Currently submitted to: JMIR Preprints
Date Submitted: May 6, 2026
Open Peer Review Period: May 6, 2026 - Apr 21, 2027
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
KidCalm ER: Design and Development of an Evidence-Based Digital Distraction Tool for Procedural Anxiety in Children Aged 1–5 Years in the Emergency Department
ABSTRACT
Background:
Procedural pain and distress in children aged 1–5 years are common in emergency medicine but remain underaddressed. Non-pharmacological distraction is a well-evidenced first-line adjunct, yet practical digital tools designed for emergency department (ED) workflows in low-resource settings are scarce. No validated digital distraction application exists for the Thai ED context.
Objective:
To describe the iterative, evidence-informed design and development of KidCalm ER, a single-file progressive web application intended to reduce procedural distress in children aged 1–5 years during ED procedures.
Methods:
KidCalm ER was designed iteratively by a board-certified emergency physician drawing on five systematic reviews and meta-analyses (Cochrane and high-quality non-Cochrane) examining distraction efficacy, interactivity benefits, and pain memory reframing. The tool was built as a single HTML5 file without external dependencies to meet the practical constraints of the Thai ED environment. No human subjects research was conducted.
Results:
KidCalm ER delivers five sequential interactive game levels using tap, sustained-hold, and drag mechanics, with bilingual narration (Thai/English), age-adaptive difficulty for children aged 1–2 versus 3–5 years, character selection, and mission-based narrative framing. The tool requires no installation or internet connection after initial load and runs on standard tablets or smartphones.
Conclusions:
KidCalm ER is a low-cost, evidence-informed, immediately deployable tool for procedural distraction in pediatric emergency care. It has not yet been validated in a clinical trial. Planned next steps include a structured usability evaluation with child-caregiver dyads and ED nursing staff, followed by a prospective pilot study within the Bangkok Hospital ED. The tool is available at https://kidcalm-er.netlify.app.
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.