problem in many immunization procedures. One nurse reported "getting kicked and hit by a struggling child" whose parents had not explained the purpose of the visit to the child. Despite the fear that the prospect of venipuncture may invoke, nurses agree that it is better to tell the child exactly what is going to happen beforehand. Nurses also reported that children's fear seemed to correlate with parents' anxiety, and cited parental anxiety as an obstacle in performing venipuncture. Klieber found several helpful parent behaviors as a part of active distraction in his study published in the Journal of Pain and Symptom Management. These included using a calm voice, giving children permission to cry, remaining firm but not threatening, and using stickers to celebrate effort. The Nursing Forum article also found active and passive distraction by way of toys and television cartoons to be helpful. The researchers agreed that effective coaching and successful clinical visits involving venipuncture could provide children with an opportunity to practice and master "adaptive coping skills." Other techniques Kettwich et al of the Department of International Medicine of the University of New Mexico conducted an experiment published in the Journal of Family Practice comparing decorated and plain syringes (see picture). The research hypothesis was that "adding decorative designs or stickers to medical devices before a procedure [would] significantly reduce aversion, fear, and anxiety…[in] needle-phobic patients." The experimental syringes were made with conventional 10-milliliter syringes, decorated so that the "markings of the barrel could still be seen". In the experiment, "the presentation of individual devices to each subject was randomized to eliminate the possibility of a consistent bias." To determine emotional responses to the medical devices, the researchers used the validated Visual analogue scale where 0 denotes lowest response and 10 shows the strongest response. The Visual Analogue Scale for Aversion, Fear, and Anxiety were used. The study defined "significant needle phobia" as an "aversion, fear, or anxiety score of greater than or equal to 5." The results of this study showed that the stress-reducing medical devices are effective in reducing aversion, fear, and anxiety towards the medical needles. The results are shown in the table, in the form (Visual Analogue Score) ± (standard deviation). For all three Visual Analogue tests, the mean score was much lower for the stress-reducing syringes; on average, the scores for the aversion, fear, and anxiety tests were 79%, 53%, and 51% lower,