{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T16:15:26Z","timestamp":1784823326975,"version":"3.55.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Background<\/jats:title>\n Venous blood sampling is a common medical procedure in preschool children that often induces significant anxiety, affecting procedural success and long-term medical adaptation. Clown care therapy (CCT) and virtual reality distraction (VRD) are non-pharmacological interventions with potential to alleviate children\u2019s anxiety, but existing research primarily focuses on Western populations, lacking direct comparisons in the Chinese cultural context, and often relies on subjective scales with insufficient use of objective physiological indicators.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare the efficacy of CCT and VRD in reducing anxiety during venous blood sampling in preschool children, and evaluate their clinical application value using both subjective and objective metrics.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This single-center, retrospective cohort study was conducted at Dongcheng District, the First Affiliated Hospital of Anhui Medical University. Medical records of 220 preschool children aged 3\u20136\u202fyears who underwent venous blood sampling between January 2022 and January 2025 were reviewed. Based on the non-pharmacological distraction method administered as part of routine clinical care and documented in their medical records, participants were categorized into two groups: the CCT group (\n n<\/jats:italic>\n \u202f=\u202f110), which received interactive play by medical clowns, and the VRD group (\n n<\/jats:italic>\n \u202f=\u202f110), which used virtual reality devices during the procedure. Outcomes included subjective anxiety scores (modified Yale Preoperative Anxiety Scale, m-YPAS), objective physiological indicators (heart rate, crying duration, cortisol changes), clinical operation indicators (cooperation level, first-attempt success rate, sampling time), and parental satisfaction. Inter-group comparisons were conducted to assess intervention efficacy.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The CCT group suggested significantly lower anxiety scores during blood sampling (\n t<\/jats:italic>\n \u202f=\u202f4.128,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001), smaller increase in heart rate (\n t<\/jats:italic>\n \u202f=\u202f5.217,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001), shorter crying duration (\n t<\/jats:italic>\n \u202f=\u202f6.384,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001), and less cortisol change (\n t<\/jats:italic>\n \u202f=\u202f3.724,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001) compared to the VRD group. Cooperation level was better in the CCT group (\n p<\/jats:italic>\n \u202f&lt;\u202f0.001), first-attempt success rate was higher (\u03c7\n 2<\/jats:sup>\n \u202f=\u202f5.143,\n p<\/jats:italic>\n \u202f=\u202f0.023), and sampling time was shorter (\n t<\/jats:italic>\n \u202f=\u202f4.926,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). Parental satisfaction was higher in the CCT group (\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). Multivariate analysis indicated CCT was independently associated with greater anxiety reduction (\n p<\/jats:italic>\n \u202f&lt;\u202f0.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n In this retrospective analysis, CCT was associated with better outcomes than VRD in alleviating anxiety induced by venous blood sampling in preschool children, significantly improving subjective anxiety, physiological stress responses, clinical efficiency, and parental satisfaction. Its interactive, human-centered nature may be particularly acceptable in this setting, though this requires further investigation.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2026.1785095","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T12:23:25Z","timestamp":1773836605000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Efficacy comparison of clown care therapy versus virtual reality distraction on venipuncture-induced anxiety in preschool children: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Yannan","family":"Cheng","sequence":"first","affiliation":[{"name":"School of Nursing, Anhui Medical University","place":["Hefei, China"]},{"name":"Department of Pediatrics, Dongcheng Campus, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang-cui","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Dongcheng Campus, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingfang","family":"Hong","sequence":"additional","affiliation":[{"name":"School of Nursing, Anhui Medical University","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2215","DOI":"10.1007\/s00431-022-04440-9","article-title":"Clown therapy for procedural pain in children: a systematic review and meta-analysis","volume":"181","author":"Fusetti","year":"2022","journal-title":"Eur J