Virtual reality (VR) as a distraction tool decreases anxiety and fear in children undergoing procedures, but its use has not been studied during transthoracic echocardiograms (TTEs). We hypothesized that VR in children undergoing pre-intervention TTEs decreases anxiety and fear and increases TTE study comprehensiveness and diagnostic accuracy when compared with standard distractors (television, mobile devices). Patients (6-18 years old) scheduled for pre-intervention TTEs at Lucile Packard Children's Hospital in 2021 and 2022 were prospectively enrolled and randomized to VR and non-VR groups. Patients completed pre- and post-TTE surveys using the Children's Anxiety Meter-State (CAM-S) and Children's Fear Scale (CFS). Patients, parents, and sonographers completed post-TTE experience surveys. TTEs were reviewed by pediatric cardiologists for study comprehensiveness and compared with electronic medical records for diagnostic accuracy. Among 67 enrolled patients, 6 declined VR, 31 randomized to the VR group, and 30 to the non-VR group. Anxiety (average CAM-S difference 0.78 ± 1.80, p = 0.0012) and fear (average CFS difference 0.36 ± 0.74, p = 0.0005) decreased in both groups. There was no difference between groups in the change in anxiety and fear pre- and post-TTE (p = 0.96-1.00). TTE study comprehensiveness and diagnostic accuracy were high in both groups. Procedure time (time in the echocardiography room) was less for the VR group (48.4 ± 18.1 min) than the non-VR group (58.8 ± 24.4 min), but without a statistically significant difference (p = 0.075). VR is similar to standard distractors and may decrease procedure time. Patients, parents, and sonographers rated the VR experience highly and encouraged its use with future procedures.

Children experience fear and anxiety not only during painful procedural interventions but also during painless procedural interventions such as electrocardiography (ECG). Pediatric nurses should be aware of the emotional changes experienced by children during ECG procedures.

The aim of this single-center, single-blinded, randomized controlled intervention study was to investigate the impact of the undersea-themed examination table cover (UTETC) on the levels of fear and anxiety experienced by children during ECG procedures.

This study was conducted between April 1 and July 31, 2022, in the pediatric emergency department of a training and research hospital in Turkey. The participants included 80 children (experimental group = 40, control group = 40) aged 3-12 years. The experimental group underwent the procedure in the ECG room using the UTETC, while the control group underwent the routine procedure in the examination room. The entire process was video-recorded. Video recordings were watched by two nurses who were not otherwise involved in this study, and the data were collected using the Descriptive Data Form, the Children's Fear Scale, and the Children Emotional Manifestation Scale.

No statistically significant difference was found in the descriptive characteristics of the two groups ( p > .05). The experimental group completed the procedure more successfully than the control group with significantly lower levels of procedure-related fear and anxiety ( p < .05).

The UTETC was found to be effective in reducing fear and anxiety in children aged 3-12 years during ECG procedures in a pediatric emergency department.

To determine the effects of using an alcohol-free, silicone-based adhesive remover spray and squeezing a stress ball on pain and fear of pain during the removal of peripheral intravenous cannulas and fixation materials (acrylate-based hypoallergenic adhesives) in children aged 6-9 years.

This trial was structured as a randomized controlled parallel-group experimental study at a single-center. This study was conducted with 90 children aged 6-9 years (routine care group = RCG; n = 30, adhesive remover spray group = ARSG; n = 30, ball squeezing + adhesive remover spray group = BS + ARGS; n = 30) admitted to the pediatrics service of a university hospital between May and July 2024. The Wong-Bakers FACES® Pain Rating Scale and the Children's Fear Scale were used as data collection tools. The children's pain and fear of pain were assessed 2 min before, during and 2 min after the procedure.

The mean age of the children (N = 90) was 8.28 ± 1.70 years. The pain scores of the RCG were higher than those of the BS + ARSG and ARSG. The fear of pain scores of the BS + ARSG were lower than for RCG.

Using an alcohol-free, silicone-based adhesive remover spray with ball squeeze to remove peripheral intravenous cannula and fixation material was found to be effective in shortening procedure time and reducing pain and fear of pain in children.

Using an alcohol-free, silicone-based adhesive remover spray during peripheral intravenous cannula removal in children reduces pain and fear of pain in children and increases their comfort. It reduced the nurses' workload by reducing the time spent on the procedure.

School-age children can undergo phlebotomy using virtual reality (VR). Children experienced VR through a headset, and research using fully immersive VR is limited.

This study aimed to determine the impact of active (fully immersive) and passive (immersive) VR distractions during blood collection on phlebotomy-related emotional behavior, pain, anxiety, and fear in children aged 6-12.

This parallel, randomized controlled trial used a three-arm design approach, with the CONSORT checklist serving as a guide. The study sample (n = 150) was divided into active VR, passive VR, and control groups using stratified randomization. The mean scores were obtained from the Emotional Appearance Scale for Children, Wong-Baker FACES Pain Rating Scale, Child Fear Scale, and Child Anxiety Scale-State. Evaluation of scale scores according to time*group interaction was evaluated by analysis of variance in repeated measurements.

The fear score of the active VR group was significantly lower than passive VR group and the control group (p < .001). The pain, anxiety, and emotional behavior scores of the active VR group and the passive VR group were significantly lower than the control group (p < .001).

Both VR distractions were effective in reducing pain, anxiety, and negative behavior during phlebotomy (Clinical trials: NCT06336811).

Children can be supported with pain, fear, anxiety, and emotional behavior management during phlebotomy by using fully immersive and immersive VR distractions.

Pain and anxiety caused by vaccination and other medical procedures in childhood can generate discomfort in both the patient and their parents. Virtual reality is a non-pharmacological distraction technique, capable of diverting patients' attention to a virtual environment, potentially reducing pain signals during the procedure and becoming a method of analgesia, reinforcing traditional methods. The main objective of this study was to evaluate the reduction of pain and anxiety following the administration of two vaccines.

A randomized, multicenter, open, parallel and controlled clinical trial was carried out in two assigned groups; in which were included 300 children aged 3 and 6 years, who were candidates to receive two vaccines. The intervention group used virtual reality glasses while the control group received traditional care. Pain and anxiety were assessed using validated scales; the heart rate and the satisfaction of legal guardians were also recorded.

A total of 150 patients were included in each group. 53.3% of the intervention group reported no pain during the first vaccination, compared to 25.3% of the control group; with regard to the second vaccination, 49.3% of the virtual reality group reported no pain, compared to 21.3% of the control group. 71.1% of the intervention group faced the first vaccination calmly; 52% and 56.7% did not show anxiety at the end of the vaccination respectively; as for the control group, 71.8% faced the first vaccination calmly, 23.3% did not show anxiety at the end of the first intervention and 19.3% did not show anxiety at the end of the second vaccination. The heart rate was significantly lower in the intervention group. The satisfaction of legal guardians in the virtual reality group was higher than in the control group.

the use of virtual reality reduces pain and anxiety during vaccination in pediatric population. Registered in ClinicalTrials.gov: NCT06313762.

Pediatric trauma patients are often exposed to treatments that can result in pain, fear, and anxiety. While nonpharmacological distraction techniques like stress balls have been increasingly used in pediatric care, their effectiveness during casting procedures remains unexplored.

