INTRODUCTION:

Pain and stress will significant affects the physiological and behavioral reactions in infants. It may also cause permanent structural and functional changes in infants.¹

According to international association for the study of pain, “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage.²

Due to pain, infants experience acute measurable physiologic, behavioral, metabolic and hormonal response to pain. This leads to long term negative effects on neurologic and behavioral development.³

The vocal response is an indicator of infants who reacts to painful stimuli. In full term infants, the intensity of pain could be assessed by the graded signal of cry. The assessment of pain is a difficult task for the health care professional and becomes especially challenging.⁴

NEED OF THE STUDY:

The untreated pain lead to acute consequences like prolonged hyperglycemia, decreased pain threshold, increased hormonal release, breakdown of fat, and storage of carbohydrate. The long-term consequences like further cognitive deficits, poor motor performance, and attention deficits.⁵

During vaccination 2/3^rd of children and 1/4^th of parents are afraid of needles due to that 5% of the parents reported avoiding or delaying their children immunization.⁶

Anything that can distract from the painful stimulus is potentially helpful. He also said that, distracting the child by showing favorite toy, teddy bear, and by holding or rubbing their hand during the procedures provides comfort. Distraction techniques helps to shift the attention from any treatment to any other stimulant which may help the child better control his perception of pain⁷.

During immunization studies showns that distraction can be very much effectives to make the child to be cope up with pain and fear than parental comfort.⁸Distractions focus child attention on interesting or challenging tasks from painful medical procedures. Distraction is useful for children of all ages undergoing procedural pain. Children can be distracted by music, videogames, storytelling, blowing party blower etc. Infants can be distracted by showing them interesting toys or bright colored objects.⁹

A randomized control trial was conducted at York University. The main objective was to assess the effectiveness of distraction (using a hand-held toy) during routine infant’s immunization procedure. The samples included twenty-five mothers and their healthy infants between 12-20 months. They were exposure to typical care, research assistant distraction and mother lead distraction. The results concluded that the infant exposure to research assistant lead distraction showed less pain scores.¹⁰

Health professionals are responsible for protecting children from pain. In order to reduce pain and anxiety in each child should be evaluated both by pharmacological and non-pharmacological measures.¹¹

STATEMENT OF THE PROBLEM:

A Quasi-experimental study to assess the effectiveness of distraction on level of pain perception among infants receiving DPT immunization in Southern Railway Hospital Perambur, Chennai.

OBJECTIVES:

1. To assess the post assessment level of pain perception among infants receiving DPT immunization with distraction.

2. To assess the post assessment level of pain perception among infants receiving DPT immunization without distraction.

3. To compare the effectiveness of distraction on post assessment level of pain perception among infants receiving DPT immunization between experimental and control group.

4. To associate the post assessment level of pain perception among infants receiving DPT immunization between experimental and control group with their demographic variables

RESEARCH HYPOTHESIS:

RH₁: There will be a significance difference in the level of pain perception among infants receiving DPT immunization between experimental and control group.

RH_{2 :}There will be a significance association in the level of pain perception among infants in both the groups with their demographic variables.

METHODOLOGY:

In this study quantitative approach and quasi experimental research design was adopted. The total sample size is 30 experimental and 30 control were selected by using non probability purposive sampling technique in the immunization OPD of the selected hospital. Oral consent was taken. The tool consists of Demographic variables and Modified Neonatal Infants pain scale.

DATA ANALYSIS PROCEDURE:

The data were analyzed and interpreted based on the objectives using both descriptive and inferential statistics. Frequency and percentage were used to analysis the variables. Unpaired ‘t’ test was used to compare the effectiveness of distraction. One way ANOVA was used to associate the mean difference within and between the groups. Chi-square test was used to find out the association of both the group with their demographical variables.

Section A: Frequency and percentage distribution of demographic variables of the infants.

Section B: Frequency and percentage distribution of post assessment level of pain perception in experimental group.

Section C: Frequency and percentage distribution of post assessment level of pain perception in control group.

Section D: Comparison of post assessment level of pain perception between Experimental and control group.

Section E: Comparison of mean score with in the experimental and control group.

Section F: Bon ferioni’s multiple comparisons of mean difference score within the groups of 2^nd and 3^rd doses, between experimental and control group.

Section G: Association of post assessment level of pain perception among in both the groups with their demographic variables.

