Common medical procedures to assess and treat patients can cause significant pain and distress. Clinicians should have a basic approach for minimizing pain and distress in children, particularly for frequently used diagnostic and therapeutic procedures. This statement focuses on infants (excluding care provided in the NICU), children, and youth who are undergoing common, minor but painful medical procedures. Simple, evidence-based strategies for managing pain and distress are reviewed, with guidance for integrating them into clinical practice as an essential part of health care. Health professionals are encouraged to use minimally invasive approaches and, when painful procedures are unavoidable, to combine simple pain and distress-minimizing strategies to improve the patient, parent, and health care provider experience. Health administrators are encouraged to create institutional policies, improve education and access to guidelines, create child- and youth-friendly environments, ensure availability of appropriate staff, equipment and pharmacological agents, and perform quality audits to ensure pain management is optimal.

Objective: This systematic review and meta-analysis examined the effectiveness of the Buzzy device combining cold and vibration for needle-related procedural pain in children. Materials and Methods: Databases search was conducted from inception to December 2017 to identify randomized controlled trials using the Buzzy device for pain management in children undergoing needle-related procedures. Selection of studies, data extraction, and assessment of risk of bias and quality of evidence were independently performed by 2 reviewers. Quantitative and qualitative analyses were conducted. Results: A total of 9 studies involving 1138 participants aged between 3 and 18 years old were included in the systematic review and 7 were suitable for meta-analysis. The meta-analysis compared the Buzzy device with a no-treatment comparator and the effect of the device was significant in reducing self-report procedural pain (standardized mean difference [SMD]: −1.11; 95% confidence interval [CI]: −1.52 to −0.70; P<0.0001), parent-reported procedural pain (SMD: −0.94; 95% CI: −1.62 to −0.27; P=0.006), observer-report procedural pain (SMD: −1.19; 95% CI: −1.90 to −0.47; P=0.001), observer-reported procedural anxiety (SMD −1.37; 95% CI: −1.77 to −0.96; P<0.00001), and parent-reported procedural anxiety (SMD −1.36; 95% CI: −2.11 to −0.61; P=0.0004). There was no significant difference for the success of the procedure at first attempt and the occurrence of adverse events. Discussion: The Buzzy device seems to be a promising intervention for procedural pain management in children. However, the comparative effect is uncertain due to the presence of significant heterogeneity and very low-quality evidence. There is a need to improve the methodological quality and rigor in the design of future trials to conclude to the efficacy of the Buzzy device.

CONTEXT: Intranasal dexmedetomidine (IND) is an emerging agent for procedural distress in children.OBJECTIVE: To explore the effectiveness of IND for procedural distress in children.

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