Comparison of the effectiveness of two active distraction methods in reducing pain, fear, and anxiety in children during venipuncture: a randomized controlled trial.

BACKGROUND

Pediatric venipuncture is one of the most stressful invasive procedures for children, often accompanied by intense pain, fear, and anxiety. This study aimed to compare the effects of two active distraction methods-bubble blowing and a material-free cognitive distraction/positive reinforcement technique-on pain, fear, and anxiety.

METHODS

This randomized controlled parallel-group trial was conducted between April and July 2025 in the pediatric venipuncture unit of a university hospital in western Türkiye. The sample comprised 207 children who met the inclusion criteria. The experimental arm included 135 children allocated to either Positive Reinforcement (n = 72) or Bubble Blowing (n = 63), and the control group consisted of 72 children who received standard care without any additional intervention during venipuncture. Data were collected using the Wong-Baker FACES Pain Rating Scale, the Child Fear and Anxiety Scale, and a Visual Analog Scale. Children's self-reported pain, fear, and anxiety scores were used as the primary outcome data. Parametric and nonparametric tests and effect sizes were used in the analyses.

RESULTS

In the control group, postprocedural pain and anxiety scores increased significantly (p < .001), whereas the increase was attenuated in the bubble-blowing and positive reinforcement groups. Because baseline fear/anxiety scores differed between groups, ANCOVA was performed using preprocedural fear/anxiety scores as a covariate; the adjusted group effect remained statistically significant. In the positive reinforcement group, the increase in fear- anxiety scores was small and did not reach statistical significance. Bubble blowing was more effective than positive reinforcement in reducing pain.

CONCLUSION

Both distraction techniques were associated with lower postprocedural pain and psychological distress scores compared with standard care. Bubble blowing showed a stronger effect on pain outcomes, whereas the positive reinforcement group showed only a small, statistically non-significant increase in fear/anxiety scores. These findings support the integration of simple, low-cost distraction strategies into pediatric nursing practice and skills training.

TRIAL REGISTRATION: The clinical trial registration number is NCT07249723. Registered 18 November 2025 - Retrospectively registered.