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Pain Med. 2002 Jun;3(2):108-18.

Watch needle, watch TV: Audiovisual distraction in preschool immunization.

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Department of Medicine, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada.



To evaluate the effectiveness of audiovisual distraction compared with a blank TV screen in the reduction of pain associated with intramuscular immunization.


Subjects were randomly assigned to watch television (TV) (N = 29) or a blank TV screen (control) (N = 33) during immunization, and were videotaped. Immediately after the injection, the children rated their pain. Videotapes were coded for pain behaviors and for distraction. t tests determined between-group mean differences and chi-square tests compared proportions for clinically significant self-reported pain.


Two urban pediatric practices in Halifax, Nova Scotia, Canada.


Five-year-old children (N = 62), undergoing diphtheria, polio, tetanus, and pertussis immunization, and their parents.


An age-appropriate musical cartoon or a blank TV screen.


Pain measurements were the children's self-reports on Faces Pain Scale, facial actions on Child Facial Coding System, and Children's Hospital of Eastern Ontario Pain Scale. Distraction was measured by mean time spent watching the TV screen. Parents rated their own and their child's anxiety on a visual analogue scale.


There were no significant group differences for any pain or distraction measures. The relative risk estimate for clinically significant pain among the distraction group was 0.64 (range: 0.23-1.80). Higher levels of distraction (i.e., greater time looking at the TV screen) related to lower levels of pain on all three pain measures. Only correlations with objective pain measures were statistically significant.


Watching cartoons did not distract children during needle injection nor reduce their pain. Looking at the TV screen was related to lower behavioral pain scores in the total sample.

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