Influence of therapeutic play on salivary cortisol levels in children undergoing venipuncture.

Only 52 children were studied, with 28 in the play group and 24 in the control group, so the trial was small. The groups were not balanced: the play group had more school-age children and more girls, while the control group had more preschool-age children and more boys. The paper does not report how randomisation was concealed or how many children dropped out, so it is hard to know whether assignment affected the results. Many cortisol comparisons were made by gender, age, disease type, and number of puncture attempts, and none reached statistical significance; some borderline values should not be treated as positive findings. Several children had cortisol above the normal range before venipuncture, which may have made change harder to detect. Salivary cortisol was described as volatile and strongly influenced by physical, emotional, and situational factors, and the authors say it may not be the best marker for child stress.

Funded by the National Research Council (CNPq), Universal Notice 2016, Process Number 431794/2016-2. No other conflicts of interest are stated.

Do not conclude that therapeutic play reduces children's stress during venipuncture. The cortisol comparison was not positive, and the paper does not report statistical results for the behaviour observations.