Skip to main content
SpringerLink
Log in

Distraction for Pediatric Immunization Pain: A Critical Review

  • Published:
Journal of Clinical Psychology in Medical Settings Aims and scope Submit manuscript

Abstract

The paper provides a critical review of distraction for pediatric immunizations in order to determine clinical practicality and efficacy of this commonly employed intervention. The MEDLINE and PsycINFO databases were searched to identify papers that included an evaluation of a distraction intervention as a method of pediatric immunization pain management. Fifteen papers were included in this review. Effect sizes were calculated to estimate the clinical significance of findings. In order to examine possible differences in effect sizes related to distraction characteristics, chi square analyses were conducted. Results indicate that distraction is clinically effective in the reduction of pain during pediatric immunizations. Support is found for behavioral and cognitive explanations of distraction mechanisms. Further, various distraction stimulus characteristics were found to be associated with the clinical significance of findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Anand, K. J., Coskun, V., Thrivikraman, K. V., Nemeroff, C. B., & Plotsky, P. M. (1999). Long-term behavioral effects of repetitive pain in neonatal rat pups. Physiology and Behavior, 66, 627–637.

    Article  PubMed  Google Scholar 

  • Blount, R. L., Bachanas, P. J., Powers, S. W., Cotter, M. C., Franklin, A., Chaplin, W., et al. (1992). Training children to cope and parents to coach them during routine immunizations: Effects on child, parent, and staff behaviors. Behavior Therapy, 23, 689–705.

    Google Scholar 

  • Blount, R. L., Piira, T., & Cohen, L. L. (2003). Management of pediatric pain and distress due to medical procedures. In M. Roberts (Ed.). Handbook of pediatric psychology: Third edition (pp. 216–233). New York: Guilford.

    Google Scholar 

  • Bowen, A. M., & Dammeyer, M. M. (1999). Reducing children's immunization distress in a primary care setting. Journal of Pediatric Nursing, 14, 296–303.

    PubMed  Google Scholar 

  • Broome, M. E., & Endsley, R. (1989). Maternal presence, childrearing practices, and children's response to an injection. Research in Nursing and Health, 12, 229–235.

    PubMed  Google Scholar 

  • Cassidy, K. L., Graham, J. R., McGrath, P. J., Finley, G. A., Smith, D. J., Morley, C., et al. (2002). Watch needle, watch TV: Audiovisual distraction in preschool immunization. Pain Medicine, 3, 108–118.

    Article  PubMed  Google Scholar 

  • Center for Disease Control and Prevention [CDC] (2004). Recommended Childhood and Adolescent Immunization Schedule. Morbidity and Mortality Weekly Report, 53(16), Q1–Q3.

    Google Scholar 

  • Chambless, D. L., & Ollendick, T. H. (2001). Empirically supported psychological interventions: Controversies and evidence. Annual Review of Psychology, 52, 685–716.

    Article  PubMed  Google Scholar 

  • Cohen, L. L. (2002). Reducing infant immunization distress through distraction. Health Psychology, 21, 207–211.

    Article  PubMed  Google Scholar 

  • Cohen, L. L., Bernard, R. S., Greco, L. A., & McClellan, C. B. (2002). A child-focused intervention for coping with procedural pain: Are parent and nurse coaches necessary? Journal of Pediatric Psychology, 27, 749–757.

    Article  PubMed  Google Scholar 

  • Cohen, L. L., Blount, R. L., Cohen, R. J., McClellan, C. B., Bernard, R. S., & Ball, C. M. (2001). Children's expectations and memories of acute distress: The short and long-term efficacy of pain management interventions. Journal of Pediatric Psychology, 26, 376–374.

    Article  Google Scholar 

  • Cohen, L. L., Blount, R. L., Cohen, R. J., Schaen, E. R., & Zaff, J. F. (1999). Comparative study of distraction versus topical anesthesia for pediatric pain management during immunizations. Health Psychology, 18, 591–598.

    Article  PubMed  Google Scholar 

  • Cohen, L. L., Blount, R. L., & Panopoulos, G. (1997). Nurse coaching and cartoon distraction: An effective and practical intervention to reduce child, parent, and nurse distress during immunizations. Journal of Pediatric Psychology, 22, 355–370.

    PubMed  Google Scholar 

  • Cohen, L. L., & MacLaren, J. E. (November, 2003). Movie distraction for pediatric procedural pain. In S. Safren (Chair) & D. Ahern (Discussant), Use of Technology in Behavioral Assessments and Interventions. Symposium to be presented at the AABT Convention, Boston.

