White Noise as a Non-Pharmacological Adjunct to Reduce Pain and Crying in Young Children Undergoing Non-Invasive Ventilation or High-Flow Nasal Cannula Therapy: A Randomized Controlled Trial

Abstract

Background: Children receiving non-invasive ventilation (NIV) or high-flow nasal cannula (HFNC) therapy often experience distress and procedural pain, which can impair mask tolerance, reduce adherence, and prolong hospitalization. Pharmacological analgesia is limited in this context due to potential respiratory depression. White noise, an inexpensive and simple auditory stimulus, has shown calming benefits in neonates but remains underexplored in older pediatric age groups.

Objective: To determine whether white noise reduces pain and crying duration in children aged 1–5 years undergoing NIV or HFNC therapy and to evaluate its effect on parental satisfaction.

Methods: In this single-center, parallel-arm randomized controlled trial, 172 children aged 1–5 years requiring NIV or HFNC were randomized equally to receive either white noise at 40–50 dB via bedside speakers (n = 86) or standard care (n = 86). Pain was assessed using the FLACC scale, and crying duration was recorded in seconds at baseline, 15 minutes after therapy initiation, and post-therapy. Parental perception of care was measured using a 10-point Likert scale. Data were analyzed using the Mann–Whitney U test due to non-normal distributions, with significance set at p < 0.05. R

esults: Baseline characteristics were comparable between groups. At 15 minutes, children in the white noise group had significantly lower FLACC scores (median 4.24 vs. 5.78, p < 0.001) and shorter crying duration (median 120.7 s vs. 172.4 s, p < 0.001). Parental perception scores were higher in the intervention group (median 8.50 vs. 6.21, p < 0.001). Post-therapy, crying duration remained significantly lower (129.8 s vs. 173.6 s, p < 0.001), but pain scores equalized between groups (p = 0.521).

Conclusion: White noise is an effective, well-tolerated, and low-cost adjunct that reduces procedural pain and crying in young children undergoing NIV or HFNC and improves caregiver satisfaction. Its integration into routine respiratory care is feasible and may reduce reliance on pharmacologic sedation.