Smartphone-Based Cartoon Distraction During Cast Removal in Children

Cast removal can cause considerable fear and anxiety in children despite being a generally painless procedure. This randomized controlled trial evaluated whether watching a cartoon on a smartphone during circumferential upper-extremity cast removal reduces procedure-related fear and behavioral distress in children aged 4 to 12 years compared with standard care. Participants were randomly assigned in a 1:1 ratio to standard cast removal alone or standard cast removal combined with smartphone-based cartoon distraction. The primary outcome was fear assessed using the Children's Fear Scale (CFS). Secondary outcomes included behavioral distress assessed using the Observational Scale of Behavioral Distress-Revised (OSBD-R) and pulse rate measured by pulse oximetry.

Inclusion Criteria: * Children aged 4 to 12 years. * Scheduled to undergo removal of a short-arm or long-arm circumferential plaster cast. * Undergoing cast removal at the orthopedic outpatient clinic. Exclusion Criteria: * Presence of a neurological disorder that could affect the assessment of fear, anxiety, or behavioral responses. * Presence of a cognitive disorder that could interfere with study participation or outcome assessment.