NON-PHARMACOLOGICAL THERAPY TO REDUCE CHILDREN'S FEAR OF INVASIVE PROCEDURES: SCOPING REVIEW
Abstrak
Invasive procedures, such as intravenous catheterization, intramuscular injection, and blood sampling, often induce fear and pain in children, thus negatively impacting their experience and triggering needle phobia. Therefore, non-pharmacological interventions, such as distraction techniques, are considered effective in reducing fear and pain during such procedures. This review aims to identify and analyze various effective non-pharmacological distraction techniques for reducing children's fear during invasive procedures in hospitals. This scoping review was conducted according to the PRISMA-ScR framework. Literature searches were conducted in the PubMed, ScienceDirect, Scopus, EBSCO-host, and Google Scholar databases using the relevant keywords. Articles meeting the inclusion criteria (RCTs and quasi-experimental studies, published between 2020 and 2025, in English) were assessed for quality using the JBI tool. Data were extracted and analyzed thematically. Of the 1,620 articles, 15 studies met the inclusion criteria. Distraction techniques were categorized into two groups: (1) passive distraction (e.g., Buzzy, listening to music, watching cartoons, and virtual reality) and (2) active distraction (e.g., TICK-B, blowing balloons, interacting with animals, and drama games). Both techniques were effective in reducing children's fear, pain, and anxiety, with Buzzy and TICK-B being the most commonly used interventions. Both active and passive distraction techniques are equally effective in reducing children's fear of invasive procedures. These findings provide guidance for healthcare professionals in selecting interventions appropriate to a child's needs and clinical context. Further research is needed to explore the effectiveness of these techniques in different age groups and geographical regions.
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Referensi
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11. Buyuk ET, Odabasoglu E, Uzsen H, Koyun M. The effect of virtual reality on Children’s anxiety, fear, and pain levels before circumcision. Journal of Pediatric Urology. 2021;17(4):567.e1-567.e8. doi:https://doi.org/10.1016/j.jpurol.2021.04.008
12. Cianetti S, Lombardo G, Lupatelli E, et al. Dental fear/anxiety among children and adolescents. A systematic review. European Journal of Paediatric Dentistry. 2017;18(2):121-130.
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17. Uzsen H, Tural Buyuk E, Odabasoglu E, Koyun M. The effects of vibration and pressure interventions on children’s pain, fear and anxiety: A randomized controlled trial. J Pediatr Nurs. 2024;75:196-204. doi:10.1016/j.pedn. 2023.12.022
18. Suleman SK, Yahya NB, Nilsson S, Enskär K. Comparison of Trace Image Colors for Kids-Book With Two Active Distractions in Reducing Pain and Fear of Children During the Venipuncture Procedure. Eur J Pediatr. 2023;183(1):113-122.doi:10.1007/s004 31-023-05271-y
19. Benazeera, Aranha P, Yashaswini. Play Intervention Applied to Hospitalized Children: Effects on Anxiety and Medical Fear. Journal of the Liaquat University of Medical and Health Sciences. 2024;23(3):210-216. doi:10.22442/jlumhs.2024.01150
20. Suleman SK, Yahya NB, Nilsson S, Enskär K. Comparing the use of colored Trace Images in Kids’ Books with passive distractions to decrease pain and fear during cannulation in children: A randomized clinical trial. Eur J Integr Med. 2024;69. doi:10.1016/j.eujim. 2024.102379
21. Koç S, Küçük Alemdar D. Effect of a musical toy used during peripheral venous access on children’s pain, fear and parental satisfaction: Randomized controlled trial. J Pediatr Nurs. 2024;77:e573-e582. doi:https://doi.org/ 10.1016/j.pedn.2024.05.024
