Children's Fear Research Articles

Assessing Fears of Negative Consequences in Children With Symptoms of Avoidant Restrictive Food Intake Disorder.

Fear of Aversive Consequences (FOAC), such as choking or vomiting, is an important associated feature of Avoidant/Restrictive Food Intake Disorder (ARFID). However, the manifestation of FOAC in young children is poorly understood. This study aimed to describe the fears of children with ARFID symptoms and examine the concordance between parent and child ratings of fear. Child-reported FOAC was assessed using an interview designed for children between 6 and 10 years old, the Gustatory Avoidance and Gastrointestinal Stress Symptoms (GAGSS). Parents were administered a semi-structured diagnostic interview regarding their child's symptoms, the Pica, ARFID, and Rumination Interview. Among 68 children with ARFID diagnoses or symptoms (41.2% female, 85.3% White, mean age = 8.2 years, SD = 1.1 years; range 5.2-9.9 years), 91.2% of children endorsed at least one fear relative to 26.5% of parents. Among parent-child dyads, 36.8% disagreed about the child's fear of stomach pain (κ = 0.12) and 48.5% disagreed about the child's fear of vomiting, (κ = 0.08), both indicating low inter-rater reliability. On average, children endorsed 4.3 (SD = 2.3) fears out of 9 options. The most frequently endorsed fears were that food will "taste bad," (n = 43, 63.2%), "make you gag" (n = 37, 54.4%), and "look disgusting" (n = 36, 52.9%). Findings highlight ways in which fear may manifest in children with ARFID that are not easily discernable by adults. Greater precision in depicting childhood fears may facilitate the earlier detection of problematic eating behaviors.

Dental fear and caries prevalence in schoolchildren with hearing impairment in Greece.

There have been limited reports on hearing impaired (HI) children's oral health, but no data on their dental fear. The aim of this study was to assess dental fear and caries prevalence in HI children and adolescents. Upon ethical approval, all elementary and junior/senior high schools for the HI in Greece were invited to participate in the study. Students were asked to fill in the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). High school students additionally answered the Modified Dental Anxiety Scale (MDAS). Both questionnaires were translated into sign language by the same licensed interpreter. Caries prevalence was evaluated by dmfs/DMFS indices. Statistics by SPSS Statistics 28 (IBM) included parametric and non-parametric tests (significance at p ≤ 0.05). 33 elementary and 53 junior/senior high school students (mean age = 10.89 ± 2.63 and 16.23 ± 1.33years, respectively) participated in the study. Means of CFSS-DS were 24.1 ± 9.9 and 26.9 ± 10.5, respectively. Mean MDAS (high school students) was 11.3 ± 4.7. Mean dmfs was 2.5 ± 5.2 for elementary and mean DMFS was 3.5 ± 5.4 for elementary and 7.3 ± 9.0 for high school students, higher than similar-age general population. Dental fear was not significantly associated to age, gender, severity of hearing impairment (HI) or caries prevalence. HI children present similar dental fear values, but higher caries prevalence compared to similar-age Greek hearing population.

Golden Breath: Feasibility and acceptability of a biofeedback-based virtual reality game on reducing children's needle-related pain and fear

BackgroundNeedle procedures can cause pain and fear in children. Current literature reports that biofeedback-based virtual reality applications may help alleviate children's pain and fear. This study aims to evaluate the feasibility, acceptability, and safety of the newly developed game Golden Breath, which uses biofeedback-based virtual reality to reduce children's needle-related pain and fear. MethodsThe development of Golden Breath includes; (1) development of the application's features based on needs assessment, (2) gamification of the application content based on literature, (3) development of the prototype, (4) expert evaluation and feedback on the application content, (5) usability testing by 11 children (4–12 years). ResultsRegarding acceptability, the expert evaluation showed a high usability of the system. All children provided positive feedback and reported high satisfaction with Golden Breath. The game was feasible and effective for reducing children's pain and fear levels during needle procedures. Golden Breath was deemed safe for children because it did not cause symptoms such as dizziness, vomiting, or nausea. ConclusionThe expert evaluation, children's feedback, and pilot study results showed that the Golden Breath game is feasible, acceptable, and safe for children during the needle-related procedure. The pilot study revealed that the Golden Breath game effectively reduced pain and fear during blood sampling in children. Practice to implicationsIt is recommended that healthcare professionals use Golden Breath to optimize the well-being of children receiving treatment for chronic and acute diseases.