  • Dawson, M. E., Schell, A. M., & Filion, D. L. (1989). Attentional resource allocation and autonomic orienting. In N. W. Bond & D. Siddle (Eds.), Psychobiology: Issues and applications (pp. 113–234). Oxford: North Holland.

    Google Scholar 

  • Drotar, D. (2002). Enhancing reviews of psychological treatments with pediatric populations: Thoughts on next steps. Journal of Pediatric Psychology, 27, 167–176.

    Article  PubMed  Google Scholar 

  • Felt, B. T., Mollen, E., Diaz, S., Renaud, E., Zeglis, M., Wheatcroft, G., et al. (2000). Behavioral interventions reduce infant distress at immunization. Archives of Pediatric and Adolescent Medicine, 154, 719–724.

    Google Scholar 

  • Fowler-Kerry, S., & Lander, J. R. (1987). Management of injection pain in children. Pain, 30, 169–175.

    Article  PubMed  Google Scholar 

  • French, G. M., Painter, E. C., & Coury, D. L. (1994). Blowing away shot pain: A technique for pain management during immunization. Pediatrics, 93, 384–388.

    PubMed  Google Scholar 

  • Gonzalez, J. C., Routh, D. K., & Armstrong, F. D. (1993). Effects of maternal distraction versus reassurance on children's reactions to injections. Journal of Pediatric Psychology, 18, 593–604.

    PubMed  Google Scholar 

  • Howell, D. C. (2002). Statistical methods for psychology (5th ed., pp. 104–107). Pacific Grove, CA: Duxbury.

  • Institute of Medicine (2000). Calling the shots—Immunization finance policies and practices. Washington, DC: National Academy Press.

    Google Scholar 

  • Jacobson, N. S., Roberts, L. J., Berns, S. B., & McGlinchey, J. B. (1999). Methods of determining and defining the clinical significance of treatment effects: Description, application, and alternatives. Journal of Consulting and Clinical Psychology, 67, 300–307.

    Article  PubMed  Google Scholar 

  • Jacobson, R. M., Swan, A., Adegbenro, A., Ludington, S. L., Wollan, P. C., and Poland, G. A. (2001). Making vaccines more acceptable—Methods to prevent and minimize pain and other common adverse events associated with vaccines. Vaccine, 19, 2418–2427.

    Article  PubMed  Google Scholar 

  • Jay, S. M., Ozolins, M., Elliot, C. H., & Caldwell, S. (1983). Assessment of children's distress during painful medical procedures. Health Psychology, 2, 133–147.

    Google Scholar 

  • Johnson, M. H., Breakwell, G., Douglas, W., & Humphries, S. (1998). The effects of imagery and sensory detection distracters on different measures of pain: How does distraction work? British Journal of Clinical Psychology, 37, 141–154.

    PubMed  Google Scholar 

  • Keene, M. F. (1986). Comparison of intramuscular injection techniques to reduce site discomfort and lesions. Nursing Research, 35, 207–210.

    PubMed  Google Scholar 

  • Kleiber, C., & Harper, D. C. (1999). Effects of distraction on children's pain and distress during medical procedures: A meta-analysis. Nursing Research, 48, 44–49.

    Article  PubMed  Google Scholar 

  • Manimala, M. R., Blount, R. L., & Cohen, L. L. (2000). The effects of parental reassurance versus distraction on child distress and coping during immunizations. Children's Health Care, 29, 161–177.

    Article  Google Scholar 

  • McAllister, W. R., & McAllister, D. E. (1995). Two-factor fear theory: Implications for understanding anxiety-based clinical phenomena. In W. T. O'Donohue & L. Krasner (Eds.), Theories of behavior therapy: Exploring behavior change (pp. 145–171). Washington, DC: American Psychological Association.

    Google Scholar 

  • McCaul, K. D., & Malott, J. M. (1984). Distraction and coping with pain. Psychological Bulletin, 95, 516–533.

    Article  PubMed  Google Scholar 

  • Megel, M. E., Houser, C. W., & Gleaves, L. S. (1998). Children's responses to immunizations: Lullabies as a distraction. Issues in Comprehensive Pediatric Nursing, 21, 129–145.

    Article  PubMed  Google Scholar 

  • Melzack, R., & Wall, P. D. (1965). Pain mechanisms: A new theory. Science, 150, 971–979.

    PubMed  Google Scholar 

  • Mowrer, O. H. (1947). On the dual nature of learning—A reinterpretation of “conditioning” and “problem-solving.” Harvard Educational Review, 17, 102–148.

