Children's Fear Research Articles

The Effect of Distraction Techniques on Pain, Fear, and Anxiety in Children Undergoing Circumcision: A Meta-Analysis of Randomized Controlled Trials.

Circumcision is a common pediatric operation, and distraction technique can be used as an adjunct analgesic method during the perioperative period. The study aims to explore the effect of distraction techniques on reducing pain, fear, and anxiety in children undergoing circumcision. The PubMed, ClinicalTrials.gov, and Embase databases were searched for articles published from January 1, 2000, to December 31, 2023. Only randomized controlled trials (RCTs) were included. Meta-analysis and forest plots were carried out using Review Manager 5.4.1 software, and outcomes were reviewed by two authors independently. We used the Risk of Bias assessment form (ROB2) developed by the Cochrane Collaboration to assess the quality of included studies. PRISMA 2020 guidelines were used in this article to achieve the quantitative and qualitative synthesis of data. A total of seven RCTs were included. The intervention group consisted of 417 patients, while the control group had 245 patients. The meta-analysis and sensitivity analysis results showed that the distraction technique could significantly relieve pain (MD -1.3, 95% confidence interval [CI]: [-1.61 to -0.99], p < .00001), fear (SMD -1.04, 95%CI -1.68 to -0.4, p = .001), and anxiety (SMD -1.07, 95%CI [-1.64 to -0.51], p = .0002). Similarly, therapeutic play significant could significantly relieve fear (MD -0.4, 95%CI [-0.71 to -0.1], p = .01) and anxiety (SMD -1.31, 95%CI [-2.59 to -0.04], p = .04), virtual reality (VR) could significantly relieve anxiety (SMD -0.67, 95%CI [-0.98 to -0.37], p < .0001). Distraction techniques can alleviate perioperative pain, fear, and anxiety in children undergoing circumcision.

Hen's egg ladder: Therapy option for the gradual introduction of hen's eggs in cases of hen's egg allergy.

More than 10 years ago, the British Society for Allergy and Clinical Immunology (BSACI) published guidelines for the management of egg allergy [1]. For the first time, these included a stepwise plan for the reintroduction of egg for egg-allergic children who could already tolerate well-cooked egg, such as cakes and cookies. Since then, various egg ladders have been developed [2, 3, 4, 5, 6, 7, 8, 9]. In the past 3 years, several studies have been published suggesting that a gradual introduction of highly processed to less processed egg containing foods contribute to the acceleration of tolerance development [2, 3, 4, 5]. However, depending on the study and egg ladder, the egg products vary in their level of processing (wheat matrix, degree, and location of heating (e.g., oven, pan, pot), egg quantity, and egg protein). In the UK, the introduction of the egg ladder is recommended at the age of 12 months or if the last reaction occurred 6 months before. The benefits of introducing egg at home include an early increase in the variety of foods, reduction of food fears, improved nutrient intake, and the avoidance of hospitalization fears in children [10]. Children with mild reactions in the past can start with small amounts of baked goods at home. Food challenges in an inpatient setting to exclude or reconfirm the allergy should be conducted if the patients have previously had severe allergic reactions, i.e., anaphylaxis, or if the smallest amounts triggered an allergic reaction or if existing asthma is poorly controlled [10, 11]. The present work includes, in addition to the evaluation of study results, a presentation of the recent studies regarding egg ladders. From these, a new egg ladder as therapeutic option for the German-speaking region has been developed. As already done for the milk ladder a detailed step-by-step plan, selection criteria, a recipe collection, and also ideas for commercial prepackaged food items can be found in the appendices [11].

A new method of distracting attention: Is it effective for pain and fear during phlebotomy in children?