Retraction Note to: Effects of artificial intelligence aibo intervention on alleviating distress and fear in children

Retraction Note to: Effects of artificial intelligence aibo intervention on alleviating distress and fear in children

Dental Fear in Children with Cleft Lip and Palate and their Correlation to Salivary Cortisol Levels

Dental Fear in Children with Cleft Lip and Palate and their Correlation to Salivary Cortisol Levels

Reduction of Dental Anxiety in Children Using Virtual Reality: A Randomised Controlled Trial.

The aim of this research is examining the effectiveness of Virtual Reality (VR) in the reduction of dental anxiety in children with novel methods. The three arm parallel-group randomised clinical study was conducted in children aged 6-10 years. Pulpotomy procedure was performed on randomised 90 selected children (n=30 in each group; AG: group applied active distraction using VR glasses, PG: group applied passive distraction, i.e., watching cartoons on a screen mounted onto a dental unit, CG: control group). Before and after the procedure, children were administered Facial Pain Scale (FIS), Children's Fear Rating Scale (CFSS-DS) and Frankl Behaviour Rating Scale (FBRS). The pulse rate was measured to check the anxiety levels of all treated children at five different time points. Statistical significance was determined as p<0.05. VR has been found to positively contribute to the performance of children in adapting to dental treatment. The VR application aims to create positive attitude in children by providing them a safe atmosphere and becoming a useful tool in the dental profession.

Research on the comprehensive child life intervention program (CCLIP) for adjusting medical fear in children with central nervous system (CNS) cancers: a randomized controlled trial study protocol

BackgroundMedical fear is a common psychological reaction in hospitalized children, especially during radiotherapy for central nervous system (CNS) cancers. This fear not only causes negative emotions such as anxiety and depression but also affects children’s quality of life and treatment outcomes. It is exacerbated by factors such as unfamiliar environments during radiation therapy and separation from parents. Child Life, as a professional service, offers physical and mental support to children through medical understanding and psychological preparation, addressing their social and psychological needs, among other things. This study aims to construct a comprehensive Child Life intervention program (CCLIP), consisting of four key components: psychological adjustment and preparation, therapeutic play, pain management and coping strategies, and family support. The integration of effective intervention methods aims to reduce medical fear in children undergoing radiotherapy, promote psychological well-being, improve treatment compliance, and enhance quality of life.MethodsThis study is a protocol for a randomized controlled trial. Using a random number table method, we plan to recruit 38 eligible children who meet the inclusion criteria and then randomize them into two distinct groups: the intervention group and the control group. The intervention group will receive the CCLIP, and the control group will receive standardized care. Data will be collected through questionnaires and on-site assessments during the one-month intervention period at four distinct time points: the day of admission (T0), the first radiotherapy positioning (T1), mid-radiotherapy (T2), and postradiotherapy (T3). The primary outcome measure is the effectiveness of the CCLIP in reducing medical fear among children receiving radiation treatment for CNS cancers. Secondary outcomes include anxiety, depression, radiation adherence, quality of life among children, and parental satisfaction.DiscussionThis study aims to alleviate medical fear among children with CNS tumors undergoing radiotherapy through the implementation of the CCLIP while enhancing their mental health and quality of life. The expected outcomes of this research include providing effective intervention strategies for clinical practice, improving the treatment experience and long-term prognosis of children, and having positive impacts on children and their families.Trial registrationThis study is registered at the Chinese Clinical Trial Registry, ChiCTR2400082622. Registered 2 April, 2024.