This study aims to evaluate the impact of stress ball distraction on fear and anxiety in pediatric extremity fracture patients during casting procedures.

This randomized controlled trial, with a parallel group design, was conducted from February to May 2023 in a hospital in Erzurum, Turkey, to evaluate stress ball distraction on fear and anxiety in children aged 6-12 years presenting to the emergency department with extremity fracture.

Among 66 children randomized to the stress ball (n = 33) or control (n = 33) group during casting procedures (mean age 8.5 years, 47% female), both groups were comparable at baseline. The stress ball group showed decreased fear scores (mean [SD], 2.24 [1.25] to 1.30 [1.07], p < .001), while controls showed increases (2.42 [1.02] to 3.15 [1.08], p < .001). State anxiety scores decreased in the stress ball group (mean [SD], 4.97 [2.52] to 3.09 [1.79], p < .001) but remained unchanged in controls (3.93 [0.32] to 3.91 [0.29], p = .487).

Our findings show that stress ball distraction reduced fear and anxiety in children during the casting procedures and is an easy and cost-effective intervention.

The study aimed to determine the fear, pain, and anxiety levels of children aged 7-18 years before and after enema.

This descriptive and cross-sectional study was conducted between January 8 and May 3, 2024. STROBE guidelines were followed in the study. The sample of the study consisted of 160 children between the ages of 7-18 who underwent enema. The data were collected using the Children's Fear Scale (CFS), Wong-Baker FACES® Pain Rating Scale (WBS) and Children's Anxiety Meter-State (CAMS) for Children. p-value less than 0.05 was considered statistically significant. Descriptive statistics tests, independent sample t-tests, and repeated measures ANOVA were used.

Before the enema, children's fear (2.19 ± 1.09) and pain scores (2.94 ± 1.08) were high and anxiety scores (3.60 ± 1.81) were low. There was no statistical difference between fear, pain, and anxiety levels according to some sociodemographic and clinical characteristics (p > 0.05). After the enema, children's fear (2.49 ± 1.34), pain (2.94 ± 1.35) and anxiety scores (3.88 ± 2.22) increased. However, only the increase in fear level was statistically significant (p > 0.05). There was a negative correlation between the child's age and the level of fear, pain, and anxiety.

An enema is a medical procedure that causes negative emotions for children, such as fear and pain, before and after it is administered. Nursing interventions are needed before and during the enema.

The high levels of fear, pain, and anxiety associated with enemas suggest the need for routine assessment and nursing interventions to control these negative emotions.

This study was conducted to examine the effects of watching videos with virtual reality glasses on pain and fear in children aged 7-12 who applied to the emergency room for suturing.

This study randomized controlled design was conducted in the emergency department of a public hospital between October 2022 and November 2024. 84 children aged 7-12 years were assigned to two different groups using block randomization method. The child, parent, and researcher assessed pain using the Wong-Baker FACES Pain Rating Scale, and fear using the Children's Fear Scale. The study data were analyzed using the Chi-square and independent Sample t-tests.

The groups were similar in clinical and demographic characteristics. The pain and fear scores of the group watching the video with the virtual reality glasses during and after the procedure were lower than those of the control group. Children who watched the video with virtual reality glasses had lower pain scores during the procedure (n = 37; 2.54 ± 2.09, p < 0.001), after the procedure (1.35 ± 1.57; p < 0.001), and fear scores during the procedure (1,68 ± 1.40; p < 0.001), after procedure (0.59 ± 1.07; p < 0.001) than the control group.

This study found that watching videos with virtual reality glasses was effective in reducing pain and fear in children aged 7-12 who undergoing sutures.

The cost-effective, easily accessible and effective (reducing pain and fear) video viewing technique with virtual reality glasses during the suturing procedure can be used safely in children between the ages of 7 and 12. Clinical Trials ID:NCT05543876.

To verify the efficacy of virtual reality compared to tablet games for pain and anxiety management in children undergoing percutaneous bone pin and/or suture removal procedures.

Randomised clinical trial using two parallel groups: (1) virtual reality or (2) tablet game.

Three-center, randomised pragmatic clinical trial, using a parallel design with two groups (experimental group: immersive virtual reality; active comparator: tablet games). Children aged 6-17 requiring percutaneous pins and/or sutures were recruited between 2020 and 2022 from three outpatient orthopaedic clinics in paediatric hospitals. Pain was measured with the Numerical Rating Scale and anxiety with the Child Fear Scale before and immediately after the procedure.

A total of 188 participants were assigned to either the virtual reality group (96 participants) or the tablet group (92 participants). At the first assessment, there was no noticeable difference between the two groups in terms of pain or anxiety levels. However, further analysis revealed that participants aged 13 and older in the virtual reality group experienced significantly lower anxiety.

Virtual reality was not more efficacious than games on a tablet for pain and anxiety of children undergoing removal of bone pins or sutures. However, virtual reality demonstrated a benefit in reducing anxiety for teenagers, particularly those aged 13-older.

Virtual reality games provide an immersive, non-pharmacological alternative of for anxiety management of teenagers during pins and/or sutures removal.

This study showed that a virtual reality game may help reduce anxiety during pins and/or sutures removal procedures in patients aged 13 years and older.

We adhered to the CONSORT checklist for reporting results.

A patient partner reviewed the study design, methods and final manuscript.

NCT03680625.

The aim of this study was to determine the effect of storytelling and painting on children's fear level and parental health care satisfaction in children aged 3-6 years receiving inhaler medication.

The randomized controlled study was conducted between 15.09.2023-20.01.2024 with 99 children aged 3-6 years and their parents who were hospitalized in the Pediatrics Clinic of a state hospital and who received inhaler medication with a mask for the first time. Information Form, Child Fear Scale (CFS), Children's Emotional Manifestation Scale (CEMS), PedsQL Health Care Satisfaction Scale (PHSS) were used for data collection.

The mean scores of the CFS and CEMS during inhaler medication administration of the children in the storytelling and painting group were found to be lower than the children in the control group (p < 0.001). The mean scores of the CFS and the CEMS during inhaler medication administration were found to be lower in the storytelling and painting groups than before the procedure (p < 0.001). It was determined that the mean scores of the PHSS of the parents in the painting and storytelling group were higher than those of the parents in the control group (p < 0.001).

It was found that storytelling and painting during inhaler medication administration in children aged 3-6 years decreased children's fear levels, negative emotional indicators while parents' satisfaction levels were higher compared to those receiving standard care.

It is recommended to use storytelling and painting, which are easy, inexpensive, effective methods during inhaler medication administration with mask in children.

To determine the effect of immersive virtual reality (VR) on perceived pain and fear in children during vaccination and parental satisfaction with the procedure.

Virtual reality can reduce the perception of pain by children but only three studies have analysed its use during vaccination to date; these had small sample sizes and imperfect methodological designs.

A randomised controlled clinical trial.

One hundred and sixty participants from the Tres Forques Health Center were randomly assigned to the intervention group (IG) (n = 82) in which distraction with immersive VR was used during the vaccination, while standard distraction techniques were used for the control group (n = 80). The primary outcome was pain (Wong-Baker FACES). Secondary outcomes included (Children's Fear Scale) and parental satisfaction with the vaccination procedure. Chi-squared tests were used for qualitative variables, relationships between quantitative variables were tested with Spearman correlations, and Mann-Whitney U- or Student t-tests were employed to assess the relationship between quantitative and qualitative variables.

