The effect of storytelling caterpillar use on pain, fear, anxiety, and parental satisfaction during blood draw in children aged 3 to 6 years: a randomized controlled trial

Abstract

Background Managing pain, fear, and anxiety during needle procedures is vital for children's comfort and cooperation. This study examined the effect of the Storytelling Caterpillar, a visual–auditory distraction tool, on pain, fear, anxiety, and parental satisfaction in children aged 3–6 years during blood draws. Methods This randomized controlled trial (June 2024–June 2025) included 140 children at the pediatric phlebotomy clinic of the Children's Hospital, Istanbul. Participants were randomized to the intervention group ( n = 70 ; Storytelling Caterpillar during venipuncture) or the control group ( n = 70 ; standard care). A single nurse performed all procedures. Outcomes were measured with the Wong-Baker FACES Pain Scale, Children's Fear Scale, Children's Anxiety Scale–State, and a Visual Analog Scale for satisfaction (Clinical trial number: NCT07127432 ). Results The intervention group had significantly lower mean pain scores than the control group (p < .001). Pre-procedure fear and anxiety did not differ between groups, but post-procedure fear (p < .001) and anxiety (p < .001) were significantly lower in the intervention group. Parents in the intervention group also reported lower pain, fear, and anxiety scores (all p < .001) and higher satisfaction (p < .001) compared to controls. Conclusion The Storytelling Caterpillar was effective in reducing pain, fear, and anxiety, and in increasing satisfaction during venipuncture in preschool-aged children. Practice implications Incorporating multi-sensory, non-pharmacological tools like the Storytelling Caterpillar into pediatric care may improve comfort, cooperation, and reduce distress during needle procedures.