{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T19:26:34Z","timestamp":1769714794415,"version":"3.49.0"},"reference-count":22,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,8,1]]},"abstract":"<jats:p>OBJECTIVE: The goal was to test a multifaceted distraction method designed to reduce injection-associated pain in school-aged children.<\/jats:p><jats:p>METHODS: A clinical trial evaluated 41 children, 4 to 6 years of age, who were given 3 standard prekindergarten immunizations; 21 were assigned randomly to an office routine control group, whereas 20 received a multifaceted, discomfort-reducing intervention. The intervention added verbal suggestions of diminished sensation and a visual focusing activity to the use of ethyl chloride, an established pain-reducing measure. The distraction materials used for the intervention consisted of topical ethyl chloride spray, an improvised, plastic, multipronged arm gripper, and a vibrating instrument descending on the contralateral arm, which provided the focusing task and visual distraction.<\/jats:p><jats:p>RESULTS: According to patient and parent Faces Pain Scale-Revised scores and nonblinded, video-taped observations scored according to the face-legs-activity-crying-consolability method, the intervention group showed highly significant reductions in pain and discomfort, compared with the control group (patient self-report, P &amp;lt; .0013; parent report, P &amp;lt; .0002; observation score, P &amp;lt; .0001).<\/jats:p><jats:p>CONCLUSION: This multifaceted distraction intervention reduced significantly the pain and discomfort of childhood immunizations in children 4 to 6 years of age.<\/jats:p>","DOI":"10.1542\/peds.2007-3466","type":"journal-article","created":{"date-parts":[[2009,7,14]],"date-time":"2009-07-14T00:29:06Z","timestamp":1247531346000},"page":"e203-e209","source":"Crossref","is-referenced-by-count":45,"title":["Reducing Immunization Discomfort in 4- to 6-Year-Old Children: A Randomized Clinical Trial"],"prefix":"10.1542","volume":"124","author":[{"given":"F. Ralph","family":"Berberich","sequence":"first","affiliation":[{"name":"Pediatric Medical Group, Berkeley, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zachary","family":"Landman","sequence":"additional","affiliation":[{"name":"Pediatric Medical Group, Berkeley, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2009,8,1]]},"reference":[{"key":"2021120905311509700_R1","doi-asserted-by":"crossref","unstructured":"Uman LS, Chambers CT, McGrath PJ, Kisely S. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev.\u20082006;(4):CD005179","DOI":"10.1002\/14651858.CD005179.pub2"},{"key":"2021120905311509700_R2","doi-asserted-by":"crossref","unstructured":"von Baeyer CL, Marche TA, Rocha EM, Salmon K. Children's memory for pain: overview and implications for practice. 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