Effects of Active and Passive Distraction Intervention on Pain Responses of Preschool Children during Immunization

능동적 및 수동적 관심전환 중재가 예방접종 시 학령전기 아동의 통증반응에 미치는 효과

  • 임은선 (전남과학대학교 간호학과) ;
  • 김진선 (조선대학교 간호학과)
  • Received : 2016.08.26
  • Accepted : 2016.11.07
  • Published : 2016.12.28


The purposes of this study were to identify the effects of distraction strategies compared to usual pain management, and to compare the effects of passive and active distraction on pain responses of preschool children during immunization. A quasi experimental with non-equivalent control group posttest design was used. Participants for each group were 30 preschool children who visited a pediatric clinic to have influenza immunization. Children in experimental groups selected one of two distraction types. Pain responses were measured by children, parents, and researcher. Pain responses by children, parents, and researcher during immunization were significantly different between groups. Children in passive or active distraction group were more distracted than children in control group. Moreover, self-reported pain response by children($2.70{\pm}0.88$) and researcher($12.97{\pm}2.39$) in active group were higher than pain scores by children($2.27{\pm}0.64$) and researcher($10.63{\pm}1.65$) in passive group. Results of this study identified that distraction intervention is an effective method for decreasing pain responses in preschool children during immunization. Passive distraction is more effective than active distraction. Use of distraction strategies during immunization should be facilitated. Further research comparing distraction strategies by types and forms is needed.


