Distraction techniques, including video viewing, before procedures can be helpful for children.

Viral warts are a common cutaneous infection in children. Liquid nitrogen cryotherapy, often used in adults, is not well tolerated by young children because of pain. Distraction techniques can decrease anxiety and pain in children undergoing procedures. Investigators performed an observational study to assess children aged 2 to 6 years for anxiety before undergoing cryotherapy for cutaneous warts. The first phase had no intervention. In the second phase, children watched an age-appropriate video (Barney or Kung Fu Panda) before cryotherapy. The modified Yale preoperative anxiety scale (m-YPAS) was administered 2 minutes before cryotherapy. The necessary treatment time, restraint requirements, and caregiver feedback were also noted.


The researchers observed 35 children in 99 cryotherapy sessions — 53 sessions with and 46 sessions without preprocedural video. Cryotherapy was performed in 15 children during the preintervention phase only, in 13 during the intervention phase only, and in 7 during both phases. The m-YPAS scores were significantly lower after the video. Anxiety scores were high in 15 of 15 children who did not see the video and in 5 of 13 children who did, a significant difference. The 7 children who had cryotherapy with and without video showed decreases in preprocedural anxiety scores after viewing, but the difference was nonsignificant, perhaps due to small sample size. Time spent coaxing and treating children decreased nonsignificantly after the intervention. Caregivers had greater satisfaction and children tolerated cryotherapy better (e.g., without use of restraint) with preprocedural video.


Citation(s):

Tey HL et al. Reducing anxiety levels in preschool children undergoing cryotherapy for cutaneous viral warts: Use of a portable video player. Arch Dermatol 2012 Jun 18; [e-pub ahead of print].