The Effect of Finger Puppet Play on Pain and Anxiety during Peripheral Vascular Opening Attempts in Preschool-age Children during Emergency Room Visits: Randomized Controlled Study

Objective: The pupose of this study is to examine the effect of finger puppet play on pain and anxiety during peripheral vascular access in preschool-age children in the emergency room. Design and methods: The study was conducted in a randomised controlled manner. The study population consisted of children aged 4–6 years who came to the paediatric emergency room of a hospital in Turkey between 25 May and 25 June 2022. The sample consisted of 97 children who met the research criteria between these dates (49 in the control group, 48 in the finger puppet play group). Stratification and block randomisation methods were used to determine the experimental and control groups.The data were collected with the Survey Form, Child Fear and Anxiety Inventory (CFAI) and Wong-Baker Facial Expression Rating Scale (WB-FAS) through interviews conducted by the researchers. Finger puppet play was shown to the experimental group during the procedure. Results: In the experimental and control groups, the child's pain and anxiety were evaluated by the child, parent, and researcher before the procedure, and similar pain and anxiety values were found from each source (p&gt;0.05). During the procedure, the child's pain and anxiety were evaluated by the child, the parent, and the researcher, and it was found that the children in the finger puppet game group experienced significantly less pain and anxiety than the children in the control group (p &lt; 0.05). Results: According to these results, the application of finger puppetry to children aged 4–6 years undergoing peripheral vascular access was effective in reducing pain and anxiety.

Infectious Diseases-Approved Virtual Reality Goggles for Common Procedures in Pediatric Surgical Patients.

Background/Objective: Virtual reality (VR) technology has been reported as effective in mitigating fear, anxiety, and pain in children undergoing various medical procedures. Our aim was to test the effectiveness of non-sponge-coated mobile phone-operated VR goggles approved by infectious diseases (ID) control in pediatric surgical patients. Methods: A prospective randomized trial in which pre-procedural and post-procedural heart rate, fear, and anxiety, and post-procedural pain were measured in pediatric surgical patients assigned to receive standard care versus standard care and VR goggles. The patients underwent line insertions, peripheral venipunctures for blood draws, drain removals, and wound care. Results: The control group and the intention-to-treat group were each randomly assigned twenty-four patients. Since eight patients who received VR goggles removed them prior to completion of the procedure, the study group included sixteen patients. In the study group, heart rate, fear, and anxiety scores were significantly lower after the procedure as compared to prior to the procedure. In the control group, these parameters were similar before and after the procedure. Post-procedural decrease in fear and anxiety was significant when comparing VR to control. However, despite better post-procedural physiological and emotional scores in the VR group as compared to control, the differences were not statistically significant. Pre-procedural anxiety was significantly higher in the study group. Conclusions: ID-approved VR goggles can reduce fear and anxiety associated with procedures commonly performed in pedicatric surgical patients. However, since increased baseline anxiety might be associated with VR, a higher benefit might be achieved if goggles were worn only by children who express a clear desire to use them.

Effectiveness of Virtual Reality for Managing Pain, Fear, and Anxiety in Children and Adolescents Undergoing Needle-Related Procedures: Systematic Review with Meta-Analysis.

The most frequently performed invasive procedures in hospitals and healthcare centers are needle-related procedures, such as intravenous cannulation and phlebotomy, and they are identified as the major sources of pain, fear, and anxiety in children and adolescents. The objective of this systematic review was to evaluate the effectiveness of VR as a distraction measure to reduce pain, fear, and anxiety in children and adolescents undergoing needle-related invasive procedures. For this purpose, the CINAHL, Scopus, WOS, and Cochrane Library scientific databases were used. The protocol review was registered in PROSPERO (ID:42024563245), and inclusion and exclusion criteria were applied. Twenty-one studies were included in the systematic review, involving a total of 2663 participants. Significant differences favored the use of virtual reality for the control of pain intensity (WBFSpatients p = 0.001; MD = -1.83; 95% CI -2.93 to -0.72; WBFSparents p = 0.0002; MD = -2.61; 95% CI -4.00 to -1.23; WBFSnurses p = 0.0001; MD = -2.71; 95% CI -2.82 to -2.60; VAS/NRS p = 0.001, MD = -0.71; 95% CI -1.13 to -0.28), anxiety (CAMpatient p = 0.02, MD = -2.92; 95% CI -5.45 to -0.38; CAMparents p = 0.01, MD = -3.87; 95% CI -6.99 to -0.75) and fear (CFSpatients p = 0.0005, MD = -1.27; 95% CI -1.99 to -0.56; CFSparents p = 0.0005, MD = -1.33; 95% CI -2.08 to -0.58; and CFSnurses p = 0.04, MD = -1.13; 95% CI -2.24 to -0.03). However, high heterogeneity was noted. The use of virtual reality as a distraction appears to be a valuable strategy for reducing pain, fear, and anxiety during needle-related procedures, although further studies with higher methodological rigor, based on a standardized protocol, are needed.