This study examined the impact of a novel distraction approach on the mitigation of fear and pain experienced by children between the ages of 7 and 12 during phlebotomy procedures. A total of 246 children who underwent phlebotomy between January and March 2019 in the pediatric blood collection unit were included in this randomized controlled trial. The participants (n = 246) were randomized to the intervention (n = 123) and control groups (n = 123). A musical blood collection tube was used in the intervention group. The Personal Information form, the Children's Fear Scale (CFS), and the Faces Pain Scale-Revised (FPS-R) were used for the collection of the data. Fear and pain were primary and secondary outcomes, respectively. A formal approval from the ethics committee was sought in order to proceed with the study. In this study, the CONSORT checklist was used as a guide and ethical principles were followed. The pain intensity and fear level of the children in the intervention group (CFS=1.73±1.07; FPS-R= 1.65±1.33) were lower than those in the control (CFS=2.86 ± 1.07; FPS-R= 3.09±1.57). The reduction in the intervention group's pain intensity and fear level differed significantly (p=0.000 and p=0.000, respectively). The results showed that using the musical blood collection tube as a new distraction technique reduces fear and pain intensity during phlebotomy in children. The musical blood collection tube can be used by health professionals as a non-pharmacological method to reduce the pain and fear of children during blood collection.

Effect of Virtual Reality on Dental Pain in Children during Local Anesthesia Administration

ABSTRACT Background: Dental procedures often generate anxiety and fear in children. Virtual reality (VR) is a novel method of distraction for behavior management during dental treatment. Aim: To evaluate the effect of using VR eyeglasses on anxiety/pain during local anesthesia (LA) administration for children. Materials and Methods: Children aged 6–12 years, rated to be Frankl +(positive) or −(negative) without any systemic background were included. Children receiving inferior alveolar nerve block anesthesia were randomized into two groups: Control group (n = 20) exposed to Tell-Show-Do (TSD) alone and study group (n = 20) exposed to TSD with VR through the use of head-mounted immersive type of display powered by a smartphone VR box. Oxygen saturation (SpO2), pulse rate (PR), and anxiety/pain were monitored preoperatively, during LA administration and postoperatively. Results: SpO2 showed no significant difference between the groups, whereas PR and perceived pain levels were significantly different between the groups. Conclusions: PR and pain scores were reduced with the use of VR in children during the administration of LA. VR can be an effective tool in managing behavior of children rated Frankl positive and negative.

Degree of fear of needles and preferred allergy immunotherapy treatment among children with allergic rhinitis: caregiver survey results.

A child's fear of needles may impact the preferred route of allergy immunotherapy (AIT) when choosing between subcutaneous immunotherapy (allergy shots) or sublingual immunotherapy (SLIT). A survey was conducted to understand caregiver health-seeking behavior for children with allergic rhinitis with or without conjunctivitis (AR/C) and explore if fear of needles impacted AIT decisions. Caregivers of children ages 5-17 years with AR/C were recruited from the Dynata US research panel to participate in an online survey from May-June 2023. The survey received institutional review board exemption status. SLIT-tablets were described as "under-the-tongue tablets". About a third (34%) of surveyed caregivers (n = 437) reported their child had a severe fear of needles and 47% reported moderate fear. Of surveyed caregivers, 53% and 43% reported they had discussed allergy shots and SLIT-tablets, respectively, with their child's physician. SLIT-tablets were preferred by 84% of caregivers; 6% preferred injections and 10% had no preference. Caregivers of children with a severe fear of needles had the highest preference for SLIT-tablets (95%) vs. injections (2%); 85% and 60% of caregivers of children with moderate and low fear, respectively, preferred SLIT-tablets. Among caregivers of children with a severe fear of needles, a higher percentage agreed that their child would welcome taking SLIT-tablets than that their child would accept taking an ongoing series of allergy shots (93% vs. 43%, respectively). Most caregivers preferred SLIT-tablets over allergy shots for their child with AR/C. Preference for SLIT-tablets corresponded with the child's degree of fear of needles. Fear of needles should be included in AIT shared decision-making conversations.

Change in oral health-related behaviours of children before and after dental treatments under general anaesthesia.

