Toward Age-Specific Application of Pediatric Non-Pharmacological Pain Strategies: A Bayesian Reanalysis of the Buzzy...

Needle-related procedures are among the most frequent and distressing experiences for children. The Buzzy device, which combines cold and vibration, has emerged as one of the best non-pharmacological tools to reduce procedural pain and anxiety. However, its effectiveness may vary substantially across age groups, a factor not consistently addressed in prior literature. This stands in sharp contrast to pain assessment, where age-specific tools are routinely applied, while comparable rigor is lacking for non-pharmacological interventions.

We conducted a Bayesian reanalysis of the most recent systematic review and meta-analysis on the Buzzy device in pediatrics, including sixteen randomized controlled trials reporting pain outcomes and six reporting anxiety outcomes. Bayesian hierarchical random-effects models were applied, and study-level covariates were examined through meta-regression. Posterior distributions, credible intervals (CrIs), and Bayes factors (BFs) served to quantify the strength of evidence.

Buzzy significantly reduces pain (SMD -1.05, 95% CrI -1.41 to -0.70) and anxiety (SMD -1.59, 95% CrI -2.65 to -0.54). Age emerged as a significant moderator of pain reduction: children aged 7 years or older showed stronger benefit (posterior probability = 97.9%; BF = 13.9). In contrast, no meaningful associations were observed with sex distribution, procedure type, or risk of bias. For anxiety, the age effect was inconclusive, reflecting limited study numbers and wide credible intervals.

This Bayesian reanalysis confirms the effectiveness of Buzzy for pediatric procedural pain while highlighting age as a key determinant. The device appears more beneficial in children aged 7 years or older, supporting its preferential use in school-aged populations, where the greatest clinical benefit is observed.