• C Kleiber and D C Harper.
• College of Nursing, University of Iowa, University of Iowa Hospitals and Clinics, Iowa City, USA. charmaine-kleiber@uiowa.edu
• Nurs Res. 1999 Jan 1; 48 (1): 44-9.

BackgroundIt 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.ObjectivesTo 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.MethodHunter 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.ResultsFor 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%.ConclusionsDistraction 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.

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