about the process before procedural interventions. Nurses would likely benefit from education on the use of distraction cards and kaleidoscope to be used during procedural interventions.

Effect of Gum Chewing on Pain and Anxiety in Turkish Children During Intravenous Cannulation: A Randomized Controlled Study

PURPOSE

Although gum chewing is a simple intervention that can be used for the management of pain and anxiety in the nursing care of children, few studies have assessed this intervention. This study aimed to investigate the effect of gum chewing on pain and anxiety during intravenous (IV) cannulation in children.

DESIGN AND METHODS

This randomized controlled study assessed 73 children aged 6 to 12 years in the general paediatric unit in a university hospital in the Trachy Region, Turkey from April to September 2017. In the experimental group, children chewed gum during the procedure. The standard care was applied to the control group. Data were collected via the Children's Anxiety Pain Scale and the Data Collection Form.

RESULTS

According to the children's self-report and the nurse's report, the pain level of the experimental group was significantly lower than the control group. Although no significant difference was noted between experimental and control groups' anxiety levels, nurses stated higher anxiety levels than children.

CONCLUSIONS

The IV cannulation procedure causes pain and anxiety in children. Nurses reported the perception of a higher level of anxiety during the procedure than the children actually experienced. Gum chewing might reduce pain during IV cannulation. Nurses should consider using gum chewing as a simple nursing implementation to increase the effects of other pharmacological and non-pharmacological techniques for management of children's procedural pain.

PRACTICE IMPLICATIONS

Nurses who work with the children could use gum chewing as a simple, inexpensive, and pleasurable intervention for the management of pain.

The Effect of Acupressure on Acute Pain During Venipuncture in Children: Implications for Evidence-Based Practice

AIMS

The study was conducted as a randomized controlled trial in order to determine the effects of acupressure on acute pain during venipuncture in children.

METHODS

The population of the study consisted of children, aged between 9 and 12 years, who received venipuncture between September 2015 and June 2016 at a university hospital in Istanbul. The sample consisted of a total of 90 children, including 45 children in the acupressure group and 45 children in the control group, who met the sample inclusion criteria. The results of the study were obtained by using an information form, the State Anxiety Inventory for Children (STAIC), the visual analog scale (VAS), and the Faces Pain Scale-Revised (FPS-R). Acupressure was applied to the children in the acupressure group for 10 min before the venipuncture procedure. Pain, heart rate, and oxygen saturation levels of the children in the acupressure and control groups were evaluated both before and after the venipuncture procedure.

RESULTS

The children in the acupressure and control groups were found to be similar in terms of age, gender, parents' educational levels and working status, number of venipuncture procedures, and mean anxiety scores. In the evaluation that was conducted before the venipuncture procedure, no statistically significant differences were observed between the heat rates, oxygen saturation levels, and expected pain scores from the venipuncture procedure in the children in the acupressure and control groups. On the other hand, it was observed that the children in the acupressure group (VAS: 19.51 ± 4.98; FPS-R: 2.08 ± 0.41) experienced less pain than the children in the control group (VAS: 47.37 ± 9.89; FPS-R: 4.84 ± 1.08), and there was a significant difference between the two groups (p< .000).

LINKING EVIDENCE TO ACTION

Acupressure administration is effective in reducing the pain that is experienced by children during a venipuncture procedure.

Mechanisms of "Cough-Trick" for Pain Relief during Venipuncture: An Experimental Crossover Investigation in Healthy Volunteers

Objectives

The easily performed “cough-trick” (CT) reduces pain during venipuncture (VP), although the underlying mechanism remains unclear. The aim was to investigate the pain-reducing effect of CT during VP in comparison with two distraction methods, as well as under the influence of naloxone.

Methods

54 healthy male volunteers participated in 3 investigations. Pain during standardized VP with CT was compared to a “weak” distraction (squeezing a rubber ball; investigation 1; n=20) and to a “strong” distraction (inflating a tourniquet to a given pressure; investigation 2; n=21). In investigation 3 (n=13), pain at a VP without intervention was compared to pain at VP with CT under naloxone; pressure pain thresholds before and after naloxone administration were also measured. Pain was assessed using a 100 mm visual analogue scale. Data were compared within each sample using Student's t-test for paired samples.