    Google Scholar 

  • O'Laughlin, E., & Ridley-Johnson, R. (1995). Maternal presence during immunizations: The effect of mother as observer in reducing child distress. Children's Health Care, 24, 175–191.

    PubMed  Google Scholar 

  • Parasuraman, R., & Davies, D. R. (1984). Varieties of attention (p. 13). Orlando, FL: Academic.

  • Pate, J. T., Blount, R. I., Cohen, L. L., & Smith, A. J. (1996). Childhood medical experience and temperament as predictors of adult functioning in medical situations. Children's Health Care, 25, 281–296.

    Google Scholar 

  • Pavlov, I. P. (1927). Conditioned reflexes: An investigation of the physiological activity of the cerebral cortex (p. 430). Oxford: Oxford University Press.

  • Piira, T., Hayes, B., & Goodenough, B. (2002). Distraction methods in the management of children's pain: An approach based on evidence or intuition? The Suffering Child, 1, 1–10.

    Google Scholar 

  • Powers, S. W. (1999). Empirically supported treatments in pediatric psychology: Procedure related pain. Journal of Pediatric Psychology, 24, 131–145.

    Article  PubMed  Google Scholar 

  • Princeton Survey Research Associates (1996). Benchmark surveys on childhood immunization. Princeton, NJ: Gallup Poll.

  • Reis, E. C. (1997). Multiple scheduled injections contribute to missed opportunities to immunize during well care visits. Ambulatory Child Health, 3, 172.

    Google Scholar 

  • Reis, E. C., Roth, E. K., Syphan, J. L., Tarbell, S. E., & Holubkov, R. (2003). Effective pain reduction for multiple immunization injections in young infants. Archives of Pediatrics and Adolescent Medicine, 157, 1115–1120.

    Article  PubMed  Google Scholar 

  • Ruda, M. A., Ling, Q., Hohmann, A., Pong, Y. B., & Tachibana, T. (2000). Altered nociceptive neuronal circuits after neonatal peripheral inflammation. Science, 289, 628–631.

    Article  PubMed  Google Scholar 

  • Sattler, J. M. (2001). Assessment of children: Cognitive applications (4th ed., p. 4). San Diego: Sattler.

  • Sparks, L. (2001). Taking the ‘ouch’ out of injections for children: Using distraction to decrease pain. The American Journal of Maternal Child Nursing, 26, 72–78.

    Article  Google Scholar 

  • Taddio, A., Goldbach, M., Ipp, M., Stevens, B., & Koren, G. (1995). Effect of neonatal circumcision on pain response during vaccination in boys. Lancet, 345, 291–292.

    Article  PubMed  Google Scholar 

  • Vanderveen, F. M., Vandermolen, M. W., & Jennings, R. J. (2001). Psychophysiology, 38, 896–902.

    Google Scholar 

  • Wall, P. D. (1978). The gate control theory of pain mechanisms: A re-examination and re-statement. Brain, 101, 1–18.

    PubMed  Google Scholar 

  • Wickens, C. D. (1984). Processing resources in attention. In R. Parasuraman & D. R. Davies (Eds.), Varieties of attention (pp. 63–102). Orlando, FL: Academic.

    Google Scholar 

  • Wickens, C. D. (2002). Multiple resources and performance prediction. Theoretical Issues in Ergonomics Science, 3, 159–177.

    Article  Google Scholar 

  • Wolpe, J. (1995). Reciprocal inhibition: Major agent of behavior change. In W. T. O'Donohue & L. Krasner (Eds.), Theories of behavior therapy: Exploring behavior change (pp. 23–57). Washington, DC: American Psychological Association.

    Google Scholar 

  • Wong, D. L., Hockenberry, M. J., Wilson, D., Winkelstein, M. L., Kline, N. E., & Hockenberry-Eaton, M. (2003). Wong's Nursing Care of Infants and Children (Seventh Edition). St. Louis: Mosby.

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, West Virginia University, Morgantown, West Virginia

    Melissa DeMore

  2. Department of Psychology, Georgia State University, Atlanta, 30302-5010, Georgia

    Lindsey L. Cohen

Authors
  1. Melissa DeMore
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lindsey L. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lindsey L. Cohen.

Additional information

This article is based on the preliminary examination paper of the first author under the direction of the second, at West Virginia University.

Rights and permissions

Reprints and permissions

About this article

Cite this article

DeMore, M., Cohen, L.L. Distraction for Pediatric Immunization Pain: A Critical Review. J Clin Psychol Med Settings 12, 281–291 (2005). https://doi.org/10.1007/s10880-005-7813-1

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10880-005-7813-1

Key Words

Search

Navigation