Toy‐Mediated Distraction: Clarifying the Role of Distraction Agent and Preneedle Distress in Toddlers

BACKGROUND: Distraction has recently gained attention as a technique that may help reduce acute pain in infants and toddlers; however, results remain equivocal. It appears that these mixed results stem from a variety of methodological differences with regard to how distraction is implemented. OBJECTIVES: To offer more definitive conclusions regarding the efficacy and mechanisms of distraction for pain management during infancy. Specifically, the goal was to examine whether the agent of distraction (ie, the specific person conducting the distraction) and preneedle distress behaviours impact the efficacy of distraction when toddlers were held by parents. METHODS: A total of 99 toddlers were randomly assigned to one of three conditions (typical care, research assistant‐directed distraction or parent‐directed distraction). Toddler distress behaviours were assessed pre‐ and postneedle. Toddlers were further grouped according to distress behaviours preneedle (low/no distress versus high distress). Parental soothing behaviours were also assessed as a manipulation check. RESULTS: Toddler postneedle pain did not significantly differ among groups. However, toddlers who were distressed preneedle displayed significantly more pain postneedle, regardless of the treatment group. There were no significant interactions between treatment group and preneedle distress behaviours. CONCLUSIONS: These results suggest that, when being held by a parent, distraction using a toy does not result in lower pain scores in the context of immunization, regardless of who offers the distraction. Furthermore, these findings raise the notion that if clinicians ensured toddlers were regulated before attempting an immunization, postneedle pain may be significantly reduced.