Results

Pain intensity at VP with CT was lower than under “weak” distraction (mean difference 5 mm; 95% CI: 0.5 to 9.6; P=0.03). Pain levels under CT and “strong” distraction were comparable. There was no difference between pain under CT after naloxone infusion and pain without intervention. Pressure pain threshold decreased (mean difference 1 mm; 95% CI: 0.1 to 1.0 mm; P=0.02) after naloxone administration.

Conclusion

Pain-reducing effect of CT during VP is superior to that of simple motor distraction and equivalent to a complex distraction method. This might be due to the activation of segmental pain inhibitory pathways during coughing indicated through the lack of pain reduction due to CT under opioid antagonist blockage.

The "Cough Trick" Reduces Pain During Removal of Closed-suction Drains after Total Knee Arthroplasty: A Randomized Trial

BACKGROUND

Drain removal after TKA can be painful. Prior research suggests that the "cough trick," in which a patient coughs at the same time she or he receives an injection, effectively decreases pain. To our knowledge, this intervention has not been evaluated as a way to reduce pain during other brief but painful interventions, such as removal of closed-suction drains after orthopaedic surgery.

QUESTION/PURPOSE

Does the cough trick reduce pain while a surgeon is removing a closed-suction drain after TKA?

METHODS

Fifty-six patients with primary osteoarthritis who underwent primary TKA were randomized into two groups: drain removal as the patient coughed (n = 28 patients; three men, 25 women) or drain removal using the usual process, without the cough trick (n = 28 patients; three men, 25 women). The study groups were not different in terms of gender, BMI, surgical time, or other baseline variables, and other than the addition of the cough trick, there were no differences in surgical treatment or other elements of aftercare. Likewise, at baseline, the verbal numeric rating scale (VNRS) score for pain before the drain was removed was not different between the groups (3.1 ± 1.7 versus 3.3 ± 1.3; p = 0.72). The level of pain before and during drain removal was recorded using a VNRS by an orthopaedic surgeon who was not involved in the care of the study patients. We considered the minimum clinically important difference on the 10-point scale to be 2 points, based on prior evidence.

RESULTS

The mean ± SD VNRS for the pain level during drain removal was lower in the cough trick group than that in the control group (1.6 ± 1.0 versus 3.7 ± 1.9, mean difference 2.1; 95% CI, 1.3-2.9; p < 0.001).

CONCLUSIONS

The cough trick during removal of a closed-suction drain tube in patients undergoing TKA reduced the level of pain in this small randomized trial. We suggest that surgeons consider this technique when removing drains after TKA because it is a noninvasive technique and it is easy to perform. Because the cough trick has been shown by others to be effective at reducing pain during venipuncture and parenteral injections, and we found it was effective for that purpose during drain removal after TKA, we believe this finding probably generalizes well to most minor procedures that cause transient, sharp pain. We suggest that it could be used to make such procedures more comfortable for patients, as well as for drain removal in other types of surgery where drains still are commonly used (including spine surgery and tumor surgery).

LEVEL OF EVIDENCE

Level I, therapeutic study.

Utility of Perioperative Laboratory Tests in Pediatric Patients Undergoing Spinal Fusion for Scoliosis

STUDY DESIGN

Retrospective comparative study.

OBJECTIVES

We aimed to characterize the frequency of perioperative laboratory tests for posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) and to assess whether test results affected clinical management.

SUMMARY OF BACKGROUND DATA

Perioperative laboratory tests for PSF including complete blood count, coagulation laboratory tests, basic metabolic panels (BMPs), and type and screen, are commonly ordered based on providers' discretion or existing order sets. Studies have shown unnecessary laboratory tests as financially and physically costly in adults; however, no studies have examined the necessity of common perioperative laboratory tests in pediatric spinal deformity surgery.

METHODS

Retrospective review of patients aged 10-18 years who underwent PSF for AIS at our center in the past three years. The clinical utility of perioperative laboratory tests was assessed based on detected incidence of anemia, blood transfusions, hematology/endocrinology/nephrology consultations, insulin administration, and postponed/canceled surgeries.

RESULTS

A total of 234 patients were included (mean age 14.4 ± 1.8 years, 75% female). Of 105 (44.9%) patients with preoperative coagulation laboratory tests, 21 (20%) had abnormal results; however, none had subsequent hematology consultations or canceled/postponed surgeries. Postoperatively, only 5 (2.1%) patients and 30 (12.8%) patients had hemoglobin values less than 8 g/dL on postoperative day (POD) 1 and 2, respectively. Multivariate analysis identified POD1 hemoglobin ≤9.35 g/dL as the only predictor of hemoglobin <8 g/dL on POD2. Overall, there were 8 (3.4%) indicated blood transfusions postoperatively. Costs of unnecessary laboratory tests averaged $95.27 (range $49.72 to $240.27) per patient.