22. Girgin BA, Göl İ. Reducing Pain and Fear in Children During Venipuncture: A Randomized Controlled Study. Pain Management Nursing. 2020;21(3):276-282. doi:https://doi.org/10.1016/j.pmn .2019.07.006
23. Sarman A, Tuncay S. Goldfish or aquatic turtle? Impact of two animal-assisted interventions on children’s pain, anxiety, and fear during IV catheterization: A randomized controlled trial. J Pediatr Nurs. 2024;75:116-124. doi:https://doi.org/ 10.1016/j.pedn.2023.12.017
24. Yaz ŞB, Başdemir S, Geçtan E. The effect of vibrating cold application and puppet use on pain and fear during phlebotomy in children: A randomized controlled study. J Pediatr Nurs.2024;74:77-84.doi:https://doi.org/10.1016/j.pedn.2023.11.018
25. Ugucu G, Akdeniz Uysal D, Guzel Polat O, et al. Effects of cartoon watching and bubble-blowing during venipuncture on pain, fear, and anxiety in children aged 6–8 years: A randomized experimental study. J Pediatr Nurs. 2022;65:e107-e114. doi:https://doi.org/10.1016/j.pedn.2022.03.016
26. Sapçi E, Bilsin Kocamaz E, Gungormus Z. Effects of applying external cold and vibration to children during vaccination on pain, fear and anxiety. Complement Ther Med. 2021;58:102688. doi:https://doi.org/10.1016/j.ctim.2021.102688
27. Turgut MA, Türkmen AS. The effect of lighted toy on reducing pain and fear during blood collection in children between 3 and 6 years: A randomized control trial. J Pediatr Nurs. 2023;70:111-116. doi:https://doi.org/ 10.1016/j.pedn.2023.02.009
28. Tuncay S, Sarman A. Ventriloquist intervention prepared with drama technique in reducing pain, anxiety and fear in children during invasive procedures. Int Emerg Nurs. 2024;75:101462. doi:https://doi.org/10. 1016/j.ienj.2024.101462
29. Kurt A, Dinç F, Akkoç B. Effect of the Helfer skin tap technique on pain, anxiety, and fear in children undergoing intramuscular injection: An open-label randomized controlled study. Archives de Pédiatrie. 2024;31(2):148-154. doi:https://doi.org/10.1016/j.arcped.2023.10.008
30. Buyuk ET, Erdeniz EH, Uzsen H, Odabasoglu E, Koyun M. The Effect of Play Activities for COVID-19 Positive and MIS-C Pediatric Patients on the Anxiety and Fear of Children and Their Parents. Paediatria Croatica. 2021;65(4):180-186. doi:10.13112/PC. 2021.31
31. Lescop K, Joret I, Delbos P, et al. The effectiveness of the BuzzyⓇ device to reduce or prevent pain in children undergoing needle-related procedures: The results from a prospective, open-label, randomised, non-inferiority study. Int J Nurs Stud. 2021;113:103803.doi:https://doi.org/1 0.1016/j.ijnurstu.2020.103803
32. Goktas N, Avci D. The effect of visual and/or auditory distraction techniques on children’s pain, anxiety and medical fear in invasive procedures: A randomized controlled trial. J Pediatr Nurs. 2023;73:e27-e35. doi:https://doi .org/10.1016/j.pedn.2023.07.005
33. Shen T, Wang X, Xue Q, Chen D. Active versus passive distraction for reducing procedural pain and anxiety in children: a meta-analysis and systematic review. Ital J Pediatr. 2023;49(1). doi:10.1186/s13052-023-01518-4
2. Gerçeker GÖ, Ayar D, Özdemir EZ, Bektaş M. Effects of virtual reality on pain, fear and anxiety during blood draw in children aged 5–12 years old: A randomised controlled study. Journal of Clinical Nursing. 2020;29(7-8):1151-1161. doi:10.1111/jocn.15173
3. Orenius T, LicPsych, Säilä H, Mikola K, Ristolainen L. Fear of Injections and Needle Phobia Among Children and Adolescents: An Overview of Psychological, Behavioral, and Contextual Factors. Sage Open Nursing. 2018;4. doi:10.1177/2377960 818759442
