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Randomized Controlled Trial
. 2025 Aug 26;15(1):31359.
doi: 10.1038/s41598-025-17250-4.

Pinwheel blowing and stress ball squeezing reduce children's pain and anxiety during intravenous catheterization in a randomized controlled trial

Reyhaneh Dehghan Dehnavi  1   2 , Nasrin Sharifi  3 , Zahra Jamshidi  4 , Zahra Hadian Shirazi  5
Affiliations
Randomized Controlled Trial

Pinwheel blowing and stress ball squeezing reduce children's pain and anxiety during intravenous catheterization in a randomized controlled trial

Reyhaneh Dehghan Dehnavi et al. Sci Rep. .

Abstract

Intravenous catheter insertion is the most common procedure in the hospital setting and causes significant pain and anxiety for hospitalized children. This randomized controlled trial aimed to compare the effects of stress ball squeezing and pinwheel blowing on pain and anxiety levels during intravenous catheter insertion in hospitalized school-aged children. Ninety children aged 6-12 years admitted to the pediatric wards of Namazi Hospital in Shiraz, Iran, between May and September 2024, were randomly assigned to three groups: a stress ball group, a pinwheel group, and a control group. Pain and anxiety were assessed before, during, and after the procedure using the Oucher Pain Scale and the Venham Picture Test (VPT), respectively. The pinwheel group reported the lowest mean pain score (8.0 ± 11.3), followed by the stress ball group (14.5 ± 14.9) and control group (50.5 ± 34.6), with statistically significant differences (p < 0.05). Similarly, anxiety scores were lowest in the pinwheel group (0.7 ± 1.1), compared to the stress ball group (1.0 ± 1.2) and the control group (4.9 ± 2.8) (p < 0.05). Both interventions were effective, but pinwheel blowing showed greater reductions in pain and is recommended as a simple, low-cost distraction method.

Keywords: Anxiety; Child; Distraction technique; Pain management; Venipuncture.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: The research was confirmed by the Medical Sciences Research Ethics Committee of Shiraz University of Medical Sciences (ID- code: IR.SUMS.NUMIMG.REC.1402.153). All participants provided informed assent, and their parents provided informed consent before the interview. It is worth noting that all methods were performed in accordance with the relevant guidelines and regulations. All steps in this study were conducted in accordance with the Declaration of Helsinki. Consent for publication: Not applicable.

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CONSORT flow diagram.
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