Association between Dental Fear and Children's Oral Health-Related Quality of Life.

This study aimed to examine the association between both parental dental fear and children's dental fear and its impact on the Oral Health-Related Quality of Life (OHRQoL) of Saudi children in the Eastern Province of Saudi Arabia. Data on 93 individuals aged 7-12 years were collected using clinical examination and Arabic-validated questionnaires: the Child Oral Health Impact Profile-Short Form (COHIP-SF19), and the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Negative binomial regression analysis was performed to study the association between children's fear and parental dental fear as well as the OHRQoL, while adjusting for certain confounders. Overall, our multivariate analyses showed that children with high dental fear (CFSS-DS ≥ 38, p = 0.027) and a higher percentage of dental caries (p = 0.013) had a significantly lower OHRQoL after adjusting for clinical and socio-demographic factors. Further, parental fear of dentists was significantly associated with children's fear of dentists (p < 0.001). Our findings demonstrate that children's fear and dental caries are both associated with poorer OHRQoL. Further, parental dental fear about dentists was associated with children's fear of dentists.

The effect of virtual reality glasses used in dental treatment on anxiety and fear in children: A randomized controlled study

IntroductionVirtual reality glasses can be used as a distraction method in dental practices for children. This study was carried out to evaluate the effect of virtual reality glasses used during tooth extraction and extirpation treatment under local anesthesia on anxiety and fear in children aged 7–10 years. MethodsThis study is a randomized controlled trial. The sample of the study consisted of 120 seven to ten-year-old children, including 60 in the EG and 60 in the CG, who received tooth extraction and extirpation treatment in the pediatric dental clinic. Data collection tools included the Children's Fear Scale, the Child Anxiety Scale-State. Data were analyzed using the Chi-square test, t-test, Shapiro-Wilk, mean and percentage distributions. ResultsThe assessments made by the researcher and the children indicated a statistically significant difference between experimental and control groups in terms of their mean anxiety and fear scores following tooth extraction and extirpation treatment (p < 0.001). After tooth extraction and extirpation treatment, it was determined that the children in the EG had lower mean anxiety and fear scores than the children in the CG. ConclusionIt was found that virtual reality glasses used during tooth extraction and extirpation treatment in children aged 7–10 years were effective in reducing their anxiety and fear levels. Virtual reality glasses can be used as a distracting method to relieve children's anxiety and fears during dental treatment procedures.

Changes of oxidative stress in 3D film to be prepared for echocardiography: A randomized controlled study.

Echocardiography (ECHO) is a nonprocedure that causes acute stress in children. Fear, anxiety, and fluctuations in children's blood pressure and heart rate can potentially lead to alterations in echocardiographic measurements. The insufficient research on virtual reality pediatric preparation applications, particularly in the context of echocardiographic procedures, underscores the necessity for additional studies focusing on pediatric patients. This study sought to assess the impact of virtual reality applications tailored explicitly for ECHO on children's oxidative stress levels. This was a prospective, randomized, controlled experimental study. Forty-eight children (experimental/24, control/24) aged 7 to 12 years who had an ECHO appointment in the pediatric cardiology outpatient clinic in the 3 months from June to August 2019 participated in the study. Participants whose blood analyses showed hemolysis were eliminated, and the study was completed with 37 children in total: 16 children in the experiment and 21 children in the control. Post hoc power analysis was performed for sample adequacy, and the power of the study was found to be 0.99. A 3D film was prepared for the research and applied to the experimental group before the procedure. All children's oxidative stress levels (cortisol, malondialdehyde, nitric oxide) and glutathione levels were checked after ECHO. The stress hormone cortisol and malondialdehyde levels were lower in the 3D-applied experimental group than in the control group. As another crucial anti-stress antioxidant factor, glutathione level increased in the experimental group compared to the control group (P < .05). The research revealed that the 3D film used to prepare ECHO reduces the stress parameters associated with heart risk and may affect the ECHO measurements. At the same time, the study also proved the positive effect of 3D film preparation by increasing the anti-stress factor.