Compared to the controls, the children in the IG reported significantly less pain and fear, while parental satisfaction was significantly higher. Reported pain and fear did not differ according to the sex of the patient. Child age was not linked to fear but was related to pain: the younger the patient, the greater the pain they described.

Immersive VR effectively controlled pain and fear in children during vaccination and increased parent satisfaction with the vaccination process. Patient sex did not influence the level of pain and fear but age did.

Improving vaccination experiences can reduce perceived pain and fear in children and increase parent satisfaction, thereby enhancing vaccination schedule adherence and improving group immunity.

The CONSORT Statement for non-pharmacological randomised clinical trials were followed.

To study the effects of virtual reality (VR) on pain perception among a paediatric population while being vaccinated. We will also investigate the effects of VR on the fear experienced by children during the vaccination procedure, as well as parental satisfaction levels.

Many studies, for example, in the fields of oncology, dermatology or plastic surgery, have described the benefits of using VR to reduce the perception of pain among paediatric populations. These results are encouraging, but their main limitations were the small sample sizes they included or their methodological design.

This will be a randomised clinical trial.

SPIRIT guidelines were followed to report this protocol, and we will use the CONSORT and CONSORT-EHEALTH guidelines to report the randomised clinical trial. The sample will comprise 148 children aged 3-14 years who will come for vaccination at the Tres Forques Health Center. The participants will be randomly allocated into intervention group (VR; n = 74) or (the control group standard-of-care; n = 74) at a 1:1 ratio. The intervention group will view experiences with a VR headset as a distraction measure. The study variables will be the level of pain and fear perceived by the child during vaccination, parental satisfaction with the vaccination procedure, and sociodemographic and vaccination variables.

The start of the study is planned for September 2020, and the results will be expected in September 2021.

This study aims to identify what measures reduce pain and fear in children during vaccination, which in turn, can help to improve the degree of parental satisfaction with these procedures.

Vaccination is an independent function of the nursing profession. Identifying which distraction measures reduce the perception of pain and fear in the paediatric population will not only improve children's experiences but will also improve the satisfaction of both parents and children, thus increasing the degree of compliance with the vaccination schedule.

In colchicine-resistant patients with familial Mediterranean fever (FMF), alternative therapies, which are administered parenterally, become necessary. Effective pain management is essential for FMF treatment. Buzzy® (Pain Care Labs, Atlanta, GA) is specifically designed to alleviate pain during needle procedures. This innovative tool integrates a cold pack with a vibration motor, thereby enabling the simultaneous application of cold therapy, tactile stimulation, and distraction techniques. By harnessing the combined effects of cold and vibration on the skin, Buzzy® significantly reduces pain perception. This study aimed to evaluate the effectiveness of Buzzy® in mitigating pain during subcutaneous administration of canakinumab in patients with FMF who are resistant to colchicine. This study included patients with colchicine resistance who were receiving canakinumab. Pain scores were evaluated before and after applying Buzzy® using the Visual Analog Scale (VAS), Wong-Baker FACES Pain Rating Scale (FPS-R), and Children's Fear Scale (CFS).

A total of 15 patients were included in the study. Nine patients (60%) were female, and six (40%) were male. The median age of the patients was nine years (five to 18 years). The median VAS, FPS-R, and CFS scores before Buzzy® were four (0 to eight), four (0 to eight), and one (0 to four), respectively. After Buzzy® application, the median VAS, FPS-R, and CFS scores were two (0 to six), two (0 to six), and 0 (0 to three), respectively. The VAS and FPS-R scores showed a significant reduction (p=0.04 and p=0.008, respectively), indicating a notable decrease in pain. Although the CFS scores also decreased following the use of Buzzy®, this reduction was not statistically significant (p=0.526).

According to the gate control theory of pain, methods like Buzzy® temporarily block pain signals from reaching the central nervous system by "closing the gates." In patients requiring continuous injections, such applications may reduce the pain and anxiety they experience.

Children's inability to forget the negative aspects of a painful event is associated with more anticipatory anxiety at an upcoming pain task and lower pain thresholds; however, the impact of forgetting on children's pain outcomes has not been examined. Retrieval-Induced Forgetting (RIF) was experimentally induced to investigate whether children would (1) forget more negative details of a previous painful autobiographic event and; (2) report better pain-related outcomes for an unrelated pain task (i.e., cold pressor task; CPT). Additionally, it was investigated whether the success of RIF was dependent on child characteristics known to influence children's memories for pain (i.e., attention bias to pain, attention switching ability and pain catastrophizing).

Healthy school children (N = 128; 9-16 years old) recalled and rehearsed memory details of two painful autobiographical events, while only children in the randomized RIF group rehearsed positive details. All children underwent two CPTs (before and after RIF) and reported pain-related outcomes. Two weeks later, children recalled CPT pain and reported on future pain expectancies.

Children in the RIF group remembered less negative details of their past autobiographical pain events, but also reported a greater reduction in pain-related fear from the CPT 2 compared to their ratings for CPT 1, than children in the control group. They furthermore expected less pain-related fear 2 weeks later for a future pain task.

Findings suggest that RIF is a promising avenue in pediatric pain management that could be harnessed to foster more positive memories and better future pain experiences.

Retrieval-induced forgetting (RIF) makes children forget negative details of a past autobiographical pain experience, decreases experienced pain-related fear for experimental pain and lowers future pain-related fear expectancies. Results show a promising role for RIF- based memory interventions in the context of paediatric pain care.

Parental anxiety and/or catastrophizing may bias the interpretation of children's pain and administration of analgesia post-tonsillectomy. We aimed to determine whether high levels of parental anxiety and/or catastrophizing impact child pain intensity interpretation and administration of analgesia.

Child-parent dyads were recruited from a tertiary care institution between July 2017-December 2019. Preoperative parental anxiety and catastrophizing were assessed using self-report measures. Postoperative data on child and parent pain intensity, as well as analgesia use, were collected up to 2 weeks post-surgery. Multivariable logistic regression models were created to assess predictors of postoperative child pain intensity and analgesia use.

Our cohort included 234 child-parent dyads. Median child age was 5 years (IQR, 4-6), and 9.0 % of children (n = 21) had a medical comorbidity. Both child- and parent-reported pain intensity were highest on postoperative day 2 (3.65 [SD = 3.08] and 3.67 [SD = 2.51], respectively). Parental catastrophizing did not predict analgesia use at home, although a minimal significant decrease in the odds of analgesia administration was observed on postoperative day 7 (OR 0.932, p = 0.017). Maximal parental anxiety did not predict higher odds of increased child postoperative pain intensity on any postoperative day.

Parental catastrophizing prior to tonsillectomy has minimal predictive value for analgesia use postoperatively. Children may be successfully advocating for their own pain control as parental anxiety and catastrophizing do not appear to be unduly influencing analgesia administration. Future studies should explore the impact of parental anxiety on vulnerable pediatric populations who may be unable to self-advocate for pain management.