This study evaluated the behavioural changes pertaining to children's oral health before and after the dental general anaesthesia (DGA), with particular focus on the factors associated with these changes. The records were collected for the children who received DGA from July 2015 to November 2016, and relevant questionnaires were obtained from their parents/guardians for the information prior to and after the DGA. The questionnaire included Early Childhood Oral Health Impact Scale (ECOHIS) and Dental Subscale of Children's Fear Survey Schedule (CFSS-DS) to investigate the changes in Oral Health-related Quality of Life (OHRQoL) and dental fear. The DGA impact on children's oral hygiene habits and oral health-related behaviours was assessed by analysing the data. The chi-square test and Mann-Whitney test were employed to evaluate the differences. Total of 141 patients (89 before DGA and 77 after DGA, 25 being common) participated in this study. There were 60 children below 5 years and 29 over 5 years before DGA, while 41 children below 5 years and 36 over 5 years after DGA. Most parents/guardians were educated above undergraduate level (59.6% before DGA, 55.8% after DGA). More children lived with grandparents (61.8% before DGA, 54.5% after DGA) than only with parents (20.2% before DGA, 26.0% after DGA). In total, 73.0% (65/89) children before DGA brushed teeth more than twice a day. This proportion increased to 90.9% after DGA (70/77, p = 0.03). The eating difficulty decreased after DGA according to ECOHIS (p = 0.01). CFSS-DS score also decreased after DGA (p < 0.05). After DGA, children's oral hygiene habits and oral health-related quality of life (OHRQoL) improved, children fear for dental treatment decreased, and parents became more attentive towards children oral health.

A study on related factors affecting dental fear in preschool children.

This study aims to examine the manifestations of dental anxiety (DA) and its influencing factors during dental visits among preschool children. The data of 166 preschool children who visited the Department of Dentistry of our hospital from April 2021 to April 2023 with oral problems were retrieved. Their DA performance was investigated using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). In addition, based on their general data and potential risk factor information, we performed logistic regression analysis to identify the factors influencing DA. Of the 166 questionnaires distributed, a total of 160 valid questionnaires were retrieved. The average CFSS-DS score was 35.57 ± 3.51 points. Sixty-six children had DA, resulting in an incidence rate of 41.25%. The top 5 items with the highest CFSS-DS scores were fear of needles, dentists, tooth extraction, drilling and oral anesthesia. When the 66 children with DA were classified into a DA group and a non-DA group, we observed significant differences in age distribution, dental experience, only child status, general anxiety symptoms, dental condition, family income and specific dental treatment procedures, particularly tooth extraction, between them (p < 0.05). Multivariate logistic regression analysis revealed that preschool children aged ≤4 years, those with prior dental experiences, single-child status, general anxiety symptoms, suboptimal dental health, family incomes below 100,000 yuan/year, and those undergoing specific dental procedures, such as tooth extractions, were independently associated with a higher risk of DA (p < 0.05). The incidence of DA in preschool children is high, and they exhibit substantial fear of needles, dentists, tooth extraction, drilling and oral anesthesia. Preschool children aged ≤4 years, with prior dental experiences, single-child status, the presence of general anxiety symptoms, suboptimal dental health, family incomes below 100,000 yuan/year, and those undergoing dental procedures, particularly tooth extraction, could be more predisposed to DA.

Effectiveness of External Precooling and Vibration Induced by BUZZY on Pain and Anxiety During Inferior Alveolar Nerve Block Injection in Children.

Purpose: Children's fear of the injection of local anesthetic agents affects their cooperation in pediatric dentistry. Different techniques are available to decrease the injection pain, including the use of precooling agents or vibrators. The present study investigated the effectiveness of Buzzy (Buzzy MMJ Labs, Atlanta, GA, USA). This device transfers cold and external vibration to the injection site during the inferior alveolar nerve block (IANB) injection. Materials and Methods: The present self-control, randomized, and double-blind clinical trial evaluated 30 children aged 6-12, who had bilateral mandibular permanent or primary carious molar teeth. On one side, the BUZZY was applied before and during the IANB injection, and the other side was considered as control. On both sides, a topical anesthetic gel was applied before injection. The pain severity and children's anxiety were determined using Wong-Baker, face, leg, activity, cry, consolability (FLACC) scales, and the heart rate. Results: The mean age of the participants was 7.18 ± 1.5 years, with 12 girls and 18 boys. The Wong-Baker scale and FLACC scale did not show any statistically significant difference between BUZZY and control (p value = 0.9 and 0.15, respectively). In addition, BUZZY tool did not significantly decrease pain and anxiety during injection, assessed through the heart rate difference (p=0.38). Conclusion: Under the limitations of the present study, a combination of precooling and vibration using the BUZZY device did not decrease pain and anxiety in children during the IANB injection.

Impact of Child-Friendly Nursing on Reducing Anxiety, Fear, and Pain in Paediatric Circumcision: A Retrospective Study.

