Taking the "ouch" out of injections for children. Using distraction to decrease pain

MCN Am J Matern Child Nurs. 2001 Mar-Apr;26(2):72-8. doi: 10.1097/00005721-200103000-00005.


Purpose: This research compared the effect of two forms of distraction on injection pain in a convenience sample of preschool children.

Design: A quasi-experimental study of 105 children (53 girls and 52 boys) ages 4 to 6 years needing DPT immunizations. Data were collected at three sites: two school-based immunization clinics and one public health center with a walk-in immunization program.

Methods: Study children were randomly assigned to receive one of three treatments with their DTP injection: touch, bubble-blowing, or standard care. Prior to injection, a measure of medical fear was obtained (Child Medical Fear Scale) and pain was measured through use of the Oucher Scale.

Data analysis: Planned comparisons within analysis of variance (ANOVA) tested the differences in pain scores by treatment. Factorial ANOVA was used to determine the influence of age or gender on treatment, and the effect of medical fear on pain was analyzed using correlational statistics and factorial ANOVA.

Results: Both forms of distraction, touch and bubble-blowing, significantly reduced pain perception. There were no interaction effects of either age or gender. Fear was a significant covariate, but distraction was effective even when fear was not held constant.

Clinical implications: Distraction appears to be an effective method for decreasing injection pain in young children. It is an easy, practical nursing intervention to help children cope with this common, painful experience.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Analysis of Variance
  • Child
  • Child, Preschool
  • Diphtheria-Tetanus-Pertussis Vaccine / administration & dosage*
  • Fear / psychology
  • Female
  • Humans
  • Injections / adverse effects
  • Male
  • Pain / etiology
  • Pain / prevention & control*
  • Pain / psychology*
  • Pain Measurement*


  • Diphtheria-Tetanus-Pertussis Vaccine