In the preoperative period, non-pharmacological methods such as multimedia applications and visual and audio technological tools are used to reduce children's fear and anxiety levels and to distract their attention to create a more enjoyable experience. One of these innovative technologies having attracted attention recently is augmented reality technology. The study was aimed investigating the effects of reading an augmented reality storybook on fear and anxiety levels of children in the age group of 7-12 years in the preoperative period.

The sample of the study consisted of 60 children who met the inclusion criteria. Of them, 30 were in the augmented reality story group, and 30 were in the normal story group. Data were collected through the following data collection tools: 'Sociodemographic Information Form', 'Children's Anxiety Meter' and 'Child Fear Scale'. The book "One Child, One Miracle" was used as an intervention tool in the study. The clinical trial registration number of this randomized controlled experimental study is NCT06399016.

In the study, a statistically significant difference and a decrease in the pre-test and post-test fear and anxiety average scores of the children in both groups was observed. The mean fear score of the children in the Augmented reality storybook reading group decreased more than did the score of the children in the normal story reading group.

In order to prevent preoperative fear and anxiety in children staying in pediatric surgery clinics, it is recommended to expand the use of augmented reality storybooks before surgery. Reading stories is an effective, inexpensive and non-pharmacological intervention.

The aim of this study was to investigate the effect of the use of projector kaleidoscope and matching card on children's fear and physiological parameters in children aged 3-6 years receiving inhaled medication.

This randomised controlled study was conducted with the guidelines of Consolidated Standards of Reporting Trials (CONSORT). The sample of children was allocated to the projector kaleidoscope group (n = 38), matching card group (n = 38) and control group (n = 38). Fear and vital signs were measured.

In the study, the mean age of the children in the projector kaleidoscope group was 4.39 ± 1.10, the mean age of the children in the matching card group was 4.34 ± 0.96 and the mean age of the children in the control group was 4.28 ± 1.18. There was a statistically significant difference between the post-test scores of the Children's Fear Scale in the evaluation of parents and nurses according to the groups of children. There was a statistically significant difference between the respiratory post-test scores according to the groups of children. It was observed that the mean heart rate of the control group participants was higher than that of the children in the matching card group. There were no statistically significant differences in the post-test saturation values among the groups of children.

It was observed that the projector kaleidoscope and matching card reduced fear and prevented increased respiratory rate in children receiving inhaler medication. In addition, it was determined that matching card had more effect on heart and respiratory rate than projector kaleidoscope.

This study aimed to compare the effects of vacutainers of three different animal characters on pain and fear in children during bloodletting.

This randomized controlled trial included 180 children between the ages of 4 and 7 years who required bloodletting for routine control. Children were randomized into two groups: experimental and control groups. Routine bloodletting procedure was applied to those in the control group. Animal characters (butterfly, peacock and rabbit) chosen by children in the experimental group was attached to the vacutainer, and then their blood was drawn. The data were obtained by face-to-face interviews with the child, parent and observer before and after the procedure. Children's pain and fear/anxiety levels were evaluated using the Wong-Baker FACES Pain Scale and the Children's Fear Scale, respectively.

There was no statistically significant difference between the groups' pre-test scores with respect to age, BMI, gender, fear/anxiety assessments of the child, parent, and observer. Children in the experimental group had significantly lower pain and fear/anxiety levels after the procedure compared to those in the control group(p < 0.000).

Animal characters (butterfly, peacock and rabbit) attached to the vacutainer is effective in reducing both fear and pain levels in children during bloodletting.

Aim: This study aimed to determine hospital fear points, specific aspects of the hospital experience that are particularly frightening for children, and fear levels of children 5-10 years old who are admitted to the hospital. Methods: This descriptive cross-sectional study of 210 children in eastern Turkey aged 5-10 years used a Demographic Findings and Hospital Fears Form and the Child Fear Scale to collect data about the children's demographics, the opinions of the mothers about their children's fears, and the children's fears about the hospital. Results: Children in the outpatient treatment services and emergency department were afraid of blood drawing, intravenous insertion, injections (shots), and separation from their mothers. In the surgical department, in addition to painful procedures, children were most afraid of being forced to undergo the procedure, insertion of medications, being in the operating room, being awakened after surgery, and seeing the incision site. In the inpatient ward, children were most afraid of nurses and doctors entering the room. Conclusions: Children feared painful procedures, separation from their mothers, and the unknown in the hospital setting.

This study evaluated the efficacy of an eye massage device that uses acupressure points combined with natural sounds to reduce anxiety and pain in children receiving dental anesthesia for the first time. A total of 105 children aged between 8 and 10 years whose dental treatment required inferior alveolar nerve block (IANB) injection participated in this randomized controlled clinical trial. The participants were randomly divided into three groups: Group A: eye massage with natural sounds; Group B: eye massage only; and Group C (control group): traditional behavior management techniques. Anxiety and pain were assessed before, during, and after anesthesia using the Children's Fear Scale (CFS), Wong-Baker pain rating scale (WBS), the Face-Legs-Activity-Cry-Consolability (FLACC) observational pain assessment scale, and pulse rate as a physiological scale. Anxiety and pain significantly decreased in groups A and B compared with those in the control group (p < 0.05), with group A showing a greater decrease in pulse rate and objective pain assessed during injection via the FLACC scale than group B (p < 0.05); however, no significant difference was noted between groups A and B regarding the data recorded after anesthesia using the WBS and CFS (p > 0.05). Changes in pulse rate and anxiety levels (CFS) measured before and after the procedure in each group revealed a significant decrease in fear and pulse rate in group A and no significant change in group B, whereas group C showed a significant increase in pulse rate and fear at the end of the procedure. Eye massage with natural sounds can effectively alleviate children's anxiety in the dental setting and reduce pain related to anesthesia, and the combination of these two interventions has the best relaxation effect on children.

Adenotonsillectomy procedures can provide effective relief to children affected by sleep-disordered breathing (SDB), but the post-adenotonsillectomy pain management remains challenging, and the most effective approach to managing postoperative pain in these cases remains uncertain. The use of electronic media as a form of distraction therapy aimed at mitigating postoperative pain in children, it is unknown whether increases in screen time can effectively reduce persistent postoperative pain intensity or the incidence of negatively biased pain memories. A total of 107 SDB children undergoing adenotonsillectomy were enrolled and divided into two groups. Children in the intervention group were allowed to increase their screen time, while screen time was restricted for children in the control group. Child-reported pain intensity and negatively biased pain memories, pain-related fear were analyzed. The results indicated that no significant differences in initial postoperative pain intensity or fear were observed among groups. However, children in the intervention group did exhibit significantly reduced remembered Day 1 postoperative pain intensity (ηp2 = 0.043, p = 0.035), memory of worst pain intensity (ηp2 = 0.047, p = 0.027), and memory of worst pain-related fear (ηp2 = 0.042, p = 0.036) as compared to controls. Subgroup analyses based on age and gender indicated that males and school-aged children presented with lower scores for negatively biased pain memories. Our study exhibited the association between screen time and post-surgical pain intensity and negatively biased pain memories, These findings suggest that increasing screen time represents an effective approach to the postoperative management of negatively biased pain memories in certain subsets of children with SDB.

