Distraction Toolkit

Last modified by Lisa Stromquist on 2018/02/13 15:44

Welcome to the toolkit about how distraction techniques can be used to prevent acute procedural pain for children. Current best evidence supports distraction techniques for children ages 2 to 18 years; however, it is likely that using age-appropriate techniques for children 0-2 years of age would likely confer some benefit, and minimal harm


Distraction can be used in conjunction with pharmacological pain management to modify pain signals, reduce fear and anxiety, and seek to optimize coping skills during a painful procedure.

“These techniques are non-invasive, inexpensive, require little equipment and in most cases brief training”  (Ali et al., 2012, p. 1366).

Distraction can also be used with oral sucrose, breastfeeding, positioning and non-nutritive sucking, in conjunction with pharmacological pain management. Links to recommendations and resources for these techniques can be found through the main webpage for the CAPHC acute procedural pain toolbox. 

The purpose of this toolbox is to make using distraction techniques in clinical practice easier. The contents, which have been provided by your clinical colleagues around the country, can help you move distraction into your regular practice, help create a policy for use in your organization, support clinical education in distraction, and provide clinical and family resources to make distraction easier to use. Use as many of the resources as you need and modify them to fit your organizational context.


In this box you’ll find:

  • Clinical and family resourcessuch as posters, handouts, distract box content ideas, and quick tip sheets to make distraction easier and more accessible to you and your patients.
  • An example of a hospital policy for the use of distraction during procedures. This policy can be used to create your own organizational policy based on your needs and context

  • Clinical PowerPoint developed by your clinical colleagues to support education about using distraction. This slide deck can be modified and delivered for your needs and context but please acknowledge the original authors and the CAPHC Pain CoP for their contributions.
  • Videos that can be shared with clinicians or families about the importance of distraction for pain prevention!
  • Background articles outlining the research evidence to support using distraction as a non- pharmacological intervention for acute procedural pain

Please note, examples of policies are provided for reference purposes, only. We encourage all users of the toolkit who wish to adopt a similar policy at their institution to review, adapt, and modify the examples, as needed. The providers of these examples do not endorse their use outside of the institution for which it was originally created.

If you have any comments, questions or additions for the box, please contact CAPHC at info@caphc.org

Thank you for supporting the CAPHC Pain Community of Practice’s mission to to improve health outcomes for infants and children by reducing pain experienced during medical procedures, healthcare interventions and chronic conditions, disease or disability. 

Family Resources Distraction Techniques and the Paediatric Pain Experience - Holland Bloorview Kids Rehabilitation Hospital
The Use of Humour to Reduce Paediatric Pain

Welcome to the Distraction in Action Tool (DAT)DAT is a web-based tool that will identify your child’s risk for distress (DistrEstimate) and provide you with instructions based on your individual child. Predictions are based on data from over 1,000 children, 4-10 years of age, having a needle stick procedure. However, distraction does work for children outside of this age range and for other medical procedures. In those cases, adjust the plan relative to the intensity of the procedure compared to a needle stick (for example, removing tape may be less intense and a bone marrow aspirate may be more intense).Copyright © 2018 The University of Iowa.

Distraction in Action - Helping Your Child During Medical Procedures - This was filmed with real patients and parents at University of Iowa Stead Family Children’s Hospital, with support from the Mayday Fund.

City of Ottawa Public Health - Reducing Pain During Vaccination 

Poster - Positionnement-bambin
Poster - Positionnement-enfant
Poster - Positionnement-nourrisson
Poster - Positionnement-prescolaire

Clinical Resources Distraction Box Contents

TREKK Bottom Line Recommendations: Procedural Pain (Translating Emergency Knowledge for Kids trekk.ca)
Tip Sheet - Coping Strategies for Painful Procedures
Positions For Comfort (PFC) Reference Chart - CHEO

Hospital Policy BC Children's Hospital Psychological Interventions - Policy and Procedure
Clinical PowerPointProcedural Distraction 101 for Staff - PPT for Download

Procedural Distraction 101 for Staff - PDF

Developer: Christine Chambers, PhD

From: Centre for Pediatric Pain Research IWK Health Centre and Dalhousie University

Title and link: It Doesn’t Have to Hurt: Strategies for Helping Children with Shots and Needles

Title and link: Ça n’a pas besoin de faire mal – Conseils pour aider les enfants à recevoir une piqûre


Developer: Sickkids Hospital

From: Sickkids Hospital

Title and video link: Maya’s Bloodwork tips

 Developer: Division of Emergency Medicine, Boston Children's Hospital , and University of Massachusetts Boston, Boston; and the Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital
From: As above
Title and Video link: Managing Procedural Anxiety in Children  (Subscription Required)
Citation: Baruch S. Krauss, M.D., Benjamin A. Krauss, and Steven M. Green, M.D.N Engl J Med 2016; 374:e19April 21, 2016DOI: 10.1056/NEJMvcm1411127
 Developer: CHU Sainte- Justine
From: CHU Sainte- Justine
Title and video link: Piqûres sans blessure  - Video voie veineuse en pédiatrie
 Developer: CHU Sainte- Justine
From: CHU Sainte- Justine
Title and video link: Pour des soins en doceur - Capsules d’information et de prévention
 Developer:Stanford Children's Health -  Lucille Packard Children's Hospital
Title and video link:  How To Manage Pain During Medical Procedures: You are the Boss of Your Brain
Background Articles Background Articles PDF

Ali, S., McGrath, T., & Drendel A. L.(in press). Pediatric Emergency Care: An Evidence-Based Approach to Minimize Acute Procedural Pain in the Emergency Department and Beyond.

Birnie, K. A., Noel, M., Parker, J. A., Chambers, C. T., Uman, L. S., Kisely, S. R., &McGrath, P. J. (2014). Systematic Review and Meta-Analysis of Distraction and Hypnosis for Needle-Related Pain and Distress in Children and Adolescents. Journal of Pediatric Psychology, 39(8), 787-808

Cohen, L., L. (2008). Behavioral Approaches to Anxiety and Pain Management for Pediatric Venous Access. Pediatrics, 122 Suppl 3, S134-9. doi: 10.1542/peds.2008-1055f.

Koller, D., & Goldman R. D. (2012). Distraction Techniques for Children Undergoing Procedures: A Critical Review of Pediatric Research. Journal of Pediatric Nursing, 27, 652 - 681

Riddell, R. P., Racine, N., Turcotte, K., Uman L. S., Horton, R., Osmun, L. D.,  Kohut, S. A., Hillgrove Stuart, J., Stevens, B., & Lisi, D. (2011). Nonpharmacological management of procedural pain in infants and young children: An abridged Cochrane review. Pain Res Manage, 16(5), 321 - 330

Pillai Riddell, R. R., Racine, N. M., Turcotte, K., Uman, L. S., Horton, R. E., Din Osmun, L., Ahola Kohut, S., Hillgrove Stuart, J., Stevens, B., & Gerwitz-Stern, A. (2012). Non-pharmacological management of infant and young child procedural pain (Review). The Cochrane Collaboration, 10, 1 -213

Uman, L. S., Chambers, C. T., McGrath, P. J., & Kisely, S. (2008). Psychological interventions for needle-related procedural pain and distress in children and adolescents (Review). The Cochrane Collaboration, 2,1 -72
Created by Lisa Stromquist on 2015/12/23 20:50