Pediatr"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"CD010686","DOI":"10.1002\/14651858.CD010686.pub2","article-title":"Virtual reality distraction for acute pain in children","volume":"10","author":"Lambert","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1190","DOI":"10.4187\/respcare.10151","article-title":"AARC clinical practice guidelines: capillary blood gas sampling for neonatal and pediatric patients","volume":"67","author":"Evans","year":"2022","journal-title":"Respir Care"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e109","DOI":"10.1016\/j.pmn.2023.06.011","article-title":"The effect of distraction methods during venous blood sampling on pain levels in school-age children: a systematic review","volume":"24","author":"Ar\u0131kan","year":"2023","journal-title":"Pain Manag Nurs"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1111\/jocn.15173","article-title":"Effects of virtual reality on pain, fear and anxiety during blood draw in children aged 5-12 years old: a randomised controlled study","volume":"29","author":"\u00d6zalp Ger\u00e7eker","year":"2020","journal-title":"J Clin Nurs"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1111\/ijlh.13846","article-title":"Differences between capillary and venous blood counts in children-a data mining approach","volume":"44","author":"Becker","year":"2022","journal-title":"Int J Lab Hematol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1080\/17434440.2023.2170783","article-title":"Minimally invasive capillary blood sampling methods","volume":"20","author":"Hoffman","year":"2023","journal-title":"Expert Rev Med Devices"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"239","DOI":"10.2337\/dc23-1379","article-title":"Transdermal blood sampling for C-peptide is a minimally invasive, reliable alternative to venous sampling in children and adults with type 1 diabetes","volume":"47","author":"Besser","year":"2024","journal-title":"Diabetes Care"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e0305101","DOI":"10.1371\/journal.pone.0305101","article-title":"Family participatory clown therapy in venipuncture in hospitalized children: a non-randomized controlled trial","volume":"19","author":"Chen","year":"2024","journal-title":"PLoS One"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1093\/qjmed\/hcz048","article-title":"Modified clown therapy using traditional Japanese-style costumes for elderly patients in post-disaster Fukushima","volume":"112","author":"Kanemoto","year":"2019","journal-title":"QJM"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e0313841","DOI":"10.1371\/journal.pone.0313841","article-title":"Application of clown care in hospitalized children: a scoping review","volume":"19","author":"Xin","year":"2024","journal-title":"PLoS One"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1111\/pan.14765","article-title":"Validity of the modified-distraction-short-scale and verbal-numeric-anxiety-fear-rating-scale for children in a preoperative setting","volume":"34","author":"Proczkowska","year":"2024","journal-title":"Paediatr Anaesth"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1007\/s40520-023-02376-0","article-title":"Intervention and application of clown care in nursing homes: a scoping review","volume":"35","author":"Xu","year":"2023","journal-title":"Aging Clin Exp Res"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1324283","DOI":"10.3389\/fped.2024.1324283","article-title":"Clown care in the clinical nursing of children: a meta-analysis and systematic review","volume":"12","author":"Wang","year":"2024","journal-title":"Front Pediatr"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e20200431","DOI":"10.1590\/0034-7167-2020-0431","article-title":"Effects of clown activities on patients eligible for palliative care in primary health care","volume":"74","author":"Santos","year":"2021","journal-title":"Rev Bras Enferm"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e54","DOI":"10.1016\/j.pedn.2021.01.001","article-title":"The effect of three different methods on venipuncture pain and anxiety in children: distraction cards, virtual reality, and buzzy\u00ae (randomized controlled trial)","volume":"58","author":"Erdogan","year":"2021","journal-title":"J Pediatr Nurs"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e2112082","DOI":"10.1001\/jamanetworkopen.2021.12082","article-title":"Efficacy of smartphone active and passive virtual reality distraction vs standard care on burn pain among pediatric patients: a randomized clinical trial","volume":"4","author":"Xiang","year":"2021","journal-title":"JAMA Netw Open"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"S53","DOI":"10.4103\/jpbs.jpbs_965_23","article-title":"Virtual reality distraction: a novel behaviour management technique","volume":"16","author":"Pawar","year":"2024","journal-title":"J Pharm Bioallied Sci"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"104455","DOI":"10.1016\/j.jdent.2023.104455","article-title":"Effectiveness of virtual reality distraction