Section A:

Table 1: Frequency and percentage distribution of demographic variables of Infants N=60

S. No

Demographic Variables

Experimental Groups (n=30)

Control Groups (n=30)

I(2^nddose)

II(3^rd dose)

I(2^nddose)

II(3^rd dose)

Age

a. 60 – 89 days

b. 90 – 119 days

100

Sex

a. Male

b. Female

Current Weight of the infants

a. 5-5.9 kg

b. 6-6.9 kg

c. 7-7.9 kg

Presence of Caregiver

a. Mother

b. Grandmother

c. Father

d. Other Relatives

100

No. of. DPT doses

a. 2^nd dose

b. 3^rd dose

100

Section B:

Table 2: Frequency and percentage distribution of post assessment level of pain perception among infants with distraction n=30

Group

Mild pain

Moderate pain

Severe pain

Experimental 2^nd doses

Experimental 3^rd doses

36.6

13.3

Section C:

Table 3: Frequency and percentage distribution of post assessment level of pain perception among infants with out distraction n=30

Group

Mild pain

Moderate pain

Severe pain

Control 2^nd doses

Control 3^rd doses

13.3

6.6

36.6

43.3

Section D:

Table 4: Comparison of post assessment level of pain perception among infants between experimental and control group N=60

Group	Post assessment		Mean difference	t- value
Experimental	Mean	S.D	5.87	t=15.561 df=58 p<0.001 ***H.S
Experimental	8.70	1.48
Control	14.57	1.43

***H.S=highly significant p<0.001

Section E

Table 5: Comparison of mean score with in the experimental and control group N=60

Group

Post assessment

F value

Experimental 2^nd dose

Experimental 3^rd dose

Control 2^nd dose

Control 3^rd dose

Mean

S. D

F=79.247

df=3.56

p<0.001

***S

8.67

8.73

14.80

14.33

1.79

1.16

1.74

1.05

Table 6: Bon Ferroin’s multiple comparisons of mean difference score within the groups of 2^nd and 3^rd doses between experimental and control group

Groups	Control group 2^nd dose	control group 3^rd dose	Experimental 2^nd v/s 3^rd dose
Experimental group 2^nd dose	Mean difference = -6.133 P < 0.001	Mean difference = -5.667 P < 0.001	Mean difference = 0.067 P < 1.000
Experimental group 3^rd dose	Mean difference = -6.067 P < 0.001	Mean difference = -5.600 P < 0.001
Control 2^nd v\s3^rd doses	Mean difference=0.467 P < 1.000

Section G:

In Association of post assessment level of pain perception in experimental group and Control group there is no significant association with demographic variables

DISCUSSION:

The frequency and percentage distribution of demographic variables, are presented as follows, with respect to their age out of 60 infants in experimental and control group, 50(100%) were in the age group of 60-89 days and 50(100%) were in 90-119 days equally in both the doses. Regarding current weight, out of 30 infants in experimental group 2^nd and 3^rd doses, majority of them, 11(73%) were equally in 5-5.9 kg and in control group majority 10(67%) were in 5-5.9 kg in 2^nd doses. With respect to sex, out of 30 infants in experimental group eight (53%) were males in 3^rd dose and eight (53%) were females in 2^nd dose and in control group majority 10(67%) were males in control 2^nd doses. Regarding presence of caregivers, out of 30 infants in experimental group 3^rd dose, majority 14(93%) were mothers and control group 3^rd dose 15(100%) were mothers. The data on number of doses in both the groups of 2^nd and 3^rd doses 50(100%) were equally observed

The first objective was to assess the level of pain perception among infants with distraction.

In experimental 2^nd dose nine (30%) infants’ experienced mild pain, six (20%) infants experienced moderate pain and in experimental 3^rd doses 11(36.6%) infants experienced mild pain and four (13.3%) infants experienced moderate pain respectively.

A comparative study was conducted at Washington state University, USA. The main aim of the study was to compare the effectiveness of distraction versus topical anesthesia during immunization. The samples included were 39 infants of 4^th graders receiving 3-injection vaccination series over a 6- month period. The results suggest that distraction shown more child coping and less child distress than ELMA cream.¹²

The second objective was to assess the post assessment level of pain perception among infants without distraction:

In control group 2^nd dose four (13.3%) infants experienced moderate pain, 11(36.6%) of infants experienced severe pain and in control 3^rd doses two (6.6%) infants experienced moderate pain and 13(43.3%) of infants experienced severe pain respectively.

The third objective of the study was to compare the effectiveness of distraction between experimental and control group.