CONCLUSIONS

Many perioperative laboratory orders may be unnecessary in pediatric spinal deformity surgery, subjecting patients to extraneous costs and needlesticks. In particular, preoperative coagulation laboratory tests, perioperative BMPs, and additional postoperative CBCs for those with hemoglobin >9.35 on POD1 may not be warranted.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

Children Listening to Music or Watching Cartoons During ER Procedures: A RCT

OBJECTIVE

This study aims to determine if listening to music and watching cartoons are effective to distract children from pain and distress during procedures in the emergency room (ER).

METHODS

This study is a single-center, 3-armed, superiority randomized controlled trial comparing listening to music, watching cartoons, and standard care during ER procedures in children aged 3-13 years. The primary outcome was pain measured from video footage with the Alder Hey Triage Pain Score (AHTPS). Children older than 4 years self-reported pain with the Faces Pain Scale-Revised (FPS-R). The secondary outcome was distress measured with the Observational Scale of Behavioral Distress-revised (OSBD-r). Another indicator of distress was heart rate.

RESULTS

Data of 191 participants were analyzed for the 3 groups: music (n = 75), cartoon (n = 62), and control (n = 54). The median age was 7.3 years (4.9-9.7). In multivariable analysis, pain assessed with the AHTPS was significantly lower (B = -1.173, 95% confidence interval -1.953, -0.394, p = .003) in the music group than in the control groups. Across the 3 groups, 108 children self-reported pain with the FPS-R after the procedure. The scores were lowest in the music group, but the differences between groups were not significant (p = .077). OSBD-r distress scores assigned during the procedures were not significantly different between the 3 groups (p = .55). Heart rate directly after the procedure was not statistically significantly different between the 3 groups (p = .83).

CONCLUSIONS

Listening to recorded music is a beneficial distraction for children experiencing pain during ER procedures, whereas watching cartoons did not seem to reduce pain or distress.

Reducing Pain and Fear in Children During Venipuncture: A Randomized Controlled Study

BACKGROUND

Venous blood sampling is a common procedure in the hospital setting and cause significant pain and stress for children.

AIM

This study was conducted to determine and compare the effects of balloon inflation, ball squeezing, and coughing methods on levels of pain and fear during venipuncture in children aged 7-12 years.

DESIGN

Experimental, randomized controlled study.

SETTING

The study was conducted at a state hospital in Turkey between March and July 2017.

PARTICIPANTS/SUBJECTS

The study population comprised children 7-12 years of age who were subjected to venous blood sampling in the phlebotomy unit of a state hospital. The study sample included 120 children for a confidence interval of 95% and statistical power of 80%.

METHODS

The children were assigned to one of four groups (balloon inflation, ball squeezing, coughing, and control groups), each including 30 participants. The children's pain and fear were rated before and after the procedure by the children themselves, their parents, and a researcher using the Wong-Baker FACES Pain Rating Scale and Children's Fear Scale, respectively.

RESULTS

Mean scores for pain and fear after the procedure were lower in all intervention groups compared with the control group (p = .001). There was no statistical difference in pain or fear scores between the intervention groups; however, the children in the coughing group had the lowest scores for both pain and fear.

CONCLUSION

Balloon inflation, ball squeezing, and coughing were all effective in reducing pain and fear associated with venipuncture in children aged 7-12 years. These are simple, rapid, and cost-effective methods that nurses can implement during venipuncture with minimal equipment and preparation.

Comparison of the Effectiveness of Two Different Methods of Decreasing Pain During Phlebotomy in Children: A Randomized Controlled Trial

PURPOSE

The purpose of this study was to examine the effect of the applications of external cold and vibration and blowing soap bubbles during phlebotomy in children aged between 3 and 6 years.

DESIGN

This study is a randomized controlled trial.

METHODS

The sample was obtained using block randomization. Children were divided into three groups: "external cold and vibration group," "blowing soap bubbles group," and "control group." Children, their parents, the nurse, and the researcher rated the children's pain during phlebotomy.