The purpose of this study was to evaluate the impact of children watching a video about their upcoming procedure on reducing anxiety and fear before endoscopy. This randomized controlled trial included 46 children aged between 6 and 12 years who underwent endoscopy in the pediatric gastroenterology unit of a hospital in the Black Sea Region of Turkey. Children were randomly assigned to the experimental group or the control group. Children in the experimental group (n = 22) watched video about their procedure, whereas children in the control group (n = 24) received a verbal explanation about the procedure in line with standard clinical practice. The children's pre-procedure fear levels were evaluated using the Children's Fear Scale, and anxiety levels were evaluated using the Children's Anxiety Meter-State measure. Parents and observers also completed the fear and anxiety level measures. Data were analyzed via SPSS version 25.0. A statistically significant difference was found between the fear and anxiety scores of the children in the experimental and control groups before and after watching the video, according to the evaluations of children, mothers, and nurses. We conclude that providing children with information about the endoscopy procedure beforehand can alleviate their associated fears and anxieties. This concern is equally important for older clients as well and suggested to be adapted to be age-appropriate for any population.

This study aimed to compare the effects of watching cartoons and playing games as a distraction method during peripheral intravenous cannula insertion on pain and fear of pain in children aged 6-9 years.

This RCT with a parallel-group randomized experimental design was conducted between May and July 2024 in the pediatric unit of a university hospital with a tertiary referral centre. Sixty-eight children aged 6-9 years were assigned to two different groups using block randomization method (Cartoon Group = CG; n = 34, Gaming Group = GG; n = 34). The Wong-Bakers FACES® Pain Rating Scale and Children's Fear Scale were used for data collection. The children's pain and fear of pain were evaluated 2 min before, during and 2 min after the procedure.

The mean age of the children (N = 64) was 7.41 ± 1.71 years (min-max = 6-9). Pain scores of GG (n = 32) were higher than CG (n = 32) (MD = 1.46; SE = 0.35; p < 0.001; %95 CI = 0.76-2.15). During the procedure, fear of pain scores of GG were higher than CG (MD = 0.78; SE = 0.32; p = 0.018; %95 CI = 0.13-1.42).

This study revealed that watching cartoons reduced the pain score by approximately 1.5 units and the fear of pain score by approximately 1 unit compared to playing online games during peripheral intravenous cannula placement in children aged 6-9 years.

In children aged 6-9 years planned to undergo peripheral intravenous cannula placement, watching a cartoon, one of the distraction techniques, can be recommended to effectively reduce pain and fear of pain. Tablets that allow watching cartoons and films, which are widely used and accessible in the clinical field, can facilitate the use of distraction techniques.

Anxiety is common in pediatric patients, especially during vascular access procedures. Most well-studied affect and anxiety scales, including the Observation Scale of Behavioral Distress-Revised (OSBD-r), the modified Yale Preoperative Anxiety Scale (mYPAS), and the modified Induction Compliance Checklist (mICC), are too cumbersome for clinical use outside of research settings. HRAD± (Happy, Relaxed, Anxious, Distressed with yes/no to cooperation) is a clinically-efficient observational scale that evaluates pediatric procedural affect and cooperation. This study examined the clinical utility of HRAD± during vascular access procedures in children. The aims were to investigate the correlation of HRAD± to highly reliable, research-based affect and cooperation scales and to assess inter-rater reliability (IRR) between observers in this setting.

This was a prospective, observational study conducted at Lucile Packard Children's Hospital Stanford. Inpatient participants were 1 month to 25 years old and undergoing a peripheral intravenous insertion or phlebotomy. Two trained research assistants (RAs) scored each patient independently during the vascular access procedure using HRAD±, OSBD-r, mYPAS, and mICC. Correlation analyses computed the associations between HRAD± and reference scales. IRR between RAs and vascular access providers was calculated using Fleiss' Kappa.

A total of 234 patients were included. HRAD± scores strongly correlated with OSBD-r and mYPAS (p < 0.0001, p < 0.0001, respectively). The cooperation assessment of HRAD± demonstrated strong correlation to mICC (p < 0.0001). IRR of HRAD± between research assistants and vascular access providers showed moderate agreement (p < 0.0001).

HRAD± demonstrated strong correlation to the reference affect and cooperation scales. This study supports the utility of HRAD± for rapid assessment of pediatric procedural anxiety and cooperation during vascular access procedures. HRAD± can serve as a practical tool for facilitating clinical decisions, and its wider incorporation into healthcare settings would importantly guide targeted interventions to reduce patient anxiety.

Dental anxiety usually stands in the way of obtaining adequate dental treatment, and the dental setting and team are considered factors that may affect dental anxiety. Many cross-sectional studies have indicated that dentally anxious children prefer their dentist to wear friendly attire rather than a conventional white coat, but no clinical trial has detected the effect of wearing a child's friendly attire on anxiety levels among young patients. A total of 120 children were enrolled in this study and divided into four groups in which the dentists wore either friendly attire or white coat in the reception and treatment areas. Anxiety and pain were assessed while the patients received a dental injection. A statistically significant decrease in anxiety levels was observed in the 1st group compared with the other three groups after dental infiltration into the maxilla. The pain scores were significantly lower in the 1st group, whereas the control group patients scored the highest scores. A child's friendly attire can help dentists build positive relationships with young patients and help reduce their anxiety.

The study aimed to evaluate the effects of musical-animated toys and audiobooks on the fear and pain in the tracheostomy care of children in the palliative care clinic.

The study design was a single-center, single-arm, crossover-controlled study. The sample consisted of 16 children who were 3-6 years old. Musical-animated toys and audiobooks were used to divert the children's attention during tracheostomy care. The children whose control data were collected on the first day were shown musical-animated toys on the second day and listened to an audiobook a week later. The children were video-recorded during the interventions.

The children who received musical-animated toy and audiobook interventions during and after tracheostomy care expressed less pain than those in the control group, and their fear levels were less during the care.

Audiobook and musical-animated toy interventions were effective in reducing children's procedure-related fear and pain during tracheostomy care in the pediatric palliative care clinic.

Virtual reality for routine immunisations in needle phobic children with and without developmental disabilities: a pilot study.

Virtual Reality (VR) headsets can improve needle procedure success and experiences for children, but they have not been evaluated to support immunisation in children with anxiety and behavioural challenges. This study assessed the feasibility and acceptability of VR for immunisation in children with needle phobia, including children with and without developmental disabilities.

A mixed method pilot study was conducted at the Royal Children's Hospital, Melbourne. Children with needle phobia aged 4-14 years scheduled for immunisation with distraction and conscious sedation were eligible. VR was offered to children with needle anxiety and/or developmental disabilities before and during immunisation in addition to standard care. Children and caregivers completed electronic surveys pre- and post-immunisation, followed by qualitative interviews post-immunisation. Clinicians completed post-immunisation surveys. Primary outcomes were feasibility and acceptability of VR according to children, caregivers and clinicians.

