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The Eeffectiveness of distraction cards in reducing pain in children: A meta-analysis of randomized controlled trials
1Faculty of Health Science, Pediatric Nursing Department, Pamukkale University, Denizli, Türkiye.
Insights
Distraction cards effectively reduce pain and anxiety in children during medical procedures. This non-pharmacological method is recommended for pediatric nursing practice.
Area of Science:
- Pediatric Nursing
- Pain Management
- Child Psychology
Background:
- Distraction cards offer age-appropriate visual and cognitive engagement.
- They serve to divert children's attention from painful stimuli during medical procedures.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of distraction cards.
- To evaluate their impact on pain and anxiety in children (ages 3-18) during invasive procedures.
Main Methods:
- Systematic review and meta-analysis of 15 randomized controlled trials (2010-2025).
- Searched multiple databases (CINAHL, PubMed, Web of Science, etc.) following PRISMA 2020 guidelines.
- Utilized random-effects model for Standardized Mean Differences (SMDs) and assessed heterogeneity (I² statistic).
Main Results:
- Distraction cards significantly reduced pain across self, parent, and observer reports (large effect sizes).
- Significant anxiety reduction was noted in parent and observer reports, but not children's self-reports.
- High heterogeneity (I² > 90%) was observed in the analyses.
Conclusions:
- Distraction cards are a low-cost, implementable non-pharmacological intervention.
- Recommended for pediatric nursing to enhance patient experience and reduce procedural pain/anxiety.
- Supports parental involvement in care during painful procedures.
Background:
Distraction cards, colorful pictures, and puzzles are age-appropriate visual and cognitive content that can be used to divert a child's attention away from painful stimuli.
Objective:
This systematic review and meta-analysis aimed to evaluate the effectiveness of distraction cards in managing pain and anxiety during invasive medical procedures in children aged 3 to 18 years.
Methods:
Fifteen randomized controlled trials published between 2010 and 2025 were included. Articles were identified using specific keywords in the CINAHL, Cochrane Central, Web of Science, PubMed, Scopus, ScienceDirect, Eric, EBSCO, and OVID databases. The study followed PRISMA 2020 guidelines, and risk of bias was assessed using the Cochrane Collaboration tool. Data were synthesized using a random-effects model to calculate Standardized Mean Differences (SMDs) with 95% confidence intervals, assessing heterogeneity via the I2 statistic.
Results:
Pooled results demonstrated that distraction cards significantly reduced pain levels across all reporters, with large effect sizes observed in children's self-reports (SMD) = -0.90), parent reports (SMD = -1.29), and observer reports (SMD = -1.28). Regarding anxiety, while parents (SMD = -0.97) and observers (SMD = -1.15) reported significant reductions, children's self-reported anxiety reduction did not reach statistical significance (p = 0.14). High heterogeneity (I2 > 90%) was observed across the analyses.
Conclusion:
Findings support the integration of distraction cards into pediatric nursing practice to improve children's experiences during painful procedures, reduce negative emotional responses, and involve parents in care. Distraction cards are a low-cost and easily implementable non-pharmacological method. Their use by pediatric nurses to reduce procedure-related pain is recommended.
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