Distracting children undergoing vaccination





Immunization, Distraction, Pain, Children, Child psychology


Vaccination is a procedure considered painful for children; therefore, the healthcare team should provide conditions for adequate pain assessment and control. This study sought to evaluate whether behavioral distraction procedures contribute to reduce pain perception and anxiety indicators in children during vaccination. One hundred and four children between three and 12 years attending a Health Center in the Federal District participated in the study. Children were divided into four groups: baseline, groups with balloons, cards and tablets. Data were obtained by means of sociodemographic questionnaires, the Monica and Friends Pain Scale and the Observational Scale of Distress Behavior. The collected data were measured using the SPSS Statistics program. Results show that the intervention groups had lower averages, concerning pain levels, incidence of competing behaviors and duration of vaccine procedures, compared to baseline.


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Author Biographies

Graziele Lopes Teles, Universidade Federal de Goiás

Universidade Federal de Goiás, Goiânia-GO, Brazil.

Áderson Luiz Costa Júnior, Universidade de Brasília

Universidade de Brasília. Brasília-DF, Brazil.


Aydin, D., & Sahiner, N. C. (2017). Effects of music therapy and distraction cards on pain relief during phlebotomy in children. Applied Nursing Research, 33, 164-168. doi:10.1016/j.apnr.2016.11.011

Aydin, D., Sahiner, N. C., & Çiftçi, E. K. (2016). Comparison of the effectiveness of three different methods in decreasing pain during venipuncture in children: Ball squeezing, balloon inflating and distraction cards. Journal of Clinical Nursing, 25(15-16), 2328-2335. doi:10.1111/jocn.13321

Barros, L. (2010). A dor pediátrica associada a procedimentos médicos: Contributos da psicologia pediátrica [Procedural pediatric pain: Contributions from pediatric psychology]. Temas em Psicologia, 18(2), 295-306. Retrieved from http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S1413-389X2010000200005&lng=pt&tlng=en

Bergomi, P., Scudeller, L., Pintaldi, S., & Dal Molin, A. (2018). Efficacy of non-pharmacological methods of pain management in children undergoing venipuncture in a pediatric outpatient clinic: A randomized controlled trial of audiovisual distraction and external cold and vibration. Journal of Pediatric Nursing: Nursing Care of Children and Families, 42, e66-e72. doi:10.1016/j.pedn.2018.04.011

Birnie, K. A., Chambers, C. T., Taddio, A., McMurtry, C. M., Noel, M., Riddell, R. P., & Shah, V. (2015). Psychological interventions for vaccine injections in children and adolescents: Systematic review of randomized and quasi-randomized controlled trials. The Clinical Journal of Pain, 31(10 Suppl.), S72-S89. doi:10.1097/AJP.0000000000000265

Birnie, K. A., Noel, M., Chambers, C. T., Uman, L. S., & Parker, J. A. (2018). Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database of Systematic Reviews, (10), CD005179. doi:10.1002/14651858.CD005179.pub4

Burns-Nader, S., Atencio, S., & Chavez, M. (2016). Computer tablet distraction in children receiving an injection. Pain Medicine, 17(3), 590-595. doi:10.1111/sme.12877

Canbulat, N., İnal, S., & Sönmezer, H. (2014). Efficacy of distraction methods on procedural pain and anxiety by applying distraction cards and kaleidoscope in children. Asian Nursing Research, 8(1), 23-28. doi:10.1016/j.anr.2013.12.001

Caprilli, S., Vagnoli, L., Basani, C., & Messeri, A. (2012). Pain and distress in children undergoing blood sampling: Effectiveness of distraction with soap bubbles with soap bubbles. A randomized controlled study. IdB - Giornale Italiano di Scienze Infermieristiche Pediatriche, 4(1), 15-18.

