Table 3 Study characteristics

Blakeney 2005 [43].

RCT, USA.

n = 32^{^3 (9)}

4-day group social skills workshop based on Changing Faces REACH OUT, and ‘usual’ treatment.

n = 32^{^10 (31)}

‘Usual’ treatment, and follow-up psychological appointments upon request only.

Anxiety/depression: CBCL^(C).

Pre-intervention and 1 year post-intervention: CBCL.

Brown 2014 [44].

RCT, Australia.

n = 47^{^12 (23)}

Ditto™ PP pre-COD, and distraction interactive story/game during COD.

n = 52^{^12 (26)}

Standard distraction during COD: TV, videos, books, toys, and caregiver soothing.

Pain: FPS-R^(Pt.), HR^(N).

Pain and distress: FLACC^(N).

Anxiety: VAS-A^{(Pt. > 8 yrs)}.

Trauma: CTSQ^{(Pt. > 6 yrs)}.

Pre-randomisation: FPS-R, HR, FLACC, VAS-A.

Pre-removal: FPS-R, FLACC, VAS-A.

Post-removal: FPS-R, HR, FLACC, VAS-A, CTSQ^{(1st COD)}.

Post- application: FPS-R, HR, FLACC, VAS-A.

During removal and application: HR.

3mths post re-epithelisation: CTSQ.

Burns-Nader 2017 [45].

RCT, USA.

n = 15^{^0 (0)}

Tablet distraction game, and CLT support during 2nd and/or 3rd COD.

n = 15^{^0 (0)}

Standard distraction, and CLT support during 2nd and/or 3rd COD.

Pain: FACES^(Pt.), nurse’s pain reports^(N).

Anxiety: CEMS^(Pt.).

Prior and during hydrotherapy: CEMS.

Post-hydrotherapy: FACEs, nurse’s pain reports, CEMS.

Chester 2018 [46].

RCT, Australia.

n = 29^{^0 (0)}

Hypnosis pre and during COD: guided imagery, breathing, muscle relaxation, and permissive and direct hypnotic suggestions.

n = 35^{^0 (0)}

Standard interventions pre and during COD: parent presence, books, TV, electronic games, DVDs, toys, bubbles, music, and Ditto™ PP and distraction.

Pain: FPS-R^(Pt.), FLACC^(N), NRS^(C), HR^(R).

Anxiety: VAS-A^{(Pt. ≥8 yrs, C < 8 yrs)}.

Trauma: CPSS^{(Pt. > 7 yrs)},

YCPC^{(C < 7 yrs)}.

Pre and post-procedure: FPS-R, FLACC, NRS, VAS-A.

During procedure: FPS-R, FLACC, NRS.

Pre-medication and post-application: HR.

3-months post-injury: CPSS, YCPC.

Elliott 1983 [47].

NRCT, USA.

n = 4^{^0 (0)}

Stress management during COD: distraction, breathing, emotive imagery, and pain reinterpretation.

n = 4^{^0 (0)}

SC during COD.

Pain and distress: BTDS^(MS).

Removal, first 15mins of hydrotherapy, and during physical therapy and dressing re-application: BTDS.

Foertsch 1998 [48].

RCT, USA.

n = 13^{^Total 1 (43)}

Familiar imagery during COD: focus on childhood memory/experience.

n = 10^{^Total 1 (43)}

Social support during COD: researcher conversation and encouragement.

Pain and anxiety: FACES^{(Pt.’s 3–9 yrs)}, VAS^{(Pt.’s 9–12 yrs)}.

Distress: OSBD^(R).

Baseline and 15-s intervals during procedure: OSBD.

Post-procedure: FACES, VAS.

Hyland 2015 [49].

RCT, Australia.

n = 50^{^0 (0)}

CLT PP, caregiver support and education, and distraction during COD.

n = 50^{^0 (0)}

SC, and minimal distraction during COD: caregiver, music, and toys/electronic devises.

Pain: CHEOPS^(IA), FACES^{(Pt.’s 5–10 yrs)}, VAS^{(Pt.’s > 10 yrs)}.

Pain and anxiety: Procedural pain and anxiety questionnaire^(C), nursing staff questionnaire^(N).

Anxiety: CFS^{(IA, Pt.)}.

Pre-procedure: Procedural pain and anxiety questionnaire.

2-min intervals during procedure: CHEOPS, CFS.

Post-procedure: FACES, VAS, Procedural pain and anxiety questionnaire, CFS.

Jeffs 2014 [50].

RCT, USA.

n = 8^{^0 (0)}

I^VR: 3D interactive program pre and during COD.

n = 10^{^0 (0)}

‘Typical’ care during COD: standard nurse communication.

