Three Distraction Techniques for Pain and Anxiety in Children During Allergy Skin Prick Testing

The Effect of Three Different Distraction Techniques on Anxiety and Pain Levels in Children During Allergy Skin Prick Testing: A Randomized Controlled Trial

This randomized controlled trial compared three distraction techniques-animated cartoons, DistrACTION® Cards, and interactive video games-with standard care for reducing procedural pain and anxiety in children aged 6-10 years undergoing allergy skin prick testing. A total of 161 children were randomly assigned to four groups. Pain was rated by the child, a parent, and the researcher with the Wong-Baker FACES Pain Rating Scale during and after the procedure, and anxiety was rated by the parent and the researcher with the Children's Fear Scale before, during, and after the procedure.

This single-center, four-arm, parallel-group randomized controlled trial was conducted in the pediatric allergy outpatient clinic of a training and research hospital in Istanbul, Turkey, between November 2019 and January 2020. Children aged 6-10 years referred for allergy skin prick testing were randomly allocated by computer-generated assignment to a cartoon group (n = 40), a DistrACTION® Cards group (n = 40), a video game group (n = 40), or a standard-care control group (n = 41). All tests were performed by the same pediatric nurse under identical conditions. Between-group differences were tested with one-way ANOVA and change over time with two-way repeated-measures ANOVA.

Inclusion Criteria:

• Aged 6-10 years
• Referred for allergy skin prick testing
• Consent of both child and parent
• No analgesic use in the previous six hours
• Able to understand the Wong-Baker FACES Pain Rating Scale and answer the card questions

Exclusion Criteria:

• Neurodevelopmental conditions (diagnosis of autism or intellectual disability)
• Chronic mental, cognitive, or visual problems
• Cognitive, visual, or hearing impairment preventing scale use