Between May and December 2022, we screened 54 children and included 30; 15 with and 15 without developmental disability. Preparation to use VR took less than five minutes for most children (24/30; 80 %). Twenty nine (96 %) used VR immediately before immunisation, and 17 (57 %) continued using it during immunisation (7 with developmental disability, 10 without). Twenty seven (90 %) children were immunised successfully, with a small reduction in required sedation. Of those who used VR during immunisation, 16/17 (94 %) reported a more positive overall experience. Of those who only used VR before immunisation, 3/13 (23 %) still reported benefit. VR was therefore described as beneficial for 19/30 (63 %) participants (9 with developmental disability, 10 without). Caregivers reported willingness to use VR in future immunisation encounters for 23/30 (77 %) children (11 with developmental disability, 12 without).

This pilot study suggests VR was feasible and acceptable for many children with needle phobia, both with and without developmental disability. These findings will inform a randomised controlled trial to assess effectiveness.

The use of a rapid, easy-to-use intervention could improve needle-related procedural pain management practices in the context of the Emergency Department (ED). As such, the Buzzy device seems to be a promising alternative to topical anesthetics. The aim of this study was to determine if a cold vibrating device was non-inferior to a topical anesthetic cream for pain management in children undergoing needle-related procedures in the ED. In this randomized controlled non-inferiority trial, we enrolled children between 4 and 17 years presenting to the ED and requiring a needle-related procedure. Participants were randomly assigned to either the cold vibrating device or topical anesthetic (4% liposomal lidocaine; standard of care). The primary outcome was the mean difference (MD) in adjusted procedural pain intensity on the 0-10 Color Analogue Scale (CAS), using a non-inferiority margin of 0.70. A total of 352 participants were randomized (cold vibration device n = 176, topical anesthetic cream n = 176). Adjusted procedural pain scores' MD between groups was 0.56 (95% CI:-0.08-1.20) on the CAS, showing that the cold vibrating device was not considered non-inferior to topical anesthetic. The cold vibrating device was not considered non-inferior to the topical anesthetic cream for pain management in children during a needle-related procedure in the ED. As topical anesthetic creams require an application time of 30 min, cost approximately CAD $40.00 per tube, are underused in the ED setting, the cold vibrating device remains a promising alternative as it is a rapid, easy-to-use, and reusable device.

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

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.

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.

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).

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.

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

gov Identifier: NCT05818761.

Healthcare professionals need to use effective pain and anxiety-relieving methods during blood drawing in children.

This study aimed to compare the effects of three different distraction methods (Virtual Reality Glasses, Kaleidoscope, and Distraction Cards) in reducing pain and anxiety during blood drawing in children.

This study was a randomized controlled study. The research was conducted on 400 children between the ages of 7 and 11 years who required blood for routine check-ups upon the doctor's request and who met the sample selection criteria. Children were randomized into four groups: Virtual Reality Glasses, Kaleidoscope, Distraction Cards, and Control Group. Data were collected using the Interview and Observation Form, Wong-Baker FACES Pain Rating Scale, and Children's Fear Scale. Wong-Baker FACES and Children's Fear Scale were assessed and reported by children, parent, and observer.

Pain assessments of the child, parent, and observer after the procedure, and anxiety assessments of the parent, and observer after the procedure in the Virtual Reality Glasses, Kaleidoscope, and Distraction Cards Group were significantly lower than the Control Group (p < 0.001).

All three methods applied to the child during blood drawing were effective in reducing the child's pain and anxiety level. However, it was found that the most effective method to relieve pain and anxiety is virtual reality glasses.

These results contribute to the pain and anxiety management of children during blood drawing.

NCT06192498.

Vaccination is an invasive procedure that causes pain. Uncontrolled pain negatively affects all aspects of life, including health. This study aimed to determine the effects of the Helfer skin tap technique and Buzzy® application on the levels of pain and fear experienced by 4-year-old children during measles-mumps-rubella (MMR) vaccination.

This study adopted a randomized controlled experimental design. The study sample consisted of 96 children (Helfer skin tap technique group: n = 32, Buzzy® group: n = 32, control group: n = 32) who received MMR vaccination. Children in the Buzzy® and Helfer skin tap technique groups received their respective interventions before and after vaccine injection, while children in the control group received routine vaccine injection.

Based on the parents' and nurse's observations, the pain and fear scores after vaccine injection were lowest in the Buzzy® group and highest in the control group. Based on the children's assessments, the pain scores after vaccine injection were lower in the Buzzy® group than in the Helfer skin tap technique group.

Buzzy® application and the Helfer skin tap technique have beneficial effects on children's pain and fear during MMR vaccination. Buzzy® application is more effective in reducing pain and fear during vaccine injection in children than the Helfer skin tap technique.

Nurses can increase the comfort of children by reducing pain during vaccination using Buzzy®.

This study aimed to determine the effect of animal-assisted intervention on the fears of hospitalized children in the emergency department (ED).

The randomized controlled trial was conducted between April and June 2023 in the Central Black Sea Region of Turkiye. The study included 70 children aged 5 to 7 years old (the study group was 35, and the control group was 35). The study and control groups were randomly assigned to strata using simple randomization. While goldfish were used for animal-assisted intervention in the study group, routine care was continued in the control group. The "Child Fear Scale" and "The Scale of Children's Fear of Nursing Interventions and Instruments Used in Hospital" were used as data collection tools.

The mean score of the fear scale in the post-test scores of the study group children was significantly lower than the control group (p < 0.001). After the animal-assisted intervention, the mean fear scores of the children in the care study group toward nursing interventions and the materials used decreased significantly (p < 0.001). Furthermore, when the two groups were compared, the difference between the post-test scores was not significant (p > 0.05).

Animal-assisted intervention was determined to be effective in decreasing the fear levels of the children in the study group.

During hospitalization in the emergency department, methods appropriate to the child's developmental level and animal-assisted interventions were found to be effective in reducing children's fear levels.

This study aims to compare vastus lateralis and ventrogluteal site utilizations concerning pain and fear in intramuscular injection in children between 4 and 6 years of age.

A randomized trial design was utilized in this study. Groups were randomly assigned as ventrogluteal (n=43) and vastus lateralis (n=40). Children in both groups were compared before, during, and after the procedure using the Children's Fear Scale and the Wong-Baker Faces Pain Rating Scale. Crying time was measured using a stopwatch during the procedure.

While the mean Children's Fear Scale total scores of the children in the ventrogluteal group were similar before the procedure, the mean Children's Fear Scale total scores during and after the procedure were significantly lower than the children in the vastus lateralis group. Wong-Baker Faces Pain Rating Scale mean scores were significantly lower in the ventrogluteal group. The mean crying time of the children in the ventrogluteal group was significantly lesser than those in the vastus lateralis group (p=0.000).

The results of the study showed that the choice of the ventrogluteal site in intramuscular injection in children between 4 and 6 years of age was effective in reducing pain, fear, and crying time.