The level of dental fear and anxiety is higher in children with both severe Molar-Incisor Hypomineralisation and active dental caries lesions compared to children without these conditions

PurposeTo assess levels of dental fear and anxiety (DFA) in children with and without Molar-Incisor Hypomineralisation (MIH) and dental caries lesions.MethodsIn this cross-sectional observational study, 159 children between 8 and 12 years of age were included. For the evaluation of DFA, children responded to the validated version of the Children’s Fear Survey Schedule-Dental Subscale. MIH was assessed using the MIH Index. To evaluate the activity of dental caries lesions and dental caries experience, the Nyvad criterion and the dmft/DMFT index were used, respectively. Dental hypersensitivity was evaluated using air stimulation and a Visual Analogue Scale. The association between MIH and dental caries with DFA was assessed using the generalised linear model with Poisson family, identity link function and robust variance estimation. The significance level was set at 5%.ResultsThe mean DFA score was 28.3 (SD = 13.4) with scores ranging from 15 to 64. Amongst children presenting both MIH and dental caries, the perception of DFA was notably higher compared to those with either MIH or dental caries alone. The activity of caries lesion in patients with MIH also influenced DFA levels (diff: 18.6; 95% CI: 12.0–25.2; p < 0.001). Dental caries experience in the primary dentition also demonstrated statistical significance concerning DFA (95% CI: 0.8–13.3; p value = 0.027).ConclusionChildren with MIH exhibit higher levels of DFA than children without MIH. The experience of dental caries and the activity of caries lesions significantly influence the perception of DFA in children with MIH.

Hospital and White Coat Fears in Children of Parents Working in the Healthcare Field: A Qualitative Study of Parental Experiences

Objectives: This qualitative study investigates the hospital and white coat fears experienced by children of healthcare professionals, focusing on parental insights and experiences. The study explores the prevalence and nature of these fears, the psychological impact on children, and the strategies employed by parents to mitigate their children's anxieties. Materials and Methods: Thirty parents working in various healthcare roles were interviewed using a semi-structured format. Thematic content analysis was used to analyze the data and identify recurring themes and sub-themes related to the children's fears and coping mechanisms. Results: The analysis revealed several key themes, including fear of medical procedures, separation anxiety, fear of medical equipment, the impact of parental roles, and coping mechanisms. Findings indicate that children's exposure to healthcare environments through their parents' professions heightens their awareness and fear of medical situations. Effective parental involvement and clear communication were identified as crucial factors in alleviating these fears. Conclusion: The study emphasizes the need for targeted interventions and supportive environments in healthcare settings to address these anxieties. Practical implications include recommendations for healthcare providers to create child-friendly environments and policies that support parental presence and psychological preparation for children. This comprehensive understanding of children's hospital-related fears can inform better practices and policies in healthcare settings to improve the psychological well-being of children of healthcare workers

Atraumatic care practice from the child and parent perspective: The case of a pediatric phlebotomy unit

