Multimodal distraction reduces intravenous cannulation pain and anxiety in preschoolers: Controlled prospective study

BACKGROUND Hospitalization and intravenous (IV) procedures are known to provoke significant pain and anxiety in preschool children, potentially leading to long-term psychological distress. Despite growing evidence supporting distraction techniques, practical, low-cost interventions suited for resource-limited settings remain underutilized. AIM To determine the effectiveness of a nurse-led multimodal distraction intervention – comprising balloon blowing, art therapy, and kaleidoscope use – in reducing pain and anxiety during IV therapy among hospitalized preschool children. METHODS A posttest-only controlled observational study was conducted at Shri Vinoba Bhave Civil Hospital, India. A total of 600 hospitalized preschoolers (aged 3-6 years) were randomly allocated to either an experimental group (n = 300; distraction intervention) or control group (n = 300; routine care). Pain was measured using the Wong-Baker FACES Pain Rating Scale, and anxiety was assessed using the Visual Analogue Anxiety Scale. The distraction intervention included daily 5-minute sessions: (1) Pre-procedure familiarization (balloon/art); (2) Intra-procedure distraction (kaleidoscope and balloon blowing); and (3) Post-procedure relaxation. Outcomes were evaluated on day 3. Data were analyzed using independent t -tests and correlation analysis. RESULTS Children in the experimental group had significantly lower pain scores [mean ± SD (3.07 ± 1.39)] than the control group (8.80 ± 1.01) (t = 58.56, P < 0.00001). Anxiety levels were also reduced in the experimental group (5.85 ± 1.56 mm) compared to controls (9.39 ± 0.73 mm) (t = 35.55, P < 0.00001). A moderate positive correlation was found between pain and anxiety in both groups (experimental: r = 0.67; control: r = 0.66; P < 0.05). Significant associations were also found between pain levels and variables such as age, IV site, cannula size, and medication type (P < 0.05). CONCLUSION This study demonstrates that a simple, low-cost, nurse-led multimodal distraction strategy can significantly reduce pain and anxiety in preschool children undergoing IV therapy. Its ease of use and scalability make it highly suitable for immediate integration into pediatric care, especially in low-resource healthcare settings.