Paediatric circumcision is a standard surgical procedure that frequently induces anxiety, fear, and pain in young patients. Child-friendly nursing has shown potential in alleviating psychosocial distress in paediatric care settings. However, its specific impact on patients undergoing circumcision remains underexplored. This study aimed to evaluate the effectiveness of child-friendly nursing in reducing patients' anxiety, fear and pain in patients undergoing paediatric circumcision. Clinical data of paediatric patients who underwent circumcision at Taizhou Hospital of Zhejiang Province from January 2022 to November 2023 were retrospectively analysed. Patients were divided into the traditional nursing (January 2022 to December 2022) and child-friendly nursing (January 2023 to November 2023) groups. Psychosocial parameters, including anxiety, depression, pain, and fear, were assessed using the Children's Anxiety Meter-State (CAM-S), Children's Depression Inventory (CDI), Wong-Baker FACES Pain Rating Scale (WBFPRS), and Children's Fear Scale (CFS), respectively. No significant differences were found in CAM-S, CDI, WBFPRS, and CFS scores between the two groups before intervention (p > 0.05). However, post-intervention scores for all parameters in the child-friendly nursing group were significantly lower than those in the traditional nursing group (p < 0.001). The results suggest that child-friendly nursing effectively reduces anxiety, depression, fear and pain in children undergoing circumcision. This study provides compelling evidence supporting the effectiveness of child-friendly nursing in enhancing surgical experiences and improving psychosocial outcomes for paediatric patients undergoing circumcision.

Application of magic distraction therapy for the alleviation of dental fear and anxiety in children younger than 12 years: a systematic review and meta-analysis of randomized controlled trials

Dental fear and anxiety (DFA) in children leads to increased pain sensitivity and challenging behaviors that complicate treatment. Employing magic as a distraction therapy utilizes children’s imagination and curiosity to mitigate these effects, yet its systematic evaluation is lacking. This study aimed to evaluate the effect of magic distraction therapy (MDT) in reducing DFA in children and identify the determinants of its efficacy. This study adhered to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY202420074). We searched Embase, MEDLINE, Scopus, the Cochrane Central Register of Controlled Clinical Trials, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) for randomized controlled trials (RCTs) involving children under 12 years receiving dental treatment with MDT. Studies that combined multiple distraction methods or used hypnosis were excluded. The meta-analysis analyzed the data using a random effects model, with subgroup analysis and meta-regression. The methodological quality of the studies was assessed using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). The analysis included four RCTs involving a total of 180 children aged 2 to 11 years. Overall, 25.0% of the included studies had a low risk of bias, 75.0% had some risk of bias, and none had a high risk of bias. Magic significantly reduced dental anxiety (Hedges’ g = −1.236, 95% confidence interval (CI): −1.798 to −0.673, p &lt; 0.001), particularly during treatments involving local anesthesia (p = 0.006), performed concurrently during treatment (p = 0.008), and in younger children (coefficient = −0.2077 per year, p &lt; 0.001). This study supports MDT as an effective approach for reducing DFA in children, highlighting the importance of timing, anesthesia and patient age in optimizing anxiety reduction strategies.

Family-centered Music Therapy as Procedural Support in the Pediatric Outpatient Unit: A Mixed Methods Pilot Study

Needle procedures are one of the most common reasons for children to visit hospitals. If unaddressed, negative needle experiences can worsen over time and lead to needle noncompliance, needle fears, and healthcare avoidance. This mixed methods pilot study tested the effect of combined music therapy and standard pharmacological care compared to standard care alone on fear and discomfort in children in connection to a scheduled needle procedure. Children and their parents were also interviewed on their general experience of music therapy and how they regulated fear and discomfort during needle procedures while participating in music therapy. Thirty children aged 0 to 15 and their parents were recruited at the pediatric outpatient unit at The Central Hospital in Karlstad, Sweden. The participants were randomized to an intervention group with music therapy and to a control group that received standard care alone. The children rated their fear and discomfort before, during and after a needle procedure on a child-friendly visual analogue scale. The children and parents who were randomized to the music therapy condition were interviewed about their experiences of music therapy as procedural support. No significant differences between the intervention group and the group with standard care alone were found, indicating that the two groups were equivalent with regard to experienced fear and discomfort. The content analysis of the interviews indicated that the children and their parents considered that the music therapy intervention promoted the participants’ emotion regulation, promoted adaptive coping strategies for both children and the parents, and favorably but also ambivalently affected the context and interactions in the procedural room.