PurposeThis study aimed to determine the effect of the child's self-selected distraction methods used during the phlebotomy procedure on the feeling of fear and pain in children and parental satisfaction. MethodsThe study, planned as a randomized controlled trial, was conducted with 219 children aged 5–10 years and their parents in the pediatric phlebotomy unit between March and June 2023. Different distraction methods (foam balloon, stress ball, musical book) were applied to the children in the intervention group during the phlebotomy procedure. The data were analyzed with the SPSS 22.0 package program. ResultsThere was a statistically significant difference between the scores of the children in the intervention and control groups on the Children's Fear Scale before the phlebotomy, and on the Wong-Baker Faces Pain Rating Scale after phlebotomy according to self- and parental assessment (p < 0.05). A statistically significant difference was found between the satisfaction levels of the parents after the procedure in the intervention and control groups with the health care service provided during the phlebotomy process (p < 0.05). ConclusionDistraction methods, one of the atraumatic nursing interventions used before the phlebotomy procedure, were determined to be effective in reducing the child's fear and the pain experienced due to the procedure. The study also showed that the satisfaction of parents was positively affected by the atraumatic care provided to their children. Practice implicationsThe atraumatic care approach should be used to prevent anxiety and fear experienced by parents and children and to reduce the child's pain.

A habitually open mouth posture leads to less affect strength during joy in childhood

AimCompared with children without orofacial disorders, children with a habitual lack of mouth closure and mouth breathing show less frequent and reduced or absent facial expressions. The facial feedback hypothesis states that affective sensation is enhanced by mimic involvement. In this randomized cross-sectional study with and without orofacially disordered children, we investigated the effect of lack of mouth closure on the strength of emotions related to joy, sadness and fear in children. We aimed to determine whether kindergarten and primary school-age children with a lack of mouth closure are less emotionally involved.Materials and MethodWe used facial feedback as an indicator to measure affect intensity in children with and without orofacial disorders. For this purpose, we modified the experimental design of Strack et al. (Strack et al. in J Pers Soc Psychol 54:768–777, 1988), in which the subjects were asked to hold a pencil exclusively with their teeth (experimental group 1, “joy”), with their lips (experimental group 2, “sadness” and “fear”) or with their nondominant hand (control group). Instead of cartoons, ten medium-funny animal pictures were presented individually in a predefined order to be judged on a Likert scale. The allocation to the groups was implemented using a randomized procedure, independent of the diagnosis, age and sex of the children. The only exclusion criteria were the presence of surgical scars in the orofacial area and cerebral palsy.ResultsA total of 414 children aged 4 to 17 years were studied for facial feedback, with orofacial disorders such as open mouth posture, tongue thrust, myofunctional disorder, craniomandibular dysfunction (CMD) and speech motor disorders diagnosed in 223 subjects. The significance tests showed that in all age groups, children with orofacial disorders rated the joke content of the animal pictures significantly lower than did children without orofacial disorders (4- to 6-year-olds: p value = 0.01, T value = 2.33, confidence = 99%; 7- to 8-year-olds: p value = 0, T value = 4.98, 100% confidence; 9- to 17-year-olds: p value = 0, T value = 2.87, 100% confidence). This finding indicates that children with a lack of mouth closure and other orofacial disorders not only express less pleasure with the help of facial expressions but also feel less pleasure. Moreover, the experimental setup used in this work, which has been modified for children, can be used to test facial feedback in young subjects.ConclusionIn our study, we focused on the interplay between physical and emotional development in children. If left untreated, children with a lack of oral closure may not only show deviations in the orofacial area later on, but also in their emotionality. We endeavored to highlight the importance of treating children with orofacial disorders at an early age.

The effect of virtual reality versus standard-of-care treatment on pain perception during paediatric vaccination: Study protocol for a randomised controlled trial.

To study the effects of virtual reality (VR) on pain perception among a paediatric population while being vaccinated. We will also investigate the effects of VR on the fear experienced by children during the vaccination procedure, as well as parental satisfaction levels. Many studies, for example, in the fields of oncology, dermatology or plastic surgery, have described the benefits of using VR to reduce the perception of pain among paediatric populations. These results are encouraging, but their main limitations were the small sample sizes they included or their methodological design. This will be a randomised clinical trial. SPIRIT guidelines were followed to report this protocol, and we will use the CONSORT and CONSORT-EHEALTH guidelines to report the randomised clinical trial. The sample will comprise 148 children aged 3-14 years who will come for vaccination at the Tres Forques Health Center. The participants will be randomly allocated into intervention group (VR; n = 74) or (the control group standard-of-care; n = 74) at a 1:1 ratio. The intervention group will view experiences with a VR headset as a distraction measure. The study variables will be the level of pain and fear perceived by the child during vaccination, parental satisfaction with the vaccination procedure, and sociodemographic and vaccination variables. The start of the study is planned for September 2020, and the results will be expected in September 2021. This study aims to identify what measures reduce pain and fear in children during vaccination, which in turn, can help to improve the degree of parental satisfaction with these procedures. Vaccination is an independent function of the nursing profession. Identifying which distraction measures reduce the perception of pain and fear in the paediatric population will not only improve children's experiences but will also improve the satisfaction of both parents and children, thus increasing the degree of compliance with the vaccination schedule.

