The effect of arm concealment and distraction techniques on fear, anxiety and pain reduction in pediatric venipuncture: A randomized control trial

Background: Venipuncture frequently causes significant fear and anxiety in children. While distraction techniques are effective, the combined effect of arm concealment and distraction remains largely unexplored. This Randomized Control Trial (RCT) aims to evaluate the effectiveness of both arm concealment and distraction, delivered through our invention, the Magical Bravery Box, in reducing fear, anxiety and pain during pediatric venipuncture.

Methods: This RCT involved pediatric patients aged 6–12 years requiring routine venipuncture at Phramongkutklao Hospital. Participants were randomized into control and intervention groups. The Intervention group utilized the Magical Bravery Box to provide arm concealment combined with active distraction, specifically using a music box and colorful pictures. Outcomes of fear, anxiety, and pain were measured using standard assessment tools (The Children's Fear Scale, Children's Anxiety Meter, Wong-Baker Faces Scale) alongside pulse rate.

Results: The study included 40 patients randomized into the Intervention (n=20) and Control (n=20) groups. The mean age was 8.4 ±1.7 years for the Intervention Group and 9.6 ±1.8 years for the Control Group. Within-group analysis showed a highly significant reduction in the Intervention Group for Fear (Pre: 4.6 ±3.7 vs. Post: 1.4 ±2.3; p < 0.001, Cohen's d=1.04) and Anxiety (Pre: 3.5 ±2.9 vs. Post: 1.3 ± 2.2; p < 0.001, Cohen's d=0.82), with the effect sizes categorized as large. The Control Group also showed significant reductions in Anxiety (Pre: 3.5 ±3.5 vs. Post: 1.7 ±3.2; p=0.012, Cohen's d=0.57) and Pulse Rate (Pre: 109.3 ±14.8 vs. Post: 102.4 ±17.5; p=0.005, Cohen's d=0.43), with the effect sizes categorized as medium. The reduction in Fear in the Control Group was not significant (p=0.309). When comparing groups post-intervention, there were no statistically significant differences.

Conclusion:  The Magical Bravery Box intervention achieved a large effect size in significantly reducing fear and anxiety within the Intervention Group. However, its efficacy was not statistically superior to standard care when comparing post-intervention scores. Given the lack of a significant difference, it is suggested that a larger sample size is necessary to detect a clinically meaningful difference that reaches statistical significance. Nevertheless, the within-group analysis clearly demonstrates the intervention's potential as an effective tool for managing pediatric distress during venipuncture.

Mr. Korawit Keorochana is a Year 12 student at Shrewsbury International School Bangkok Riverside. His primary research interests lie in Child Psychology and developmental wellness. Driven by this focus, he has developed an innovation aimed at preventing and mitigating the fear and anxiety experienced by children during blood collection procedures. This innovation reflects his deep commitment to applying psychological principles to create more child-friendly medical environments. His work demonstrates strong potential for practical application in pediatric healthcare settings.