FINDINGS

A statistically significant difference between groups was found on pain scores. Pain scores were lower in the groups of external cold and vibration, and blowing soap bubbles than the control group.

CONCLUSIONS

The methods of external cold and vibration and blowing soap bubbles had a pain relieving effect in children aged between 3 and 6 years during phlebotomy.

Psychological interventions for needle-related procedural pain and distress in children and adolescents

BACKGROUND

This is the second update of a Cochrane Review (Issue 4, 2006). Pain and distress from needle-related procedures are common during childhood and can be reduced through use of psychological interventions (cognitive or behavioral strategies, or both). Our first review update (Issue 10, 2013) showed efficacy of distraction and hypnosis for needle-related pain and distress in children and adolescents.

OBJECTIVES

To assess the efficacy of psychological interventions for needle-related procedural pain and distress in children and adolescents.

SEARCH METHODS

We searched six electronic databases for relevant trials: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; PsycINFO; Embase; Web of Science (ISI Web of Knowledge); and Cumulative Index to Nursing and Allied Health Literature (CINAHL). We sent requests for additional studies to pediatric pain and child health electronic listservs. We also searched registries for relevant completed trials: clinicaltrials.gov; and World Health Organization International Clinical Trials Registry Platform (www.who.int.trialsearch). We conducted searches up to September 2017 to identify records published since the last review update in 2013.

SELECTION CRITERIA

We included peer-reviewed published randomized controlled trials (RCTs) with at least five participants per study arm, comparing a psychological intervention with a control or comparison group. Trials involved children aged two to 19 years undergoing any needle-related medical procedure.

DATA COLLECTION AND ANALYSIS

Two review authors extracted data and assessed risks of bias using the Cochrane 'Risk of bias' tool. We examined pain and distress assessed by child self-report, observer global report, and behavioral measurement (primary outcomes). We also examined any reported physiological outcomes and adverse events (secondary outcomes). We used meta-analysis to assess the efficacy of identified psychological interventions relative to a comparator (i.e. no treatment, other active treatment, treatment as usual, or waitlist) for each outcome separately. We used Review Manager 5 software to compute standardized mean differences (SMDs) with 95% confidence intervals (CIs), and GRADE to assess the quality of the evidence.

MAIN RESULTS

We included 59 trials (20 new for this update) with 5550 participants. Needle procedures primarily included venipuncture, intravenous insertion, and vaccine injections. Studies included children aged two to 19 years, with few trials focused on adolescents. The most common psychological interventions were distraction (n = 32), combined cognitive behavioral therapy (CBT; n = 18), and hypnosis (n = 8). Preparation/information (n = 4), breathing (n = 4), suggestion (n = 3), and memory alteration (n = 1) were also included. Control groups were often 'standard care', which varied across studies. Across all studies, 'Risk of bias' scores indicated several domains at high or unclear risk, most notably allocation concealment, blinding of participants and outcome assessment, and selective reporting. We downgraded the quality of evidence largely due to serious study limitations, inconsistency, and imprecision.Very low- to low-quality evidence supported the efficacy of distraction for self-reported pain (n = 30, 2802 participants; SMD -0.56, 95% CI -0.78 to -0.33) and distress (n = 4, 426 participants; SMD -0.82, 95% CI -1.45 to -0.18), observer-reported pain (n = 11, 1512 participants; SMD -0.62, 95% CI -1.00 to -0.23) and distress (n = 5, 1067 participants; SMD -0.72, 95% CI -1.41 to -0.03), and behavioral distress (n = 7, 500 participants; SMD -0.44, 95% CI -0.84 to -0.04). Distraction was not efficacious for behavioral pain (n = 4, 309 participants; SMD -0.33, 95% CI -0.69 to 0.03). Very low-quality evidence indicated hypnosis was efficacious for reducing self-reported pain (n = 5, 176 participants; SMD -1.40, 95% CI -2.32 to -0.48) and distress (n = 5, 176 participants; SMD -2.53, 95% CI -3.93 to -1.12), and behavioral distress (n = 6, 193 participants; SMD -1.15, 95% CI -1.76 to -0.53), but not behavioral pain (n = 2, 69 participants; SMD -0.38, 95% CI -1.57 to 0.81). No studies assessed hypnosis for observer-reported pain and only one study assessed observer-reported distress. Very low- to low-quality evidence supported the efficacy of combined CBT for observer-reported pain (n = 4, 385 participants; SMD -0.52, 95% CI -0.73 to -0.30) and behavioral distress (n = 11, 1105 participants; SMD -0.40, 95% CI -0.67 to -0.14), but not self-reported pain (n = 14, 1359 participants; SMD -0.27, 95% CI -0.58 to 0.03), self-reported distress (n = 6, 234 participants; SMD -0.26, 95% CI -0.56 to 0.04), observer-reported distress (n = 6, 765 participants; SMD 0.08, 95% CI -0.34 to 0.50), or behavioral pain (n = 2, 95 participants; SMD -0.65, 95% CI -2.36 to 1.06). Very low-quality evidence showed efficacy of breathing interventions for self-reported pain (n = 4, 298 participants; SMD -1.04, 95% CI -1.86 to -0.22), but there were too few studies for meta-analysis of other outcomes. Very low-quality evidence revealed no effect for preparation/information (n = 4, 313 participants) or suggestion (n = 3, 218 participants) for any pain or distress outcome. Given only a single trial, we could draw no conclusions about memory alteration. Adverse events of respiratory difficulties were only reported in one breathing intervention.