Family participatory clown therapy in venipuncture in hospitalized children: A non-randomized controlled trial.

To explore the effectiveness of family participatory clown therapy in venipuncture in hospitalized children. We recruited 104 children aged 3 to 6 years for a non-randomized controlled trial from March to December 2022. All participants required peripheral venepuncture infusions for treatment. The children were assigned to either the control group (n = 52) or the experimental group (n = 52).Standard care was utilized in the control group. In the experimental group, two clown nurses and a parent provided family participatory clown therapy for 35-45 minutes per child before, during, and after venipuncture. We assessed children's pain (FLACC and W-B FPS), anxiety (VAS-A), medical fear (CFS), crying incidence, compliance, parental anxiety (S-AI), and parental satisfaction. At venipuncture, the FLACC score was lower in the experimental group (4.46±2.053) compared to the control group (5.96±2.441), the W-B FPS score was also lower in the experimental group (4.96±2.392) than in the control group (6.35±2.266), with a statistically significant difference (P<0.05).The children in the experimental group had lower levels of anxiety, medical fear, crying, and parental anxiety than the control group. In addition, child compliance and parent satisfaction were higher in the experimental group than in the control group, with statistically significant differences (P<0.05). Family participatory clown therapy can reduce pain, anxiety, medical fear, and crying during venipuncture in children. It can also improve venipuncture compliance, reduce parental anxiety, and increase parental satisfaction.

The realisation of the children’s right of participation in the community children’s care home: The analysis of the children’s experiences

The objective of the study is to reveal the realities of the realisation of the children’s right of participation in the community children’s care home based on children’s experience. For the study, qualitative study was chosen while using a semi-structured interview method. Eight children living in the community children’s care homes (henceforth referred as CCCH), which are located in different sites in Lithuania, participated in the study. The study revealed the realization expression of the child’s right of participation and difficulties in realising it at CCCH. The realization expression of the children’s right of participation at CCCH should be attributed to the respect of employees for the right of the child of participation. It is expressed through the openness of employees to the opinion of the child, giving an opportunity for the child to speak out their opinion, and listening to the opinion of the child. Discussion of the child with the adult should take place as well as adhering of the adult to the opinion of the child when taking decisions, and the encouragement and support for the autonomy of children. The child’s right of participation is also realised in everyday situations while allowing the child to manage his personal space according to his needs, involving the child in the leisure planning and organisation. The child should have an opportunity to participate in leisure activities according to their likes and interests, as well as consulting with the child regarding household chores. The study identified that the realisation difficulties of the children’s right of participation at CCCH are attributable to the dominating position of the employee and the child’s lack of trust towards himself and his own opinion. The dominating position of the employee is expressed through the non-listening to the opinion of children, disagreement with the child, the devaluation of the opinion of the child, the lack of adhering to the opinion of the child and the overriding of the opinion of the child. The child’s lack of trust towards himself and his own opinion is linked with the belief of the child that his opinion is insignificant due to negative experiences in the past, the timidity of children to speak out their opinions and the unwillingness or fear of children to worsen their relationships with employees.

Assessment of Dental Fear and Anxiety in Children Undergoing Nitrous Oxide-Oxygen Inhalation Sedation visiting BPKIHS

