The effect of buzzy and finger puppet show on children’s pain, fear, and anxiety during venipuncture in the pediatric emergency department: a randomized controlled trial

Background: Venipuncture in pediatric emergency departments commonly causes pain, fear, and anxiety in children, particularly those aged 4 to 6 years. Although non-pharmacological distraction techniques are recommended, comparative evidence remains limited. This study aimed to evaluate the effectiveness of Buzzy devices and finger puppet shows in reducing these outcomes. Methods: A randomized controlled trial was conducted with 102 children aged 4 to 6 years undergoing venipuncture in a tertiary pediatric emergency department. Participants were randomly assigned to 3 groups: Buzzy device (n = 34), finger puppet distraction (n = 34), and control (n = 34). Pain, fear, and anxiety were assessed using the Wong-Baker FACES Pain Rating Scale, Children’s Fear Scale, and Children’s Anxiety Meter-State before and after the procedure. Data were analyzed using SPSS, and the study was registered (NCT06849648). Results: No significant differences were found between groups in pre-procedure scores ( P > .05). Post-procedure scores differed significantly ( P < .001), with the control group reporting higher pain, fear, and anxiety compared to both intervention groups. Within-group analyses showed significant reductions in all outcomes in the Buzzy and finger puppet groups ( P < .001), whereas no significant change was observed in the control group. Effect sizes were large for both interventions and higher in the Buzzy group (fear: η 2 = 0.756; anxiety: η 2 = 0.825; pain: η 2 = 0.659) than the finger puppet group (fear: η 2 = 0.657; anxiety: η 2 = 0.690; pain: η 2 = 0.512). Findings should be interpreted with caution due to baseline imbalances. Conclusion: Both interventions effectively reduced pain, fear, and anxiety, with Buzzy showing greater effectiveness. These findings support the use of simple, cost-effective distraction techniques in pediatric emergency care.