A distraction intervention for pain management and behavioral distress was implemented for six children with chronic illnesses and their parents as the children underwent repeated needle sticks. The children ranged in age from two to eight years. Several different cognitive distractors were used for the children based on their respective developmental levels. The needle stick procedures during which treatment was implemented included intramuscular injections, implanted port accesses, and intravenous placements. Nine sessions of distraction were provided in which a therapist taught parents to coach their children to use distraction techniques. Dependent measures included the child's behavioral dis tress and heart rate, parent ratings of the child's fear before the procedure, parent self-ratings of feeling upset during the procedure, and nurse ratings of the child's cooperation. Reductions in child behavioral distress during the distraction treatment program were observed in five out of the six cases. Concomitant improvements in parental reports of child distress, nurse estimates of child cooperation, and parents' self-report of feeling upset during the medical proce dures also were found. Follow-up data were available for one of the successfully treated children. His improvements were maintained for both intramuscular injections and portacatheter accesses over 16 weeks without therapist involvement.
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