Introduction: Dental treatment of children is the most needed service that remains neglected because of a lack of skill to manage dental fear and anxiety (DFA). Both the non-pharmacological and pharmacological behavior management continuum should be followed to treat children. Objective: To assess and compare DFA levels in children before and after dental treatment using nitrous oxide-oxygen inhalation sedation (NOIS), to assess and compare the change in behavior in children undergoing NOIS, and to compare the level of DFA in children undergoing invasive and non-invasive dental treatment. Methods: DFA was measured using the Children's Fear Survey Schedule Dental Subscale (CFSS-DS), Modified Child Dental Anxiety Scale (MCDAS), and Facial Image Scale (FIS) before and after the dental treatment under NOIS. The change in children’s behavior during invasive and noninvasive treatment under NOIS was assessed by Frankl Behavior Rating Scale (FBRS). Results: A significant reduction in DFA was seen within each cohort as measured by 3 scales: CFSS-DS, MCDAS, and FIS (P≤0.001). There was also a positive change in behavior of children during the time of dental treatment under NOIS as measured by FBRS. However, there was no significant difference between invasive and non-invasive treatment groups with regard to DFA. Conclusions: Minimal sedation provided by NOIS significantly reduced DFA in children, and there was a positive change in their behavior during the time of treatment. NOIS was effective in decreasing DFA in both invasive and non-invasive dental treatment.

Examination of the Effect of Nurses' Death Anxiety Levels on Their Children's Fear Levels during the COVID-19 Pandemic

Objective: This study was conducted to determine the effect of death anxiety levels of nurses on the fear level of their children during the COVID-19 pandemic.&#x0D; Methods: This descriptive and cross-sectional study was carried out online with 362 nurses. Data were collected using an introductory information form, the Death Anxiety Scale, and the Children's Fear Scale.&#x0D; Results: It was found that the death anxiety levels of nurses and fear levels of their children were high. It was determined that the children of nurses who had high death anxiety had higher fear levels.&#x0D; Conclusion: The findings emphasize the importance of screening nurses' death anxiety and children's fear levels during the pandemic period and providing psychological support when necessary.

The effect of the operating room tour watched with a 3D virtual reality headset on children's fear and anxiety before the surgery – a randomized controlled study

ABSTRACT A Virtual reality (VR) tour of the operating theatre can provide a realistic experience for children. The sample of children was allocated to VR-Documentary Film Group (n = 35), VR-Operating Theater Tour Group (n = 35) and Control Group (n = 35) using randomization and experimental study. The preoperative fear of the children was assessed (Child Fear Scale-CFS and State-Trait Anxiety Inventory for Children-STAIC for children) by children themselves and their parents, and their preoperative anxiety was assessed (Children's Anxiety Meter-CAM-S) by themselves. Children's fear and anxiety scores decreased in the VR-Operating Theater Tour and VR-Documentary Film groups. In these two groups, there was a significant difference between the CAM-S scores reflecting the children’s evaluations and the CFS scores reflecting the children’s and their parents’ evaluations, and their post-test scores were lower than their pre-test scores. Children’s watching actual operating theatre tour virtually was determined as an effective method in reducing children’s preoperative fear and anxiety levels. Trial registration: ClinicalTrials.gov identifier: NCT05401539.

Удосконалення комплексного підходу до лікування функціональних закрепів у дітей

Functional constipation in children has become a serious medical issue that needs to be addressed immediately. They can significantly limit children’s physical activity and social integration, which emphasizes the importance of providing them with effective care. Purpose - to analyze and improve the results of the complex use of a lactulose-based drug and prophylactic phytocylinders with a lipophilic complex of rose hips and chamomile extract in the treatment of functional constipation in children. Materials and methods. We examined 78 children with constipation over the past 3 years. They were divided into two groups. The first group included 36 (46.2%) patients, the second - 42 (53.8%). Patients of the first group received standard treatment according to the protocols of the Ministry of Health of Ukraine, patients of the second group received similar treatment and additionally lactulose in the form of syrup and a preparation based on prophylactic phytocylinders with a lipophilic complex of rose hips and chamomile extract during the course of treatment daily in the form of rectal suppositories. Results. Most patients were female (60.2%), had average physical development parameters. The duration of constipation ranged from 1 to 3 months, and stool retention - from 3 to 5 days. At the beginning of the observation, there were complaints of changes in the shape and consistency of stools, painful defecation, flatulence, periodic abdominal pain, strong straining during defecation, fear or anxiety in children before the act of defecation. An analysis of anamnestic data showed that in one third of patients, constipation was observed during the transition from breastfeeding to artificial feeding. Conclusions. The analysis of the addition to the complex of treatment of functional constipation, in addition to lactulose, of preparations based on prophylactic phytocylinders with a lipophilic complex of rose hips and chamomile extract is a safe and quite effective method of correcting these disorders in young children, as evidenced by the results obtained. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Goldfish or aquatic turtle? Impact of two animal assisted interventions on children's pain, anxiety, and fear during IV catheterization: A randomized controlled trial

