Comparison of the Effect of Body Position (Supine and Semi-Fowler's) on Pain Level During Invasive Procedures in Children Aged 1-6 Years

Invasive medical procedures performed in pediatric emergency departments (such as intravenous catheter insertion) may cause significant pain and distress in children. The pain experienced during such procedures can negatively affect both the physical and psychological well-being of children. Pain perception may vary depending on factors such as the child's age, developmental level, previous experiences, and the position in which the procedure is performed. Accurate assessment of pain is particularly challenging in children aged 1-6 years due to their limited communication skills. In this age group, behavioral observation-based pain assessment tools are widely used. The FLACC (Face, Legs, Activity, Cry, Consolability) scale is a behavioral assessment tool developed for children aged 2 months to 7 years, with established validity and reliability. Recent systematic reviews support the reliability of this scale across various clinical settings.

This study is designed as a quantitative, prospective, randomized controlled experimental study to evaluate the effect of body position on pain levels during invasive procedures (blood sampling and intravenous catheter insertion) in children aged 1-6 years. The study will be conducted in the pediatric emergency department of a hospital located in the Aegean region, and the study population will consist of children aged 1-6 years who present to this unit and require invasive procedures.

The sample will consist of a total of 64 children who meet the inclusion criteria and whose parents provide written informed consent. After enrollment, participants will be assigned to two groups using a simple randomization method. The randomization process will be carried out using computer-generated random numbers or the sealed envelope method to ensure impartiality. Each participant will be assigned according to a pre-generated randomization list, thereby minimizing selection bias. As a result, children will be equally divided into two groups, with 32 children in each group:

Supine position group Semi-Fowler's (semi-sitting) position group

Children aged 1-6 years who require invasive procedures, have no chronic illness, do not use regular analgesics, and whose parents provide consent will be included in the study. Children with chronic pain, neurological or psychiatric disorders, physical conditions preventing appropriate positioning, or without parental consent will be excluded.

Data will be collected by the researchers through face-to-face observation and interviews in the pediatric emergency department. Two main instruments will be used for data collection: a Descriptive Information Form developed by the researchers and the FLACC (Face, Legs, Activity, Cry, Consolability) Behavioral Pain Assessment Scale, which is a valid and reliable tool for assessing pain in children. During the procedure, children's pain levels will be assessed based on direct observation and recorded in a standardized manner for each participant.

During the study, invasive procedures will be performed according to the position determined by randomization, and pain assessment will be conducted during the procedure. The collected data will be anonymized and coded, with no personal identifying information recorded. All data will be stored in accordance with confidentiality principles. The coding key will be kept only by the principal investigator and will not be shared with third parties.

After data collection, the data will be transferred to an electronic environment and analyzed using appropriate statistical software (SPSS). Descriptive statistics will be calculated first, followed by normality tests. Depending on the data distribution, either the independent samples t-test or the Mann-Whitney U test will be used to compare the two groups. The level of statistical significance will be set at p < 0.05.

The study will be conducted within the specified time frame after obtaining ethical approval, and all processes will be carried out in strict accordance with ethical principles, participant rights, and data security. This study aims to determine the position that causes less pain during invasive procedures in children.