Christ, T. (2020). Metade das crianças brasileiras está com o calendário vacinal incompleto [Half of Brazilian children have an incomplete vaccination schedule]. Retrieved from https://www.bio.fiocruz.br/index.php/br/noticias/1967-metade-das-criancas-brasileiras-esta-com-o-calendario-vacinal-incompleto

Eden, L. M., Macintosh, J. L. B., Luthy, K. E., & Beckstrand, R. L. (2014). Minimizing pain during childhood vaccination injections: Improving adherence to vaccination schedules. Pediatric Health, Medicine and Therapeutics, 5, 127-140. doi:10.2147/PHMT.S50510

Ferreira, E. B., Cruz, F. O. A. M., Silveira, R. C. C. P., & Reis, P. E. D. (2015). Distraction methods for pain relief of cancer children submitted to painful procedures: Systematic review. Revista Dor, 16(2), 146-152. doi:10.5935/ 806-0013.20150028

Gerçeker, G. O., Binay, S., Bilsin, E., Kahraman, A., & Yilmaz, H. B. (2018). Effects of virtual reality and external cold and vibration on pain in 7- to 12-year-old children during phlebotomy: A randomized controlled trial. Journal of PeriAnesthesia Nursing, 33(6), 981-989. doi:10.1016/j.jopan.2017.12.010

Lisboa, V. (2020). Em queda há 5 anos, coberturas vacinais preocupam Ministério da Saúde [Falling for 5 years, vaccination coverage worries Ministry of Health]. Retrieved from https://agenciabrasil.ebc.com.br/saude/noticia/2020-10/em-queda-ha-5-anos-coberturas-vacinais-preocupam-ministerio-da-saude#

Ministério da Saúde. (2019). Nova campanha traz histórias impactantes para alertar sobre vacinação [New campaign brings impacting stories to warn about vaccination]. Retrieved from http://portalms.saude.gov.br/noticias/agencia-saude/44493-novacampanha-traz-historias-impactantes-para-alertar-sobre-vacinacao

Ministry of Health. National Health Council. (2013). Resolution No. 466, of 12 December 2012. Approves regulatory guidelines and standards for research involving human beings. Diário Oficial da União, seção 1. Retrieved from https://conselho.saude.gov.br/resolucoes/2012/466_english.pdf

Pancekauskaitė, G., & Jankauskaitė, L. (2018). Paediatric pain medicine: Pain differences, recognition and coping acute procedural pain in paediatric emergency room. Medicine, 54(6), 94. doi:10.3390/medicine54060094

Risaw, L., Narang, K., Thakur, J. S., Ghai, S., Kaur, S., & Bharti, B. (2017). Efficacy of flippits to reduce pain in children during venipuncture - A randomized controlled trial. The Indian Journal of Pediatrics, 84(8), 597-600. doi:10.1007/s12098-017-2335-z

Robabi, H., Askari, H., & Saeedinegad, F. (2017). Comparing the effectiveness of two distraction techniques of inflating balloon and watching cartoon in reducing the vaccination pain among school-age children. Medical-Surgical Nursing Journal, 5(3), 18-22. Retrieved from https://doaj.org/article/0e942ddbdc8e435a9dd7763cbd950b9e

Sahiner, N. C., & Bal, M. D. (2016). The effects of three different distraction methods on pain and anxiety in children. Journal of Child Health Care, 20(3), 277-285. doi:10.1177/1367493515587062

Silva, R. D. M., Austregésilo, S. C., Ithamar, L., & Lima, L. S. (2017). Therapeutic play to prepare children for invasive procedures: A systematic review. Jornal de Pediatria, 93(1), 6-16. doi:10.1016/j.jped.2016.06.005

Talwar, R., Yadav, A., Deol, R., & Kaur, J. (2014). Efficacy of distraction technique in reducing pain among children receiving vaccination. International Journal of Current Research and Review, 6(19), 42-46. Retrieved from http://www.ijcrr.com/article_html.php?did=749&issueno=0




How to Cite

Teles, G. L., & Costa Júnior, Áderson L. (2022). Distracting children undergoing vaccination. Paidéia (Ribeirão Preto), 32, e3205. https://doi.org/10.1590/1982-4327e3205



Psychological Evaluation