4. Mulyadi S, Lisa W. Psikologi Kepribadian. Gunadarma; 2016.
5. Vanny TNP, Agustin WR, Rizqiea NS. Gambaran Ketakutan Anak Usia Prasekolah Akibat Hospitalisasi. Jurnal Keperawatan ’Aisyiyah. 2020;7(2):13-17. doi:10.33867/jka.v7i2.209
6. Kyle T, Carman S. Buku Ajar Keperawatan Pediatri. 2nd ed. EGC; 2017.
7. Wahyudi M. Bayi dan Balita Pun Bisa Alami Gangguan Kecemasan. Kompas. 2023. Accessed February 17, 2025. https://www.kompas.id/baca/humaniora/2023/10/26/bayi-dan-balita-pun-bisa-alami-gangguan-kecemasan
8. Dogan P, Didisen NA, Yılmaz HB. An important initiative in pediatric nursing: Atraumatic care and approaches. İzmir Katip Çelebi University Faculty of Health Science Journal. 2021;6(2):131-135.
9. Saputro H, Fazrin I. Anak Sakit Wajib Bermain Di Rumah Sakit.; 2017.
10. Karimi H, Alavi NM. Florence Nightingale: the mother of nursing. Nursing and midwifery studies. 2015;4(2):e29475.
11. Buyuk ET, Odabasoglu E, Uzsen H, Koyun M. The effect of virtual reality on Children’s anxiety, fear, and pain levels before circumcision. Journal of Pediatric Urology. 2021;17(4):567.e1-567.e8. doi:https://doi.org/10.1016/j.jpurol.2021.04.008
12. Cianetti S, Lombardo G, Lupatelli E, et al. Dental fear/anxiety among children and adolescents. A systematic review. European Journal of Paediatric Dentistry. 2017;18(2):121-130.
13. Peterson J, Pearce PF, Ferguson LA, Langford CA. Understanding scoping reviews: Definition, purpose, and process. Journal of the American Association of Nurse Practitioners. 2017;29(1):12-16. doi:10.1002/2327-6924.12380
14. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71
15. Tuncay S, Sarman A, Budak Y. SuperKid makes it easier: Effect of an intervention prepared with cognitive behavioral technique on reducing fear and pain of children during intravenous insertion. J Pediatr Nurs. 2023;73:e164-e171. doi:https://doi.org/10.1016/j.pedn.2023.08.008
16. Goktas N, Avci D. The effect of visual and/or auditory distraction techniques on children’s pain, anxiety and medical fear in invasive procedures: A randomized controlled trial. J Pediatr Nurs. 2023;73:e27-e35. doi:10.1016 /j.pedn.2023.07.005
17. Uzsen H, Tural Buyuk E, Odabasoglu E, Koyun M. The effects of vibration and pressure interventions on children’s pain, fear and anxiety: A randomized controlled trial. J Pediatr Nurs. 2024;75:196-204. doi:10.1016/j.pedn. 2023.12.022
18. Suleman SK, Yahya NB, Nilsson S, Enskär K. Comparison of Trace Image Colors for Kids-Book With Two Active Distractions in Reducing Pain and Fear of Children During the Venipuncture Procedure. Eur J Pediatr. 2023;183(1):113-122.doi:10.1007/s004 31-023-05271-y
19. Benazeera, Aranha P, Yashaswini. Play Intervention Applied to Hospitalized Children: Effects on Anxiety and Medical Fear. Journal of the Liaquat University of Medical and Health Sciences. 2024;23(3):210-216. doi:10.22442/jlumhs.2024.01150
20. Suleman SK, Yahya NB, Nilsson S, Enskär K. Comparing the use of colored Trace Images in Kids’ Books with passive distractions to decrease pain and fear during cannulation in children: A randomized clinical trial. Eur J Integr Med. 2024;69. doi:10.1016/j.eujim. 2024.102379
21. Koç S, Küçük Alemdar D. Effect of a musical toy used during peripheral venous access on children’s pain, fear and parental satisfaction: Randomized controlled trial. J Pediatr Nurs. 2024;77:e573-e582. doi:https://doi.org/ 10.1016/j.pedn.2024.05.024