Pain: APPT-WGRS^{(Pt.’s 8–17 yrs)}.

Anxiety: STAI-CH^(Pt.).

Pre-procedure: APPT-WGRS, STAI-CH.

n = 10^{^0 (0)}

I^PD: PD (i.e. movie) pre and during COD.

Kavanagh, 1983 [51].

NRCT, USA.

n = 4^{^0 (0)}

Max. procedure ‘predictability’: specific nurse attire, and ‘patient control’ of ‘appropriate’ aspects of procedure.

n = 5^{^0 (0)}

Min. ‘predictability’, and medical staff control over procedure.

Pain: Nurse reports 0–6 scale^(N).

Anxiety: CBI^{(N, C of pt.’s 1–3 yrs)}.

2–3 times daily: Nurse reports.

Weekly: CBI.

Kipping 2012 [52].

RCT, Australia.

n = 20^{^0 (0)}

Off-the-shelf VR pre and during COD.

n = 21^{^0 (0)}

Standard distraction during COD: TV, stories, music, and caregiver.

Pain: VAS^{(Pt., C)}.

Pain and distress: FLACC^(N).

Baseline, and retrospective post-removal and application: VAS, FLACC.

Miller 2010 [53].

RCT, Australia.

n = 20^{^2 (10)}

I^MMD-PP: MMD-PP pre-COD, and standard distraction during COD.

n = 20^{^3 (15)}

Standard distraction during COD: toys, TV, and nurse/caregiver interactions.

Pain: FACES^(Pt.), VAS^(C).

Pain and distress: FLACC^(N).

Pre and post-removal, pre and post-application: FACES, VAS, FLACC.

n = 20^{^1 (5)}

I^MMD-D: MMD-D interactive story/game during COD.

n = 20^{^4 (20)}

I^VGD: VGD during COD.

Miller 2011 [54].

RCT, Australia.

n = 20^{^0 (0)}

MMD-PP, MMD-D interactive story/game pre and during COD.

n = 20^{^0 (0)}

Standard PP and distraction pre and during COD.

Pain: FACES^(Pt.), VAS^(C), HR^(N).

Pain and distress: FLACC^(N).

Pre and post-removal, pre and post-application: FACES, VAS, FLACC.

During removal and application: HR.

Moore 2015 [55].

NRCT, USA.

n = 12^{^0 (0)}

CLT MP pre-COD: standard medical equipment, and puppets.

n = 9^{^0 (0)}

SC during COD: standard PP, and clinical staff verbal explanations.

Pain: FPS^(Pt.).

Pain and distress:

FLACC^(R).

Anxiety: STAI-CH^(C).

Pre and post-procedure: FPS, FLACC, STAI-CH.

Post-removal: FPS.

Quay 1983 [56].

RCT, USA.

n = 26^{^0 (0)}

Discharge preparation weekly by nurse, written information, and procedural rehearsal 3 days pre-discharge.

n = 24^{^0 (0)}

Routine instructions 3 days pre-discharge.

Anxiety: STAI-CH^{(Pt., C)}.

1-day pre-discharge, 1st follow-up visit: STAI-CH.

Sveen 2017 [57].

RCT, Sweden.

n = 31^{^16 (52)}

Internet based CBT and ACT support program.

n = 31^{^3 (10)}

SC during COD.

Post-traumatic stress: IES-R^(C), PSI-SF^(C), PSS^(C).

Pre-procedure, post-procedure, 3mths post-injury, 12mths post-injury: IES-R, PSI-SF, PSS.

Van der Heijden 2018 [58].

RCT,

South Africa.

n = 71^{^3 (4)}

3–5 min MT, and parental soothing post-COD.

n = 64^{^3 (4)}

SC during COD, and parental soothing post-COD.

Pain: COMFORT-B^(R), FACES^(Pt.).

Distress: OSBD-r^(R), FPS-R^(Pt.).

Pre-procedure, hallway, entering room: OSBD-r, COMFORT-B.

Pre and post-procedure: FPS-R, FACES.

Whitehead-Pleaux 2006 [59].

RCT, USA.

n = 8^{^0 (0)}

MT during COD.

n = 6^{^0 (0)}

Verbal support and distraction by music therapists during COD.

Pain: FACES^(Pt.), HR^(R).

Behavioral distress: NAPI^(R).

Anxiety: Fear Thermometer^(Pt.).

Pre and post-procedure: FACES, HR, Fear Thermometer.

During procedure: FACES, HR, NAPI, Fear Thermometer.