The Power of Distraction
Jack loved to play “I Spy.” Jack was fully engaged in a game when it was time for
him to receive his pediatric immunization. There were no tears, only a slight
glance toward the poke when the needle went in.
One important tool used with children to make procedures more comfortable is
the technique of distraction. Distraction diverts attention away from a stimulus
(like a painful procedure) onto the source of distraction. Distractions come from
both external sources (physical stimuli through the five senses) and internal sources such as thoughts,
emotions, fantasies and physical urges.
Distraction is caused by one of the following:
 greater interest in something other than the object of attention
 great intensity, novelty or attractiveness of something other than the object of attention
Just how does distraction work? It is believed that the brain has a limited capacity to focus attention on
stimuli. Using up attentional resources through distraction leaves less room to focus on the painful
stimuli. Distraction is particularly appealing because it can be easily administered at the right time and in
a cost-effective manner.
Types of distraction
Distraction works when the stimulus adequately engages the child’s attention. Watching a movie,
counting, singing, listening to music, playing video games, blowing bubbles, playing with toys, playing
games and telling or reading a story are familiar ways to provide diversion. You will engage the child
when you offer choices for distraction before starting a procedure. Keep in mind that too many demands,
or too much distraction, for a child’s attention during a procedure may be counterproductive.
Distraction with props
 An Item from the child’s home (favorite book or toy, for example)
 Cards – ask child to look at laminated cards and locate objects you describe.
 Bubbles – have parent blow bubbles asking the child to watch the path, color and size of the bubble.
 Counting – engage child in counting objects from distraction cards.
 Color light – ask child to look at a colorful, swirling light.
 Bravery stickers – at the end of the procedure, provide the child with a sticker to put on Poke-a-Dot or
in the Poke Plan Passport.
Distraction without props
 Colored Cloud - the child holds a big breath, and then imagines breathing a color out with the
procedure. Try sky writing or aiming puffs at imaginary targets.
 Touch - a parent touches the child’s uninvolved arm, directing them to concentrate on these
sensations.
 Tell a story – ask the child to fill in the details: What color is the castle? What kind of pet? What
animals are in the king’s barn?
 Counting – engage the child in counting objects (dots, ceiling tiles, letters in a sign).
 Trace – trace a letter or number on the child’s arm or leg and ask child to guess what letter or number
was traced.
1/30/13 Owner for ACS: marywats@med.umich.edu
When to use distraction
Timing is important! Distraction was found to lower children’s behavioral distress during both the
anticipatory (something is about to happen!) and post-injection recovery phase (something just
happened!) Use distraction during and after the poke/procedure to speed recovery and decrease the
memory of pain. Distraction at the end of a poke or procedure has proven to be especially effective.
One Voice
Hearing more than one voice can be confusing and chaotic; each person has to speak louder to become
heard, which leads to increased noise levels. One voice should be designated to do the speaking during a
procedure. This one voice can be the MA, Nurse, Provider or Parent, etc.
You can read more about age-appropriate distraction by reviewing the handout entitled “Comfort and
Distraction Tips for Parents or Clinical Staff.”
1/30/13 Owner for ACS: marywats@med.umich.edu