The experimental group mean and standard deviation was 8.70 with 1.48 and control group mean and standard deviation was 14.57 with 1.43 respectively. The unpaired‘t’ value was 15.561 which was highly significant at p<0.001 level. It indicates that the infant who received distraction shown decreased level of pain perception. So there is a significant difference in the level of pain perception among infants receiving DPT immunization between experimental and control group.

The study conducted by A randomized controlled trail study was conducted at Georgia state university, Atlanta on 136 infants (ranges 1-21 months). The main objective was to assess the effectiveness of movie distraction in reducing infants’ immunization distress. The results suggest that a movie distraction showed less distress in infant’s receiving immunization.¹³

CONCLUSION:

The present study conclude that Distraction is very effective for the infants during any minor procedure and also it is very feasible for the health care professional to utilize on different age groups of the children.

REFERENCES:

1. Franlang Porter, “Infant pain may have long term effects”, Center for the advancement of health, Science daily October 11 2021, on www.sciencedaily.com/releases/1999/08/990816065623.htm

2. N S Morton Pain assessment in children Paediatr Anaesth 1997;7(4):267-72. doi: 10.1046/j.1460-9592.1997.d01-83.x. available on https://pubmed.ncbi.nlm.nih.gov/9243682/

3. Kanwaljeet J S Anand, Jacob V Aranda, Charles B Berde et.al, Summary proceedings from the neonatal pain-control group Pediatrics 2006 Mar;117(3 Pt 2):S9-S22 doi: 10.1542/peds.2005-0620C. available on https://pubmed.ncbi.nlm.nih.gov/16777824/

4. Fran Lang Porter, Cynthia M. Wolf, Jennifer Gold.et.al, Pain and Pain Management in Newborn Infants: A Survey of Physicians and nurses, Journal of American academy of Pediatrics,1997;100;626 DOI: 10.1542/peds.100.4.626 https://www.researchgate.net/publication/13910734_

5. Wong’s and whaley, Clinical Manual of pediatric, 5th edition, mosby publication,2000

6. Anna Taddio, Moshe Ipp, Suganthan Thivakaran, Survey of the prevalence of immunization non-compliance due to needle fears in children and adults, DOI: 10.1016/j.vaccine.2012.05.011. 2012 Jul 6;30(32):4807-12. https://pubmed.ncbi.nlm.nih.gov/22617633/

7. Manimala MR, Blount RL, Cohen LL. The effects of parental reassurance versus distraction on child distress and coping during immunizations. Children’s Health Care. 2000;29:161–177. https://doi.org/10.1207/S15326888CHC2903_2

8. Manimala MR, Blount RL, Cohen LL. The effects of parental reassurance versus distraction on child distress and coping during immunizations. Children’s Health Care. 2000;29:161–177. https://psycnet.apa.org/record/2000-05712-002

9. McCaul, K. D., and Malott, J. M. (1984). Distraction and coping with pain. Psychological Bulletin, 95, 516–533.

https://doi.org/10.1037/0033-2909.95.3.516

10. Jessica Hillgrove-Stuart, MA, Rebecca Pillai Riddell, PhD Rachel Horton, MA, et.al. Toy-mediated distraction: Clarifying the role of distraction agent and preneedle distress in toddlers, Pain Res Manag. 2013 Jul-Aug; 18(4): 197–202. doi: 10.1155/2013/392125, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812191/

11. Myron Yaster, David G. Nichols Pain management in the critically ill child The Indian Journal of Pediatrics 2001 DOI10.1007/BF02752416 68 8 749-769 https://www.infona.pl/resource/bwmeta1.element.springer-c622822c-f156-3cb5-8b62-fe8ffac88d8b

12. L L Cohen, R L Blount, R J Cohen, E R Schaen, J F Zaff Comparative study of distraction versus topical anesthesia for pediatric pain management during immunizations Health Psychology. 1999 Nov;18(6):591-8. doi: 10.1037//0278-6133.18.6.591. https://pubmed.ncbi.nlm.nih.gov/10619532/

13. Cohen, L. L., MacLaren, J. E., Fortson, B. L.et.al , Randomized clinical trial of distraction for infant immunization pain. Pain, 125(1-2), 165-171. DOI: 10.1016/j.pain.2006.05.016.: https://scholarworks.gsu.edu/psych_facpub.

Received on 22.10.2021 Modified on 17.12.2021

Asian J. Nursing Education and Research. 2022; 12(2):197-200.

DOI: 10.52711/2349-2996.2022.00039