Objective: Extended reality (XR) has increasing usage in medicine, especially surgical fields, but the scope of applications is largely limited to intraoperative navigation. The aim of this scoping review is to evaluate all the available literature on how XR technologies have been applied to otolaryngology-head and neck surgery (OHNS) beyond the operating room for applications such as patient education and interdisciplinary communication. Review Methods: Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, we systematically searched PubMed and Scopus. Studies were reviewed without temporal restriction. Inclusion criteria comprised English-language, peer-review papers or conference abstracts studying XR technologies for non-operative uses such as patient education, physician training, or interdisciplinary preoperative planning in the field of OHNS. Results: Database searching initially identified 1607 records. After filtering for duplicates, screening for relevance, and applying the inclusion criteria, 10 studies were ultimately included. This study identifies gaps in the existing literature and describes future applications and key areas of research. XR is a novel strategy for increasing patients' comprehension of their procedures and can facilitate improved communication and planning amongst a multidisciplinary surgical team during preoperative discussions. However, the existing literature is small in scale and has low statistical power for demonstrating clinical benefits. Conclusions: More robust studies are required to determine the true value of implementing XR. XR is a promising new technology with potential to advance education and patient care in OHNS. Ongoing research will continue to optimize the use of XR technology, ensuring safe and effective integration into clinical practice.

The Teddybear Hospital (TH) Project is an effort to increase children's knowledge and decrease their anxiety. It is also intended to improve medical students' pediatric communication skills. This study evaluated the educational effects on participating preschool children and medical students.

Preschool children were offered to bring their stuffed toys to the TH at our tertiary academic medical center. Medical students who had completed the pediatric surgery rotation staffed the TH, performed examinations, and interacted with the children. The children's knowledge of anatomy, medical equipment, and healthy lifestyle, along with their level of anxiety towards hospitalization, was assessed using preinterventional and postinterventional validated survey tools. Preschool peers who did not participate in the TH served as controls. Participating medical students were tested on professionalism and pediatric surgical knowledge during, and 3 weeks after the intervention, and compared to their nonparticipating peers.

A total of 131 children (63 intervention, 68 control) and 48 medical students (16 intervention, 32 control) participated in the study. Children's state anxiety decreased by 0.98 points (95% CI: -0.3 to -1.8, P <0.001), while knowledge increased significantly on 'healthy lifestyle' by 1.4 points (95% CI: 1.01-1.79, P <0.05), on 'medical equipment' by 4.5 points (95% CI: 3.8-5.2, P <0.0001), and on 'anatomy' by 5.05 points (95% CI: 4.73-5.73, P <0.01). No changes were detected in any of the outcome measures in the control group. Medical students' objective professionalism increased by 4.2 points (95% CI: 1.58-6.80, P <0.01) compared to nonparticipant medical students. The tests did not show an increase in the medical students' pediatric surgical knowledge.

Preschool participation in a TH increased knowledge and decreased anxiety regarding hospitalization and medical personnel. It also helped medical students to playfully acquire medical professionalism.

The most frequently performed invasive procedures in hospitals and healthcare centers are needle-related procedures, such as intravenous cannulation and phlebotomy, and they are identified as the major sources of pain, fear, and anxiety in children and adolescents. The objective of this systematic review was to evaluate the effectiveness of VR as a distraction measure to reduce pain, fear, and anxiety in children and adolescents undergoing needle-related invasive procedures. For this purpose, the CINAHL, Scopus, WOS, and Cochrane Library scientific databases were used. The protocol review was registered in PROSPERO (ID:42024563245), and inclusion and exclusion criteria were applied. Twenty-one studies were included in the systematic review, involving a total of 2663 participants. Significant differences favored the use of virtual reality for the control of pain intensity (WBFSpatients p = 0.001; MD = -1.83; 95% CI -2.93 to -0.72; WBFSparents p = 0.0002; MD = -2.61; 95% CI -4.00 to -1.23; WBFSnurses p = 0.0001; MD = -2.71; 95% CI -2.82 to -2.60; VAS/NRS p = 0.001, MD = -0.71; 95% CI -1.13 to -0.28), anxiety (CAMpatient p = 0.02, MD = -2.92; 95% CI -5.45 to -0.38; CAMparents p = 0.01, MD = -3.87; 95% CI -6.99 to -0.75) and fear (CFSpatients p = 0.0005, MD = -1.27; 95% CI -1.99 to -0.56; CFSparents p = 0.0005, MD = -1.33; 95% CI -2.08 to -0.58; and CFSnurses p = 0.04, MD = -1.13; 95% CI -2.24 to -0.03). However, high heterogeneity was noted. The use of virtual reality as a distraction appears to be a valuable strategy for reducing pain, fear, and anxiety during needle-related procedures, although further studies with higher methodological rigor, based on a standardized protocol, are needed.

Venipuncture is one of the most commonly performed medical procedures in paediatric care, but it can also be one of the most painful and distressing experiences for patients. Finding effective strategies to manage pain and fear associated with venipuncture is crucial for improving the paediatric patient experience and promoting positive health outcomes. This study aimed to evaluate the efficacy of a combined approach using a topical analgesic cream (TKTX cream) and a distraction technique (Trace Image and Colouring for Kids-Book, TICK-B) in reducing pain intensity and fear levels in children undergoing venipuncture procedures.

We conducted this randomised controlled trial among 176 children aged 6-12 years undergoing venipuncture. Participants were randomly assigned to four groups: TICK-B, TKTX cream, TICK-B+TKTX cream and a control group. Pain and fear were measured using the Wong-Baker FACES Pain Rating Scale and Children's Fear Scale. The study was carried out from 20 February 2024 to 1 June 2024 at the emergency unit of Heevi paediatric teaching hospital in the Kurdistan region of Iraq. In the intervention groups, TICK-B was applied for 2-3 min before needle insertion, and TKTX cream was applied 20 min before the venipuncture procedure. All outcome measures were evaluated 2-3 min after the completion of the venipuncture procedure.

The combined TICK-B (colouring book) and TKTX cream (topical anaesthetic) intervention was the most effective in reducing both pain intensity (mean score 2.80 vs 7.24 in the control, p<0.001) and fear levels (mean score 0.93 vs 2.83 in the control, p<0.001) during and after venipuncture procedures compared with individual interventions and control.

The combined TICK-B distraction and TKTX cream topical anaesthetic intervention was the most effective in reducing pain intensity and fear during and after venipuncture in children, providing a practical strategy for healthcare providers to optimise needle procedure management.

NCT06326125.

Managing pain and distress in children experiencing procedural pain is a priority in pediatric care. Nitrous oxide (pre-mixed formulation of 50% nitrous oxide to 50% oxygen) is widely used to alleviate anxiety or pain during care procedures in various medical domains. This pharmacological intervention is safe to administer to children. Administration by non-anesthesiologist personnel is widespread throughout the world, though it is almost exclusively performed by doctors and nurses. The purpose of this study is to describe the experience of nitrous oxide (N2O) use by medical assistants and safe handling during the performance of painful procedures.

A retrospective study was conducted in a pediatric outpatient unit of a regional hospital, including medical and surgical consultations.

Nitrous oxide was administered by medical assistants to 324 children aged 3 to 19 years. No respiratory and/or cardiovascular problems were noted. Most patients were calm and relaxed.

The use of N2O for minor procedures in children in a pediatric outpatient unit improved pain management through administration by medical assistants with a high level of satisfaction from patients, parents and health professionals.

This study suggests that the use of nitrous oxide by trained medical assistants can be safe, feasible and effective within the specific context of this study.

In pediatric emergency units, intramuscular injection is one of the most common procedures that cause pain and fear in children. Reducing pain and fear is important for patient comfort.

