Television Numbs Pediatric Pain

SIENA, Italy, Aug. 17 -- For soothing a child's pain when blood is drawn, TV cartoons are a better analgesic than a mother's touch, found investigators here.

Watching television killed the pain of venipuncture for children better than active distraction by a parent in an Italian study published online today in the Archives of Disease in Childhood.

"This does not mean that the mothers' presence is negative," said Carlo V. Bellieni, M.D., of the University of Siena, and colleagues. "Children who are experiencing pain in a health care setting, of course, need the supportive presence of a parent to help them cope effectively."

The study included 69 children seven to 12 years old who had blood drawn at a hospital but who were not accustomed to the procedure. They were randomized to receive no distraction during the procedure, active distraction by the parent (typically the mother) speaking and caressing them, or passive distraction by an age-appropriate cartoon during the procedure.

No topical anesthetics were used.

Children in the TV group rated their pain as significantly lower than the control group did (8.91 versus 23.04 on a scale of 0 to 100, P=0.045) as did their mothers (12.17 versus 21.30, P=0.037).

The children distracted by their parent reported less pain than those not distracted at all, but not significantly so (17.39 versus 23.04). However, the parent actually reported more pain for the child they were actively distracting (23.04 versus 21.30).

This difference "shows the difficulty mothers have in interacting positively at a difficult moment in their children's life," Dr. Bellieni said.

Previous studies have also shown distraction to be a powerful analgesic, though their results have conflicted as to the best method of distraction. Other non-pharmacological strategies attempted in children include using toys, looking through kaleidoscopes, blowing bubbles, non-procedural talk, listening to short stories, and even virtual reality glasses.

Distraction works to increase pain tolerance even in neonates, according to a previous study by the research group.

Age and gender made no difference in pain scores reported by the children on the commonly used visual analog Oucher scale. Parent-reported scores were not significantly different from those reported by their children.

One important limitation of the study was that participants in the study were not blinded. The child and parent listened to a description of the procedure and the pain scoring system and were told which group they were in before they entered the blood sampling room.

Although health professionals often encourage parents to wait outside the room where the procedure takes place, their presence is important for pain reduction and psychological support, said the Italian group.

"The children will recall that they were not left alone on a stressful occasion," Dr. Bellieni said.

The American Academy of Pediatrics recommends that even in the hospital nonpharmacologic or stress management and emotional support are essential. It suggests training staffers in distraction and imagery and allowing though not requiring family presence during painful procedures.