Wilson LP, Khan Z, Patil PN, Konnur RG, Sriram N. Multimodal distraction reduces intravenous cannulation pain and anxiety in preschoolers: Controlled prospective study. World J Clin Pediatr 2026; 15(1): 111388 [DOI: 10.5409/wjcp.v15.i1.111388]
Corresponding Author of This Article
Pushparaj Nilkanth Patil, MD, Associate Professor, Department of Pediatrics, NAMO Medical Education and Research Institute, Sayali Road, Silvassa 396230, Dadra and Nagar Haveli and Daman and Diu, India. piyush.patil05@gmail.com
Research Domain of This Article
Pediatrics
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Pediatr. Mar 9, 2026; 15(1): 111388 Published online Mar 9, 2026. doi: 10.5409/wjcp.v15.i1.111388
Multimodal distraction reduces intravenous cannulation pain and anxiety in preschoolers: Controlled prospective study
Leana Phebe Wilson, Zubair Khan, Pushparaj Nilkanth Patil, Rajesh G Konnur, Nagarajan Sriram
Leana Phebe Wilson, Department of Pediatric Nursing, NAMO College of Nursing, Silvassa 396230, Dadra and Nagar Haveli and Daman and Diu, India
Zubair Khan, Pushparaj Nilkanth Patil, Department of Pediatrics, NAMO Medical Education and Research Institute, Silvassa 396230, Dadra and Nagar Haveli and Daman and Diu, India
Rajesh G Konnur, DEAN, Kurji Holy Family Hospital College of Nursing, Patna 800010, Bihar, India
Nagarajan Sriram, Department of Vice Principle, NAMO College of Nursing, Silvassa 396230, Dadra and Nagar Haveli and Daman and Diu, India
Author contributions: Wilson LP and Khan Z conducted data collection and participant recruitment; Wilson LP and Patil PN drafted the manuscript; Patil PN conceptualized and designed the study; Konnur RG and Sriram N performed data analysis and interpretation; all authors approved the final version for submission.
Institutional review board statement: The study was reviewed and approved by the Institutional Ethics Committee of NAMO Medical Education and Research Institute and Shri Vinoba Bhave Civil Hospital (No. DMHS/IEC/2016/214/3953).
Informed consent statement: All study participants, or their legal guardians, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest related to the study design, data collection, analysis, interpretation of results, or writing of this manuscript.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset are available from the corresponding author at piyush.patil05@gmail.com. Participants gave informed consent for data sharing.
Corresponding author: Pushparaj Nilkanth Patil, MD, Associate Professor, Department of Pediatrics, NAMO Medical Education and Research Institute, Sayali Road, Silvassa 396230, Dadra and Nagar Haveli and Daman and Diu, India. piyush.patil05@gmail.com
Received: July 1, 2025 Revised: July 27, 2025 Accepted: October 29, 2025 Published online: March 9, 2026 Processing time: 251 Days and 3.9 Hours
Abstract
BACKGROUND
Hospitalization and intravenous (IV) procedures are known to provoke significant pain and anxiety in preschool children, potentially leading to long-term psychological distress. Despite growing evidence supporting distraction techniques, practical, low-cost interventions suited for resource-limited settings remain underutilized.
AIM
To determine the effectiveness of a nurse-led multimodal distraction intervention – comprising balloon blowing, art therapy, and kaleidoscope use – in reducing pain and anxiety during IV therapy among hospitalized preschool children.
METHODS
A posttest-only controlled observational study was conducted at Shri Vinoba Bhave Civil Hospital, India. A total of 600 hospitalized preschoolers (aged 3-6 years) were randomly allocated to either an experimental group (n = 300; distraction intervention) or control group (n = 300; routine care). Pain was measured using the Wong-Baker FACES Pain Rating Scale, and anxiety was assessed using the Visual Analogue Anxiety Scale. The distraction intervention included daily 5-minute sessions: (1) Pre-procedure familiarization (balloon/art); (2) Intra-procedure distraction (kaleidoscope and balloon blowing); and (3) Post-procedure relaxation. Outcomes were evaluated on day 3. Data were analyzed using independent t-tests and correlation analysis.
RESULTS
Children in the experimental group had significantly lower pain scores [mean ± SD (3.07 ± 1.39)] than the control group (8.80 ± 1.01) (t = 58.56, P < 0.00001). Anxiety levels were also reduced in the experimental group (5.85 ± 1.56 mm) compared to controls (9.39 ± 0.73 mm) (t = 35.55, P < 0.00001). A moderate positive correlation was found between pain and anxiety in both groups (experimental: r = 0.67; control: r = 0.66; P < 0.05). Significant associations were also found between pain levels and variables such as age, IV site, cannula size, and medication type (P < 0.05).
CONCLUSION
This study demonstrates that a simple, low-cost, nurse-led multimodal distraction strategy can significantly reduce pain and anxiety in preschool children undergoing IV therapy. Its ease of use and scalability make it highly suitable for immediate integration into pediatric care, especially in low-resource healthcare settings.
Core Tip: This study highlights the effectiveness of a low-cost, multimodal distraction approach – combining balloon blowing, art therapy, and kaleidoscope use – in reducing pain and anxiety among preschool children undergoing intravenous therapy. Using validated tools like the Wong-Baker Faces Pain Rating Scale and Visual Analogue Anxiety Scale, the intervention showed significant impact. It offers a scalable, nurse-led solution for procedural pain management in low-resource settings, where expensive technologies like virtual reality are often impractical.
