Clinical Question: Does distracting children undergoing laceration repair decrease their anxiety and pain distress?

Setting: Emergency department

Study Design: Randomized controlled trial (nonblinded)

Allocation: Concealed

Synopsis: Distraction can diminish anxiety and pain during procedures—it is a large aspect of the Lamaze method used in childbirth. The researchers conducting this study evaluated the effect of age-appropriate distracters on 240 children between six and 18 years of age presenting to an emergency department for simple laceration repair. After receiving topical anesthetic, the children were randomly assigned, using concealed allocation, to receive a distraction or to spend time with study personnel without distraction.

The children in the distraction group were offered a compact disc player with headphones, video games, a cartoon video, to have a book read to them, or they were given help blowing bubbles. Suturing was performed in a standardized manner. Using a 7-point facial pain scale, pain did not differ between the two groups. Parental assessment of pain distress, as measured using a 100-mm visual analog scale, was significantly less in distracted children younger than 10 years (P < .01), although preprocedure scores in both groups were low (2.91 to 3.31 out of a possible 10). Children older than 10 years were evaluated using the State Trait Anxiety Inventory for Children, and anxiety scores on this scale were lower in the children receiving distraction, with a change from the start to the end of the procedure of 12.3 (95% confidence interval [CI], 10.5 to 14.2) in the distracted group and 6.1 (95% CI, 4.6 to 7.5) in the control group (P < .001).

Bottom Line: Pleasing, age-appropriate distractions (e.g., video games, cartoons, music) during a procedure such as a laceration repair do not improve pain relief attained with topical anesthesia but decrease situational anxiety in children older than 10 years. (Level of evidence: 1b)