Influence of static cartoons combined with dynamic virtual environments on preoperative anxiety of preschool-aged children undergoing surgery.

Preschoolers become anxious when they are about to undergo anesthesia and surgery, warranting the development of more appropriate and effective interventions. To explore the effect of static cartoons combined with dynamic virtual environments on preoperative anxiety and anesthesia induction compliance in preschool-aged children undergoing surgery. One hundred and sixteen preschool-aged children were selected and assigned to the drug (n = 37), intervention (n = 40), and control (n = 39) groups. All the children received routine preoperative checkups and nursing before being transferred to the preoperative preparation room on the day of the operation. The drug group received 0.5 mg/kg midazolam and the intervention group treatment consisting of static cartoons combined with dynamic virtual environments. The control group received no intervention. The modified Yale Preoperative Anxiety Scale was used to evaluate the children's anxiety level on the day before surgery (T0), before leaving the preoperative preparation room (T1), when entering the operating room (T2), and at anesthesia induction (T3). Compliance during anesthesia induction (T3) was evaluated using the Induction Compliance Checklist (ICC). Changes in mean arterial pressure (MAP), heart rate (HR), and respiratory rate (RR) were also recorded at each time point. The anxiety scores of the three groups increased variously at T1 and T2. At T3, both the drug and intervention groups had similar anxiety scores, both of which were lower than those in the control group. At T1 and T2, MAP, HR, and RR of the three groups increased. The drug and control groups had significantly higher MAP and RR than the intervention group at T2. At T3, the MAP, HR, and RR of the drug group decreased and were significantly lower than those in the control group but were comparable to those in the intervention group. Both the drug and intervention groups had similar ICC scores and duration of anesthesia induction (T3), both of which were higher than those of the control group. Combining static cartoons with dynamic virtual environments as effective as medication, specifically midazolam, in reducing preoperative anxiety and fear in preschool-aged children. This approach also improve their compliance during anesthesia induction and helped maintain their stable vital signs.

Soothing venipuncture: Bubble blowing and ball squeezing in reducing anxiety, fear, and pain in children.

The objective of this study was to investigate the impact of bubble-blowing and ball-squeezing interventions on children's levels of anxiety, fear, and pain during venipuncture procedures. This study was designed as a randomized controlled trial. Out of 108 children aged 5-10 years, 72 were allocated to the two experimental groups, while 36 were assigned to the control group. The levels of anxiety, fear, and pain experienced by the children were assessed using the "Wong-Baker FACES® Pain Rating Scale," "Child Anxiety Scale-State," and "Child Fear Scale," respectively. Intergroup comparisons were analyzed using one-way ANOVA, while intragroup comparisons were conducted using Wilks' Lambda analysis. It was observed that 50% of the children in the control group, 47.2% in the bubble-blowing group, and 47.2% in the ball-queezing group did not receive information about the painful procedure. Anxiety, fear, and pain scores of all groups were statistically similar in the initial measurement without any intervention. Children in the bubble-blowing and ball-squeezing groups experienced lower anxiety, fear, and pain during and at the end of the painful procedures. The study discovered that interventions involving bubble blowing and ball squeezing significantly decreased children's levels of anxiety, fear, and pain both during and after intravenous procedures. Information on procedures, alongside interactive techniques like bubble blowing and ball squeezing, helps pediatric nurses calm children, easing anxiety, fear, and pain. Implementing these strategies enhances treatment experiences and confidence in healthcare.