Comparison of the Effects of Drawing Pictures and Inflating Balloons on Anxiety and Pain Caused by Diphtheria-Pertussis-Tetanus Immunization in School-Aged Children

Frequent experience of pain and anxiety can cause neuro-developmental disorders, reduced learning ability, and behavioral problems in children.

For this reason, the present study aimed at comparing the effects of drawing pictures and blowing up balloons on the anxiety and pain intensity arising from diphtheria-pertussis-tetanus (DPT) immunization (triple vaccine) in school-aged children.

The present study was a quasi-experimental research conducted on children, who had been referred to Ilam clinics for DPT immunization during year 2016. 120 children, who met the inclusion criteria were enrolled in this study. They were randomly divided to three groups, namely experimental group A (drawing pictures before immunization up to its completion), experimental group B (inflating balloons before immunization up to its completion), and control group C (routine care group). The data collection instruments in this study included numeric pain rating scale, behavioral scale of pain responses (for the assessment of the child’s pain), Pieri’s pictorial anxiety scale, and self-rating scale of clinical phobias (for the assessment of the child’s anxiety). The SPSS version 16 (IBM Corp., Armonk, N.Y., USA) was used to analyze the data through descriptive statistics.

The results showed that no statistically significant differences were observed in demographic characteristics of children under the study among the groups (P < 0.05). The results also showed that the practice of distraction technique via drawing pictures reduced the children’s anxiety and pain caused by the vaccine. However, only anxiety decreased in the group that experienced the distraction method through inflating balloons. Additionally, the implementation of this technique did not have a statistically significant effect on the level of perceived pain in patients that inflated balloons (P < 0.05).

The implementation of these non-pharmacological and low-cost distraction techniques is suggested to be incorporated in care and treatment routines, particularly in clinical setting. It is also recommended that the personnel receive training in this field and that research be conducted to determine the willingness of health care workers to perform distraction techniques and eliminate the existing barriers