The Effectiveness of Child Life Services in Reducing Pediatric Procedural Pain: A Systematic Review and Three-Level...

To examine the effectiveness of Child Life Services (CLS) in reducing procedural pain among pediatric patients.

A registered systematic review and three-level meta-analysis of randomized controlled trials (RCTs) and quasi-experimental studies was conducted following PRISMA 2020 guidelines. Six databases were searched from inception to 2 June 2025. Eligible studies included RCTs comparing CLS with standard care in children aged 0-18 years undergoing medical procedures. Risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for quasi-experimental studies. Pooled standardized mean differences (Hedges' g) were estimated using three-level random-effects model. Four categorical moderators were examined: measurement timing, age group, procedure type, and assessor type.

Twelve studies (N = 1,366) were included. CLS significantly reduced procedural pain compared with standard care (g = -0.72, 95% CI [-1.19, -0.24], p =0.007). Heterogeneity was primarily attributable to between-study differences (Level 3 I² = 85.0%). Assessor type was the only significant moderator (F = 8.68, p =0.008). Within-level analyses revealed that CLS produced significant pain reduction among children 7 years and younger (g = -0.81, p =0.018), during one-time injections (g = -0.93, p =0.021), and in post-procedure assessments (g = -0.66, p =0.027). The overall finding was robust across sensitivity analyses, and no evidence of publication bias was detected.

CLS demonstrates a significant effect in alleviating procedural pain in children. Self-reported pain outcomes show better effects than observer-rated outcomes. While the benefits appear particularly pronounced among younger children and one-time injections, the evidence for older children and surgical contexts warrants further investigation.