  2. E. S. Im and J. S. Kim, "Distraction techniques for children undergoing procedures: A critical review of korean intervention research," Child Health Nursing Research, Vol.20, No.4, pp.340-349, 2014.
  3. N. L. Schechter, W. T. Zempsky, L. L. Cohen, P. J. McGrath, C. M. McMurtry, and N. S. Bright, "Pain reduction during pediatric immunizations: evidence-based review and recommendations," Pediatrics, Vol.119, No.5, pp.1184-1198, 2007.
  4. D. Soetenga and T. A. Pellino, "Assessment of the validity and reliability of the university of wisconsin children's hospital pain scale for preverbal and nonverbal children," Pediatric Nursing, Vol.25, No.6, p.670, 1999.
  5. R. M. Kennedy, J. L. Luhmann, and W. T. Zempsky, "Clinical implications of unmanaged needle-insertion pain and distress in children," Pediatrics, Vol.122, pp.S130-133, 2008.
  6. M. McCaffery and A. Beebe, Pain: Clinical manual for nursing practice, St. Louise: Mosby, 1989.
  7. C. Kleiber and D. C. Harper, "Effects of distraction on children's pain and distress during medical procedures: A meta-analysis," Nursing Research, Vol.48, No.1, pp.44-49, 1999.
  8. F. R. Berberich and Z. Landman, "Reducing immunization discomfort in 4-to 6-year-old children: A randomized clinical trial," Pediatrics, Vol.124, No.2, pp.e203-209, 2009.
  9. J. M. Boivin, L. Poupon-Lemarquis, W. Iraqi, R. Fay, C. Schmitt, and P. Rossignol, "A multifactorial strategy of pain management is associated with less pain in scheduled vaccination of children. A study realized by family practitioners in 239 children aged 4-12 years old," Family Practice, Vol.25, No.6, pp.423-429, 2008.
  10. K. L. Cassidy, G. J. Reid, P. J. McGrath, G. A. Finley, D. J. Smith, C. Morley, E. A. Szudek, and B. Morton, "Watch needle, watch TV: Audiovisual distraction in preschool immunization," Pain Medicine, Vol.3, No.2, pp.108-118, 2002.
  11. G. M. French, E. C. Painter, and D. L. Coury, "Blowing away shot pain: A technique for pain management during immunization," Pediatrics, Vol.93, No.3, pp.384-388, 1994.
  12. L. L. Cohen, "Behavioral approaches to anxiety and pain management for pediatric venous access," Pediatrics, Vol.122, No.3, pp.134-139, 2008.
  13. D. Koller and R. D. Goldman, "Distraction techniques for children undergoing procedures: A critical review of pediatric research," Journal of Pediatric Nursing, Vol.27, pp.625-681, 2012.
  14. C. V. Bellieni, D. M. Cordelli, M. Raffaelli, B. Ricci, G. Morgese, and G. Buonocore, "Analgesic effect of watching TV during venipuncture," Archives of Disease in Childhood, Vol.91, No.12, pp.1015-1017, 2006.
  15. J. E. MacLaren and L. L. Cohen, "A comparison of distraction strategies for venipuncture distress in children," Journal of Pediatric Psychology, Vol.30, No.5, pp.387-396, 2005.
  16. S. Mason, M. H. Johnson, and C. Woolley, "A comparison of distracters for controlling distress in young children during medical procedures," Journal of Clinical Psychology in Medical Settings, Vol.6, pp.239-248, 1999.
  17. S. Nilsson, K. Enskar, C. Hallqvist, and E. Kokinsky, "Active and passive distraction in children undergoing wound dressings," Journal of Pediatric Nursing, Vol.28, pp.158-166, 2013.
  18. J. Y. Son, The effects of video distraction by a mobile phone on pain during intravenous injection for hospitalized preschool children, Inha University, Master's thesis, 2009.
  19. M. H. Cho, Effects of distraction on pain and fear behavioral responses during immunization among preschool children, Ewha Womans University, Master's thesis, 2011.
  20. M. J. Hong, The effect of listening to music on the pain behavioral responses on infant Immunization, Sookmyung Women's University, Master's thesis, 2012.
  21. S. Caprilli, L. Vagnoli, C. Basani, and A. Messeri, "Pain and distress in children undergoing blood sampling: Effectiveness of distraction with soap bubbles: A randomized controlled study," Giornale Italiano di Scienze Infermieristiche Pediatriche, Vol.4, No.1, pp.15-18, 2012.
  22. D. L. Wong and C. M. Baker, "Pain in children: Comparison of assessment scales," Pediatric Nursing, Vol.14, No.1, pp.19-27, 1988.
  23. C. T. Chambers, K. Giesbrecht, K. D. Craig, S. M. Bennett, and E. Huntsman, "A comparison of faces scales for the measurement of pediatric pain: Children's and parents' ratings," Pain, Vol.83, No.1, pp.25-35, 1999.
  24. J. F. Keck, J. E. Gerkensmeyer, B. A. Joyce, and J. G. Schade, "Reliability and validity of the faces and word descriptor scales to measure procedural pain," Journal of Pediatric Nursing, Vol.11, No.6, pp.368-374, 1996.
  25. E. C. Huskisson, "Measurement of pain," Lancet, Vol.304, No.7889, pp.1127-1131, 1974.
  26. E. Sanchez-Rodriguez, J. Miro, and E. Castarlenas, "A comparison of four self-report scales of pain intensity in 6- to 8-year-old children," Pain, Vol.153, pp.1715-1719, 2012.
  27. S. Lebaron and L. Zeltzer, "Assessment of acute pain and anxiety in children and adolescents by self-reports, observer reports, and a behavior checklist," Journal of Consulting and Clinical Psychology, Vol.52, No.5, pp.729-738, 1984.
  28. H. Y. Koo, H. R. Park, and J. H. Lim, "Effects of distraction using balloon art on pain during intravenous injections in preschool children," Child Health Nursing Research, Vol.13, No.1, pp.66-72, 2007.
  29. J. H. Lim and Y. Shin, "Effects of distraction by a cellular phone on pain and fear during venipuncture procedure for hospitalized preschool children," Child Health Nursing Research, Vol.13, No.4, pp.506-511, 2007.
  30. M. Ipp, E. Cohen, M. Goldbach, and C. Macarthur, "Effect of choice of measles-mumps-rubella vaccine on immediate vaccination pain in infants," Archives Pediatrics & Adolescent Medicine, Vol.158, No.4, pp.323-326, 2004.