interventions to reduce dental anxiety in paediatric patients: a systematic review and meta-analysis","volume":"132","author":"Yan","year":"2023","journal-title":"J Dent"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1213\/ANE.0000000000005004","article-title":"Pediatric distraction on induction of anesthesia with virtual reality and perioperative anxiolysis: a randomized controlled trial","volume":"132","author":"Jung","year":"2021","journal-title":"Anesth Analg"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"97","DOI":"10.17796\/1053-4625-43.2.5","article-title":"Effect of virtual reality distraction on pain and anxiety during dental treatment in 5 to 8 year old children","volume":"43","author":"Shetty","year":"2019","journal-title":"J Clin Pediatr Dent"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1186\/s12903-021-01678-x","article-title":"Effect of virtual reality distraction on pain and anxiety during infiltration anesthesia in pediatric patients: a randomized clinical trial","volume":"21","author":"Felemban","year":"2021","journal-title":"BMC Oral Health"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1292","DOI":"10.1111\/pan.14546","article-title":"Virtual reality in pediatrics, effects on pain and anxiety: a systematic review and meta-analysis update","volume":"32","author":"Tas","year":"2022","journal-title":"Paediatr Anaesth"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"3032","DOI":"10.1111\/jocn.16217","article-title":"Use of virtual reality in managing paediatric procedural pain and anxiety: an integrative literature review","volume":"31","author":"Addab","year":"2022","journal-title":"J Clin Nurs"},{"key":"ref25","first-page":"93","article-title":"Effectiveness of virtual reality glasses as a distraction for children during dental care","volume":"42","author":"Cust\u00f3dio","year":"2020","journal-title":"Pediatr Dent"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e2112082","DOI":"10.1001\/jamanetworkopen.2021.12082","article-title":"Efficacy of smartphone active and passive virtual reality distraction vs standard care on burn pain among pediatric patients: a randomized clinical trial","volume":"4","author":"Xiang","year":"2021","journal-title":"JAMA Netw Open"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"995","DOI":"10.1186\/s12903-023-03595-7","article-title":"Virtual reality and behaviour management in paediatric dentistry: a systematic review","volume":"23","author":"Barros Padilha","year":"2023","journal-title":"BMC Oral Health"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1344","DOI":"10.1213\/ANE.0000000000004165","article-title":"Systematic review and meta-analysis of virtual reality in pediatrics: effects on pain and anxiety","volume":"129","author":"Eijlers","year":"2019","journal-title":"Anesth Analg"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e230001","DOI":"10.1001\/jamanetworkopen.2023.0001","article-title":"Effects of an immersive virtual reality intervention on pain and anxiety among pediatric patients undergoing venipuncture: a randomized clinical trial","volume":"6","author":"Wong","year":"2023","journal-title":"JAMA Netw Open"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"842847","DOI":"10.3389\/fpsyg.2022.842847","article-title":"Effects of virtual reality-based distraction of pain, fear, and anxiety during needle-related procedures in children and adolescents","volume":"13","author":"Wang","year":"2022","journal-title":"Front Psychol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1213\/ANE.0000000000005004","article-title":"Pediatric distraction on induction of anesthesia with virtual reality and perioperative Anxiolysis: a randomized controlled trial","volume":"132","author":"Jung","year":"2021","journal-title":"Anesth Analg"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"101886","DOI":"10.1016\/j.ejon.2020.101886","article-title":"The effect of virtual reality on pain, fear, and anxiety during access of a port with huber needle in pediatric hematology-oncology patients: randomized controlled trial","volume":"50","author":"Ger\u00e7eker","year":"2021","journal-title":"Eur J Oncol Nurs"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"104115","DOI":"10.1016\/j.ijnurstu.2021.104115","article-title":"Effectiveness of virtual reality in the management of paediatric anxiety during the perioperative period: a systematic review and meta-analysis","volume":"125","author":"Simonetti","year":"2022","journal-title":"Int J Nurs Stud"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1785095\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T12:23:26Z","timestamp":1773836606000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1785095\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,18]]},"references-count":33,"alternative-id":["10.3389\/fmed.2026.1785095"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1785095","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,18]]},"article-number":"1785095"}}