AUTHORS' CONCLUSIONS

We identified evidence supporting the efficacy of distraction, hypnosis, combined CBT, and breathing interventions for reducing children's needle-related pain or distress, or both. Support for the efficacy of combined CBT and breathing interventions is new from our last review update due to the availability of new evidence. The quality of trials and overall evidence remains low to very low, underscoring the need for improved methodological rigor and trial reporting. Despite low-quality evidence, the potential benefits of reduced pain or distress or both support the evidence in favor of using these interventions in clinical practice.

Effects of Virtual Reality and External Cold and Vibration on Pain in 7- to 12-Year-Old Children During Phlebotomy: A Randomized Controlled Trial

PURPOSE

The aim of this study was to evaluate the effects of the virtual reality (VR) and external cold and vibration methods on pain scores in children aged 7 to 12 years during phlebotomy.

DESIGN

A randomized controlled study.

METHODS

The sample of children (n = 121) was allocated to the groups (group 1, VR; group 2, external cold and vibration; group 3, control) by blocked randomization. Pain scores were assessed after the phlebotomy using self-report, parent's reports, report from the nurse who attempted the phlebotomy, and researchers' report with the Wong-Baker FACES scale.

FINDINGS

Pain scores were determined to be lower in groups 1 and 2. Although there was no difference between the groups 1 and 2, a statistically significant difference was found between groups 1 or 2 and group 3 based on all pain scores.

CONCLUSIONS

Results suggest that VR and external cold and vibration are effective in reducing the pain in 7- to 12-year-old children during phlebotomy. VR can be used safely for the pain management of children who are growing up in the age of technology.

Effectiveness of a virtual reality intervention to minimize pediatric stress and pain intensity during venipuncture

PURPOSE

Virtual reality (VR) technology is an effective tool in treatment of acute pain. Numerous studies show the effectiveness of this method both in a clinical context and in the laboratory. However, research results on the effectiveness of VR in pediatric venipuncture pain is not conclusive-not all studies report the analgesic effect of VR. In addition to testing effectiveness of VR, we also assess the usability of a novel hands-free interface.

DESIGN AND METHODS

Patients of paediatric nephrology clinic (N = 38; mean age 11 years, range 7-17) participated in a posttest only between group quasi-experimental study. Participants in the treatment group received the venipuncture procedure with VR distraction. They were wearing a head-mounted Oculus DK2 HMD, and playing a game designed by the authors of the study. The game was based on Multiple Object Tracking (MOT) task, where players have to remember and simultaneously track several moving targets. MOT has been used in many studies on attention and working memory. Participants rated their pain and stress intensity on visual analogue scales (VAS) on a scale of 0 to 100 and answered a short questionnaire.

RESULTS

The VR group reported significantly lower pain intensity than the controls (mean = 15.16 ± 20.51 vs. 37.05 ± 30.66; t = 2.59, df = 36, p < .02, d = 0.863). Similar results were obtained for stress level (11.16 ±18.58 vs 41.89 ± 40.89; t = 2.98, df = 36, p < .01, d = 0.993). There were no correlations with age.

PRACTICE IMPLICATIONS

VR can be as an effective tool to minimize pediatric pain and stress due to venipuncture. The MOT-based VR game was suitable for children at the studied age range. This solution can be easily applied by nurses in their clinical practice.