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

J Pediatr Nurs. 2026 Feb 27;88:222-230. doi: 10.1016/j.pedn.2026.02.020. Online ahead of print.

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.

PMID:41762783 | DOI:10.1016/j.pedn.2026.02.020