Three Distraction Techniques for Pain and Anxiety in Children During Allergy Skin Prick Testing

The Effect of Three Different Distraction Techniques on Anxiety and Pain Levels in Children During Allergy Skin Prick Testing: A Randomized Controlled Trial

This randomized controlled trial compared three distraction techniques-animated cartoons, DistrACTION® Cards, and interactive video games-with standard care for reducing procedural pain and anxiety in children aged 6-10 years undergoing allergy skin prick testing. A total of 161 children were randomly assigned to four groups. Pain was rated by the child, a parent, and the researcher with the Wong-Baker FACES Pain Rating Scale during and after the procedure, and anxiety was rated by the parent and the researcher with the Children's Fear Scale before, during, and after the procedure.

Study Overview

• Status: Completed
• Conditions: Procedural Pain; Procedural Anxiety
• Intervention / Treatment: Behavioral: Animated cartoon distraction; Behavioral: Distraction card intervention; Behavioral: Interactive video game distraction

Detailed Description

This single-center, four-arm, parallel-group randomized controlled trial was conducted in the pediatric allergy outpatient clinic of a training and research hospital in Istanbul, Turkey, between November 2019 and January 2020. Children aged 6-10 years referred for allergy skin prick testing were randomly allocated by computer-generated assignment to a cartoon group (n = 40), a DistrACTION® Cards group (n = 40), a video game group (n = 40), or a standard-care control group (n = 41). All tests were performed by the same pediatric nurse under identical conditions. Between-group differences were tested with one-way ANOVA and change over time with two-way repeated-measures ANOVA.

• Study Type: Interventional
• Enrollment (Actual): 161
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Istanbul, Turkey (Türkiye)
    • Bakirkoy Dr. Sadi Konuk Research and Training Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Aged 6-10 years
• Referred for allergy skin prick testing
• Consent of both child and parent
• No analgesic use in the previous six hours
• Able to understand the Wong-Baker FACES Pain Rating Scale and answer the card questions

Exclusion Criteria:

• Neurodevelopmental conditions (diagnosis of autism or intellectual disability)
• Chronic mental, cognitive, or visual problems
• Cognitive, visual, or hearing impairment preventing scale use

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Cartoon group (CG); Children watched a self-selected, age-appropriate animated cartoon on a tablet computer during the skin prick test.	Behavioral: Animated cartoon distraction; Children watched a self-selected, age-appropriate animated cartoon on a tablet computer during the skin prick test.
Experimental: DistrACTION® Cards group (DC); Children viewed DistrACTION® Cards and answered goal-directed visual-search questions asked by the researcher during the skin prick test.	Behavioral: Distraction card intervention; Children viewed DistrACTION® Cards and answered goal-directed visual-search questions asked by the researcher during the skin prick test.
Experimental: Video game group (VG); Children played a self-selected interactive video game on a tablet with the non-tested arm during the skin prick test.	Behavioral: Interactive video game distraction; Children played a self-selected interactive video game on a tablet with the non-tested arm during the skin prick test.
No Intervention: Control group (C); Children received the clinic's standard protocol; the nurse explained and performed the test, and no additional distraction was provided.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Child-reported procedural pain	Pain self-reported by the child on the Wong-Baker FACES Pain Rating Scale (0 = no pain to 10 = worst possible pain; higher scores indicate more pain).	During the skin prick test, a procedure lasting approximately 3 minutes

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Child-reported pain after the procedure	Pain self-reported by the child on the Wong-Baker FACES Pain Rating Scale (0 = no pain to 10 = worst possible pain; higher scores indicate more pain).	Immediately after the skin prick test, up to 15 minutes after the procedure
Parent-reported pain	Pain reported by the parent on the Wong-Baker FACES Pain Rating Scale (0 = no pain to 10 = worst possible pain; higher scores indicate more pain).	During the skin prick test (approximately 3 minutes) and immediately after the procedure (up to 15 minutes)
Researcher-reported pain	Pain reported by the researcher on the Wong-Baker FACES Pain Rating Scale (0 = no pain to 10 = worst possible pain; higher scores indicate more pain).	During the skin prick test (approximately 3 minutes) and immediately after the procedure (up to 15 minutes)
Parent-reported anxiety	Anxiety reported by the parent using the Children's Fear Scale (0 = no anxiety to 4 = severe anxiety; higher scores indicate higher anxiety).	Approximately 10 minutes before the skin prick test, during the test (approximately 3 minutes), and immediately after the procedure (up to 15 minutes)
Researcher-reported anxiety	Anxiety reported by the researcher using the Children's Fear Scale (0 = no anxiety to 4 = severe anxiety; higher scores indicate higher anxiety).	Approximately 10 minutes before the skin prick test, during the test (approximately 3 minutes), and immediately after the procedure (up to 15 minutes)
Interrater agreement	Intraclass correlation coefficient between child, parent, and researcher ratings.	During the skin prick test (approximately 3 minutes) and immediately after the procedure (up to 15 minutes)

Collaborators and Investigators

• Sponsor: Istanbul University
• Collaborators: Bakirkoy Dr. Sadi Konuk Research and Training Hospital
• Investigators: Principal Investigator: Leyla Erdim, Bakirkoy Dr. Sadi Konuk Research and Training Hospital

Study record dates

Study Major Dates

• Study Start (Actual): November 7, 2019
• Primary Completion (Actual): January 12, 2020
• Study Completion (Actual): January 21, 2020

Study Registration Dates

• First Submitted: August 24, 2026
• First Submitted That Met QC Criteria: August 26, 2026
• First Posted (Actual): August 31, 2026

Study Record Updates

• Last Update Posted (Actual): August 31, 2026
• Last Update Submitted That Met QC Criteria: August 26, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Keywords: child; distraction; skin prick test; video games; cartoons; distraction cards
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Procedural
• Other Study ID Numbers: 2019-19-01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No