The Effect of Watching Cartoon on Pain and Anxiety of Venipuncture in 3-6 Year-Old Children: A Randomized Controlled Clinical Trial

Background: Injection-induced anxiety in children is a significant issue, as the pain from injections creates both physical and psychological stress, reducing the child's tolerance and cooperation. Objectives: To determine the effect of watching a cartoon on venipuncture-induced pain and anxiety among 3 - 6-year-old hospitalized children. Methods: In this randomized controlled clinical trial, children admitted to the pediatric ward of Bu-Alisina Hospital in Sari were randomly allocated to intervention and control groups. For the intervention group, the distraction technique of watching a cartoon was used during venipuncture. The demographic and medical information was collected using a questionnaire, and pain and anxiety were assessed using the Spence Children’s Anxiety Scale (SCAS)-Parents version, the face, legs, activity, cry, and consolability (FLACC) Behavioral Pain Scale, and the Facial Image Scale (FIS) before and during venipuncture. Data analysis was performed using non-parametric tests, with a significance level set at less than 0.05. Results: A total of 140 children were studied in two groups, with 78 (55.71%) being boys. The mean age of children in the intervention group was 52.44 ± 14.37 months, and in the control group, it was 50.91 ± 15.66 months. In the intervention group, the mean pain ranks before and after venipuncture were 4.17 ± 2.36 and 6.0 ± 2.42, respectively, while in the control group, they were 4.40 ± 1.96 and 6.93 ± 2.21, respectively. The mean anxiety ranks before and after venipuncture were 2.61 ± 1.32 and 3.26 ± 1.35 in the intervention group, and 2.80 ± 1.016 and 3.80 ± 0.99 in the control group. The mean pain and anxiety ranks after venipuncture were significantly different between the groups (P < 0.05). Additionally, the mean ranks of pain and anxiety before and after venipuncture were significantly different within both groups (P < 0.001). Conclusions: Based on the results of this study, the cartoon distraction technique effectively reduced pain and anxiety caused by venipuncture in children.