22. Girgin BA, Göl İ. Reducing Pain and Fear in Children During Venipuncture: A Randomized Controlled Study. Pain Management Nursing. 2020;21(3):276-282. doi:https://doi.org/10.1016/j.pmn .2019.07.006
23. Sarman A, Tuncay S. Goldfish or aquatic turtle? Impact of two animal-assisted interventions on children’s pain, anxiety, and fear during IV catheterization: A randomized controlled trial. J Pediatr Nurs. 2024;75:116-124. doi:https://doi.org/ 10.1016/j.pedn.2023.12.017
24. Yaz ŞB, Başdemir S, Geçtan E. The effect of vibrating cold application and puppet use on pain and fear during phlebotomy in children: A randomized controlled study. J Pediatr Nurs.2024;74:77-84.doi:https://doi.org/10.1016/j.pedn.2023.11.018
25. Ugucu G, Akdeniz Uysal D, Guzel Polat O, et al. Effects of cartoon watching and bubble-blowing during venipuncture on pain, fear, and anxiety in children aged 6–8 years: A randomized experimental study. J Pediatr Nurs. 2022;65:e107-e114. doi:https://doi.org/10.1016/j.pedn.2022.03.016
26. Sapçi E, Bilsin Kocamaz E, Gungormus Z. Effects of applying external cold and vibration to children during vaccination on pain, fear and anxiety. Complement Ther Med. 2021;58:102688. doi:https://doi.org/10.1016/j.ctim.2021.102688
27. Turgut MA, Türkmen AS. The effect of lighted toy on reducing pain and fear during blood collection in children between 3 and 6 years: A randomized control trial. J Pediatr Nurs. 2023;70:111-116. doi:https://doi.org/ 10.1016/j.pedn.2023.02.009
28. Tuncay S, Sarman A. Ventriloquist intervention prepared with drama technique in reducing pain, anxiety and fear in children during invasive procedures. Int Emerg Nurs. 2024;75:101462. doi:https://doi.org/10. 1016/j.ienj.2024.101462
29. Kurt A, Dinç F, Akkoç B. Effect of the Helfer skin tap technique on pain, anxiety, and fear in children undergoing intramuscular injection: An open-label randomized controlled study. Archives de Pédiatrie. 2024;31(2):148-154. doi:https://doi.org/10.1016/j.arcped.2023.10.008
30. Buyuk ET, Erdeniz EH, Uzsen H, Odabasoglu E, Koyun M. The Effect of Play Activities for COVID-19 Positive and MIS-C Pediatric Patients on the Anxiety and Fear of Children and Their Parents. Paediatria Croatica. 2021;65(4):180-186. doi:10.13112/PC. 2021.31
31. Lescop K, Joret I, Delbos P, et al. The effectiveness of the BuzzyⓇ device to reduce or prevent pain in children undergoing needle-related procedures: The results from a prospective, open-label, randomised, non-inferiority study. Int J Nurs Stud. 2021;113:103803.doi:https://doi.org/1 0.1016/j.ijnurstu.2020.103803
32. Goktas N, Avci D. The effect of visual and/or auditory distraction techniques on children’s pain, anxiety and medical fear in invasive procedures: A randomized controlled trial. J Pediatr Nurs. 2023;73:e27-e35. doi:https://doi .org/10.1016/j.pedn.2023.07.005
33. Shen T, Wang X, Xue Q, Chen D. Active versus passive distraction for reducing procedural pain and anxiety in children: a meta-analysis and systematic review. Ital J Pediatr. 2023;49(1). doi:10.1186/s13052-023-01518-4
Penulis
Rahmawati, S., Rakhmawati, W., & Hendrawati, S. (2025). NON-PHARMACOLOGICAL THERAPY TO REDUCE CHILDREN’S FEAR OF INVASIVE PROCEDURES: SCOPING REVIEW. JURNAL RISET KESEHATAN POLTEKKES DEPKES BANDUNG, Online ISSN 2579-8103, 17(2), 589–600. https://doi.org/10.34011/juriskesbdg.v17i2.3007
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