This randomized controlled experimental study aimed to determine the effects of ShotBlocker® and the Helfer skin tap technique on the pain and fear experienced by children aged 6-12 years during intramuscular injection in pediatric emergency units.

This study was conducted from April 2022 to October 2023 among 177 children aged 6-12 years. ShotBlocker and the Helfer skin tap technique were applied during intramuscular injection among children in the intervention groups (ShotBlocker group: n = 59, Helfer skin tap technique group: n = 59), while children in the control group received routine injections. (n = 59). The levels of pain and fear were measured.

In the analysis of the age distribution of the children, the average age of the Helfer skin tap technique group was found to be 8.54 ± 2.00 years; ShotBlocker group, 8.46 ± 1.99 years; and control group, 9.19 ± 2.01 years. There was a significant difference in the post-intervention Wong-Baker Pain Scale and Child Fear Scale scores based on the evaluation of the children, parents, and observer nurses between the groups (p < 0.05). The pain and fear scores of the ShotBlocker group were lower than those of the control group (p < 0.05).

ShotBlocker is more effective in reducing pain than the Helfer skin tap technique among children receiving intramuscular injection. These cheap and easy-to-use methods are recommended for use in emergency units.

Pain science education (PSE) can be used as part of treatment and prevention for chronic pain in children. We assessed the effectiveness of PSE on knowledge, beliefs, attitudes, and behaviors in children and the people that care for children. We set a minimum criterion for education to address pain biology knowledge. We included studies aimed at both treatment and prevention of chronic pain. We conducted searches using 5 databases. We assessed the risk of bias using the Cochrane Risk of Bias 2 tool. Data were pooled using a random-effects meta-analysis or assessed using a narrative synthesis. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation. We screened 14,505 records and included 7 studies involving 351 caregivers and 1,285 children. Four studies were included in meta-analyses. We found low-certainty evidence that PSE has a large beneficial effect on caregiver knowledge and beliefs compared with alternative education (standardized mean difference = 1.14 [95% confidence interval: .88-1.42]; I2 = 0%). We found no difference in functional disability in children with chronic pain after PSE (Functional Disability Inventory score mean difference = .73 [95% confidence interval: -.81 to 2.27; I = 0%]). Narrative syntheses showed low-certainty evidence for improved knowledge and beliefs in children with preventative and treatment effects. Overall, we found few studies, and along with high risk of bias, this significantly contributed to the low certainty of findings. The effect of learning pain science for both preventative and treatment effects in children, carers, and the child/carer dyad remains mostly unknown. This review was prospectively registered with The international Prospective register of systematic reviews (CRD42022344382) on July 22, 2022. PERSPECTIVE: This review examines the effect of PSE on pain-related knowledge, beliefs, attitudes, and behaviors in children and the people that care for children (0-18). The findings contribute to knowledge about pain treatments and health promotion for caregivers and their children with and without chronic pain.

The aim of this study; is to determine the level of pain and anxiety experienced by pediatric patients with operated humeral supracondylar fractures during pin removal, and to investigate the effectiveness of animated video impressions.

This randomized controlled study included 180 patients aged between 4 and 12 years. The patients were divided into four groups: Group 1-control; Group 2-watched the introductory animation video before the procedure; Group 3-using analgesic before the procedure (ibuprofen 10 mg/kg); Group 4-watched the introductory animation video and used analgesic before the procedure. To assess pain before randomization, before-during-after procedure, and at outpatient clinic controls; the Wong-Baker Pain Scale (WBS), modified CHEOPS (Children's Hospital of Eastern Ontario Pain Scale), and the child's heart rate were used. To assess anxiety; the Children's Anxiety Meter (CAM), The Short State Anxiety Inventory Scale (SAIS), and The Children's Emotion Management Scales (CEMS) were used.

While a significant difference was detected between the groups in the tests performed at certain intervals (p < 0.001), no significant difference was detected between Groups 1-3 and Groups 2-4. The Modified CHEOPS and CEMS values obtained during the procedure showed significant variability between the groups (p < 0.001). Similarly, While a significant difference was detected between the groups in the WBS scores measured during the procedure (p < 0.001), it was observed that there was no significant relationship between Groups 1-3 and Groups 2-4 (p = 0.892, p = 0.820).

Watching an introductory animated video before pin removal is an effective method to relieve the anxiety and pain felt in children with supracondylar fractures.

Virtual reality (VR) distraction can be used during peripheral intravenous catheter (PIC) insertion. The vein imaging devices are recommended for increasing PIC success.

This study aimed to evaluate the effect of a Veinlite PEDI2 and passive VR distraction on the first attempt at PIC insertion success, duration of insertion, emotional behavior, pain, fear, and anxiety associated with PIC insertion in children aged 4-10 years in the pediatric emergency department.

The study was conducted with a total of 160 children who were assigned to groups (control, vein imaging, VR, and vein imaging with VR) through stratified randomization. The duration and number of attempts for PIC insertion were recorded. The children's emotional state, fear, and anxiety were evaluated before and after the procedure. After the procedure, pain was evaluated using the Wong-Baker FACES and Color Analog Scale. The mean scores obtained from the scales were compared using the Kruskal-Wallis test.

The PIC success rate on the first attempt was 80-85% in the groups. A significant difference was found between the groups in terms of total emotional behavior scores (KW = 21.608, df = 3, p < 0.001). There were statistically significant differences among the groups in emotional behavior, pain, and anxiety scores after the procedure, while no difference was observed in fear scores (KW = 6.485, df = 3, p = 0.09).

VR distraction effectively reduced pain and anxiety, while the Veinlite PEDI2 did not affect the first attempt at PIC insertion or duration.

VR and Veinlite PEDI2 can be used for PIC insertion-related pain and anxiety (ClinicalTrials.gov: NCT06243419).

The aim of this study is to examine the effects of preoperative therapeutic play on fear and anxiety levels in preschool children.

The study had an experimental pre-intervention-post-intervention design with a control group. The study was carried out with 37 children aged 3-6 years who were brought for surgical procedures at XX Research and Training Hospital between July 2020 and January 2021. While a therapeutic play intervention was performed with the children in the experimental group (n = 20), routine preoperative practices were performed in the control group (n = 17). Data were analyzed using chi-squared tests, the Mann-Whitney U test, and the Wilcoxon test. p < 0.05 was considered significant.

The fear and anxiety levels of the children in the experimental and control groups were similar pre-intervention (p > 0.05). In the post-intervention, the mean anxiety and fear scores of the experimental group were 2.15 ± 1.63 and 1.15 ± 0.58, their mean ranks were 10.80 and 12.65, while the mean anxiety and fear scores of the control group were 7.94 ± 2.07 and 2.53 ± 1.00, their mean ranks were 28.65 and 26.47, respectively, and the difference between the groups was statistically significant (respectively, MU = 6.00 p = 0.000, MU = 43.00 p = 0.000).

It was determined that the therapeutic play method applied before surgery reduced the anxiety and fear levels of children. Considering this situation, improving the skills of nurses in therapeutic play and increasing the number of personnel certified for interactive therapeutic games can reduce the risk of preoperative emotional trauma in children.

The therapeutic play method applied before surgery reduced the anxiety and fear levels of children. The routine use of therapeutic play in pediatric surgery clinics is recommended.