Effects of distraction on children's pain and distress during medical procedures: a meta-analysis

Document Type


Peer Reviewed


Publication Date


NLM Title Abbreviation

Nurs Res

Journal/Book/Conference Title

Nursing research

PubMed ID


DOI of Published Version


Start Page


End Page



BACKGROUND: It is difficult to determine the usefulness of distraction to decrease children's distress behavior and pain during medical procedures because many studies use very small samples and report inconsistent findings. OBJECTIVES: To investigate the mean effect sizes across studies for the effects of distraction on young children's distress behavior and self-reported pain during medical procedures. METHOD: Hunter and Schmidt's (1990) procedures were used to analyze 16 studies (total n = 491) on children's distress behavior and 10 studies (total n = 535) on children's pain. RESULTS: For distress behavior, the mean effect size was 0.33 (+/-0.17), with 74% of the variance accounted for by sampling and measurement error. For pain, the mean effect size was 0.62 (+/-0.42) with 35% of the variance accounted for. Analysis of studies on pain that limited the sample to children 7 years of age or younger (total n = 286) increased the amount of explained variance to 60%. CONCLUSIONS: Distraction had a positive effect on children's distress behavior across the populations represented in this study. The effect of distraction on children's self-reported pain is influenced by moderator variables. Controlling for age and type of painful procedure significantly increased the amount of explained variance, but there are other unidentified moderators at work.


Adolescent, Analysis of Variance, Bias (Epidemiology), Child, Child, Preschool, Effect Modifiers (Epidemiology), Humans, Pain/diagnosis/etiology/prevention & control, Pain Measurement, Relaxation Therapy/standards, Reproducibility of Results, Research Design/standards, Sample Size, Stress, Psychological/diagnosis/etiology/prevention & control

Published Article/Book Citation

Nursing research, 48:1 (1999) pp.44-49.

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