Overall, there is preliminary evidence that a variety of cognitive-behavioral interventions can be used with children and adolescents to successfully manage or reduce pain and distress associated with needle-related procedures. However, many of the included studies received lower quality scores because they failed to describe the randomization procedure and participant withdrawals or drop-outs from the study. Further RCTs need to be conducted, particularly for the many interventions for which we could not locate any trials.
Blowing away shot pain: a technique for pain management during immunization.
To study the effect of an active distraction technique on pain in preschool children receiving diphtheria, pertussis, and tetanus immunization.
                Randomized, unblinded controlled study.
                Columbus Public Health Department Immunization Clinics.
                One hundred forty-nine 4- to 7-year-old children.
                Children were taught to blow out air repeatedly during the injection, as if they were blowing bubbles.
                Children who were taught to blow out air during their shots had significantly fewer pain behaviors (P < .04) and demonstrated a trend toward lower subjectively reported pain (P = .06). There was no significant difference in the nurse or parent visual analog scale scores.
                A simple distraction technique can be effective in helping children cope with the pain of immunization. The use of such a technique to relieve the pain and distress associated with even a brief painful procedure should be encouraged.