Active versus passive distraction for reducing venipuncture distress in preschool children: A pragmatic randomized controlled trial

Purpose To compare the efficacy of active distraction (pinwheel blowing) versus passive distraction (cartoon watching) and usual care in reducing venipuncture-related pain, fear, and behavioral distress in preschoolers. Design An open-label randomized controlled trial. Methods Preschoolers ( N = 93) were randomized into three groups ( n = 31 per group). Pain (primary outcome), fear, and behavioral distress (secondary outcomes) were assessed before and after venipuncture using the Wong-Baker FACES Pain Rating Scale (WBFPS), Children's Fear Scale (CFS), and Face, Legs, Activity, Cry, Consolability (FLACC) scale, respectively. Analyses were conducted using intention-to-treat (ITT) and as-treated (AT) sensitivity approaches. Results In the ITT analysis, only the active pinwheel group showed significant within-group reductions across all distress metrics (all p < .05). Logistic regression indicated that the pinwheel intervention significantly predicted fear improvement compared to usual care (OR = 4.84), and was superior to cartoon distraction in reducing both pain (OR = 3.09) and fear (OR = 3.56). Generalized estimating equation models revealed a significant Time × Group interaction, with distress trajectories improving exclusively in the pinwheel group. The AT analysis corroborated and strengthened these findings, with odds ratios ranging from 3.18 to 8.54 across all outcomes. Conclusions Active pinwheel distraction may be effective in reducing venipuncture-related distress compared with passive cartoon distraction and usual care, particularly when children actively engaged with the intervention. Practice Implications Healthcare professionals should integrate developmentally appropriate active distraction strategies into pediatric venipuncture procedures to support atraumatic care.