{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T02:12:38Z","timestamp":1791598358853,"version":"4.3.4"},"reference-count":42,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,3,12]],"date-time":"2021-03-12T00:00:00Z","timestamp":1615507200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Paediatrics Child Health"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>Most toddlers experience pain and distress during doctor or dental visits. Aim of this systematic review was to investigate the role of play\u2010based interventions in pain and fear or distress management in pre\u2010school children (aged from 2 to 6\u2009years old) undergoing needle\u2010related medical procedures adhering to Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses guidelines (registration number: CRD42020192161).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The key database that was searched was PubMed\/MEDLINE along with references of relevant review studies. Only randomised controlled trials (RCTs) that fulfilled inclusion and eligibility criteria were selected for analysis. Methodological quality was evaluated using the Cochrane Collaboration's Risk of Bias Tool for RCTs and Review Manager version 5.4 was utilised in order to calculate standardised mean differences (SMDs) and create a forest plot for included studies that presented data on self\u2010reported pain ratings. Primary outcomes refer to pain, anxiety and fear assessments, while secondary outcomes refer to physiological measures and cortisol levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All included RCTs suffered from high risk of bias that relied on selection and blinding methodology, while other sources of bias were also present in some cases. Despite low\u2010quality of evidence, play\u2010based interventions seem to favour less self\u2010reported pain (SMD \u22120.39; 95% CI: \u22120.67 to \u22120.12; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup> =\u200984%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Limitations of evidence, except from high risk of bias, include inconsistency in reporting primary outcome assessments and study designs that preclude reproducibility. Play\u2010based techniques seem to contribute to pre\u2010schoolers' coping towards needle\u2010related medical procedures and further research is warranted in order to explore clinical benefits.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jpc.15442","type":"journal-article","created":{"date-parts":[[2021,3,12]],"date-time":"2021-03-12T10:40:15Z","timestamp":1615545615000},"page":"491-499","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Play and medical play in teaching pre\u2010school children to cope with medical procedures involving needles: A systematic review"],"prefix":"10.1111","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8153-9643","authenticated-orcid":false,"given":"Ioannis","family":"Kyriakidis","sequence":"first","affiliation":[{"name":"Hematology Oncology Unit, Second Pediatric Department Aristotle University of Thessaloniki, University General Hospital AHEPA  Thessaloniki Greece"},{"name":"Department of Pediatrics 404 General Military Hospital  Larissa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7265-1190","authenticated-orcid":false,"given":"Evangelia","family":"Tsamagou","sequence":"additional","affiliation":[{"name":"Department of Early Childhood Education, School of Humanities and Social Sciences University of Thessaly  Volos Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5940-5243","authenticated-orcid":false,"given":"Konstantinos","family":"Magos","sequence":"additional","affiliation":[{"name":"Department of Early Childhood Education, School of Humanities and Social Sciences University of Thessaly  Volos Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,3,12]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"52","article-title":"Fear reaction of children precipitated by a visit to or by the physician","volume":"10","author":"Goldstein LS","year":"1948","journal-title":"Tuberculol. 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