Evaluation of Play Distraction and Streamed Video Clips in Alleviating Anxiety Before Oral Premedication Among Pediatric Patients: A Randomized Controlled Trial

BACKGROUND: Preoperative anxiety in children is common and may impair cooperation and perioperative outcomes. Although oral midazolam is widely used, acceptance may be poor and residual anxiety often persists, resulting in increased distress for both child and parent. Behavioral distraction techniques may improve anxiolysis and facilitate premedication administration. AIM: To compare active distraction using play dough with passive distraction using video clips for reducing preoperative anxiety and improving acceptance of oral midazolam in children undergoing elective surgery under general anesthesia. METHODS: Two hundred and ten children aged 3-7 years with American Society of Anesthesiologists physical status I-III were randomized in a 1:1:1 ratio to receive play dough, streamed video clips, or standard care. Anxiety was assessed using the Modified Yale Preoperative Anxiety Scale at baseline, after a 3-min acclimatization period, immediately after the intervention, and 20 min after oral midazolam administration. RESULTS: Baseline anxiety scores were comparable among groups. Immediately after the intervention and 20 min after oral midazolam administration, anxiety scores were significantly lower in both intervention groups than in the standard care group (p < 0.001). Twenty minutes after oral midazolam administration, anxiety reduction was greater in the play dough group than in the streamed video clips group (adjusted mean difference -15.4, 95% confidence interval -18.2 to -12.6; p < 0.001). Acceptance of oral midazolam was highest in the play dough group (98.6%), followed by the streamed video clips group (78.6%) and the standard care group (11.4%) (p < 0.001). Both intervention groups also demonstrated lower parental anxiety and higher parental satisfaction than standard care. CONCLUSIONS: Active distraction using play dough provides superior anxiolysis and improves premedication acceptance compared with passive video distraction and standard care in young children undergoing general anesthesia. Incorporating simple play-based distraction into routine preoperative practice may improve the perioperative experience for both children and parents. TRIAL REGISTRATION: Clinical Trials Registry-India (CTRI/2024/05/067549; URL: www.ctri.nic.in).