Using Buzzy, Shotblocker, and Bubble Blowing in a Pediatric Emergency Department to Reduce the Pain and Fear Caused by Intramuscular Injection: A Randomized Controlled Trial

J Emerg Nurs. 2019 Sep;45(5):502-511. doi: 10.1016/j.jen.2019.04.003. Epub 2019 Jun 27.


Introduction: Procedural pain in general, and intramuscular (IM) injection pain in particular, is one of the most distressing and painful health care experiences for children. Pharmacologic and nonpharmacologic methods are used as forms of pain control for children undergoing acute painful interventions in emergency departments.

Methods: This study was a prospective, randomized controlled trial. The sample consisted of children aged 5 to 10 years old who required IM injections. Children were placed in 4 subgroups through randomization, using a computer program: the Buzzy (MMJ Labs. Atlanta, GA) group (n = 40), the ShotBlocker (Bionix Development Corporation, Toledo, OH) group (n = 40), the bubble-blowing group (n = 40), and the control group (n = 40). Immediately before and after the injection, the children, their parents, and an observer were asked to evaluate the child's level of fear. The Oucher scale was also employed by the observers, children, and parents immediately after the procedure to assess the level of pain in the children in each group.

Results: No statistically significant difference was determined between the control and intervention groups in terms gender, age, previous pain experienced with injection, the parent who was with the child, the parent's age. A significant difference was found between the intervention and control groups in terms of levels of pain and fear during IM injection. Pain and fear were notably less in the group of children receiving the Buzzy intervention.

Discussion: The Buzzy intervention should be used when children are undergoing IM injections to reduce their levels of pain and fear.

Keywords: Bubble blowing; Buzzy; Intramuscular injection; Pain and fear; Pediatric emergency department; ShotBlocker.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Child
  • Child, Preschool
  • Emergency Service, Hospital*
  • Fear / psychology*
  • Female
  • Humans
  • Ice
  • Injections, Intramuscular / adverse effects
  • Injections, Intramuscular / psychology
  • Male
  • Pain / etiology
  • Pain / prevention & control*
  • Pain / psychology*
  • Pediatrics / methods*
  • Photic Stimulation / methods
  • Physical Stimulation / methods*
  • Vibration / therapeutic use


  • Ice