In this prospective RCT, 120 children ages 6-12 underwent phlebotomy while using no intervention, DistrACTION® cards, inflating a balloon or identifying music from cartoons. DistrACTION® cards had the lowest reported pain (p=.04) and significantly lower anxiety than control group pain. This study is significant in that it demonstrates that given two active distraction activities, incorporating a visual task was superior to an aural/audio task. Likewise, breathing out is physiologically a useful anxiety reliever – this study supports that active visual distraction is superior to a deep breathing distraction as well.
Kaleidoscopes have long been a visual distraction for patients undergoing painful procedures. They allow children to actively manipulate the device, while passively watching colors change. This study randomized 188 children ages 7-12 to control, DistrACTION® cards, or kaleidoscope during phlebotomy. DistrACTION® cards had the lowest reported pain (significantly lower than control) and significantly reduced anxiety (p<.001) compared to both other groups. Monkey distraction Cards were used in this study, with questions including “How many monkeys are actually touching the bed” and “can you find the two monkeys which are identical?”
123 children were prospectively randomized to either DistrACTION® cards or parental presence for phlebotomy. Patients in the DistrACTION® group reported a pain of 3.90 +/- 1.94, 95% CI 3.91–4.39 compared to 6.51 +/- 1.65, 95% CI 6.10–6.92, P<.001. Procedural anxiety was also reduced. Of note, 97% in the DistrACTION® card group reported the procedure was better compared to previous phlebotomy experiences, as opposed to none of those in the control group. For children who have anxiety from previous procedures, this finding implies that improving the experience may be able to change the anxiety or perception going forward.