PurposeThis study aimed to determine the effect of goldfish and aquatic turtle nursing interventions on children's pain, anxiety, and fear during IV catheter insertion. Design and methodsThe randomized controlled trial included 98 children (control group = 32, goldfish group = 33, aquatic turtle group = 33) aged 5–6 years, attending outpatient clinic for blood sampling and catheterisation procedures. Pain was measured using the Wong Baker Facial Pain Scale, anxiety was measured using the Child Anxiety Scale-State, and child fear was measured using the Child Fear Scale, before, during, and after catheterization. ResultsWhen analyzing the pain, anxiety, and fear findings, no statistical difference was found between the scores of the mother, child, and researcher before the procedure. During the catheterization procedure, the pain, anxiety, and fear scores of the children in the fish and turtle groups increased statistically less than those in the control group. When analyzing the post-procedure findings, the pain, anxiety, and fear scores of the control group were similar to those before the procedure. In the fish and turtle groups, anxiety and fear scores were statistically the lowest (p < 0.05). ConclusionIt can be concluded that animal-assisted practices reduce anxiety and fear during and after the catheterization procedures while diverting attention from pain. Practice implicationsGoldfish or aquatic turtle intervention improve children's attitudes toward pain, anxiety, and fear during IV catheter insertion. Pediatric nurses could consider incorporating, such as the animal assisted intervention, into their clinical practice to reduce the pain, anxiety, and fear experienced by children during medical/nursing procedures.

“It’s hard because it’s something new”: challenges for forcibly displaced parents upon resettlement

PurposeParent–child relationships formed in early childhood have profound implications for a child’s development and serve as a determinant for bio-social outcomes in adulthood. Positive parenting behaviors play a strong role in this development and are especially impactful during times of crisis because they buffer stressors that may lead to externalizing and internalizing behaviors. Children of forced migrants experience numerous extreme stressors and their parents may struggle with parenting due to their own adjustment and trauma histories. The purpose of this study is to understand how these parents conceptualize their struggles with parenting upon resettlement.Design/methodology/approachThe authors conducted semi-structured interviews with 27 migrant parents from three communities (Afghan, Burmese and Congolese) to understand their parenting experiences. The authors applied thematic text analysis to analyze the data.FindingsThe authors identified four interrelated themes on parenting challenges across responses: adjustment to a new culture, acculturation differences, fear for children and balancing multiple responsibilities. The findings demonstrate that parents of different cultural backgrounds share certain experiences when negotiating a new cultural identity after resettlement. Providing educational programs that focus on these concerns may result in better outcomes for both parent and child.Originality/valueThese findings extend and reinforce the existing literature on parenting in a new context. While the parents in this research come from different cultures, they share certain experiences that are important to consider when developing parenting programs, social services and other interventions, such as what may be negotiable and nonnegotiable practices for parents of different cultures.

The Impact of Cold Spray and Ice Application During Intravenous Access on Pain and Fear in Children Aged 7-15 Years in the Pediatric Emergency Unit: A Randomized Controlled Trial

IntroductionMany strategies have been developed to prevent procedural pain in pediatric emergency units, where nurses play a vital role in ensuring patient comfort. Easy-to-use and inexpensive nonpharmacologic analgesic methods are important in emergency units. This study was conducted to determine the effect of cold spray and ice applied during venipuncture on the level of fear and pain in children aged 7 to 15 years. MethodsThis was a randomized controlled experimental study of 96 children between the ages of 7 and 15 years (cold spray group, ice group, and control group) who were scheduled to have venous access in the pediatric emergency clinic and met the sampling criteria. ResultsEvaluations of the children, parents, and observers in the groups found a statistically significant difference between the pain and fear scores after the intervention compared with the preintervention (P < .001). The pain and fear scores of the children in the control group were higher than the scores of those in the spray and ice groups (P < .001); the pain and fear scores of the children in the spray group were lower than the scores of the children in the ice group and statistically significant (P < .001). DiscussionIn conclusion, cold spray applied during intravenous access in children aged 7 to 15 effectively reduces pain and fear and should be used in the emergency unit.