Pediatric patients often undergo invasive procedures that cause fear, pain, and anxiety during diagnosis and treatment (Ali et al., 2016; Bradford et al., 2019; Eijlers, Utens, et al., 2019; Farion et al., 2008). When the literature was examined, studies on the evaluation and management of pain and anxiety generally focused on postoperative pain and anxiety (Eijlers, Dierckx, et al., 2019; Zieliński et al., 2020). However, in recent years research has begun to focus on acute pain and anxiety (Erdogan & Aytekin Ozdemir, 2021; Lambert et al., 2020). Pain is undertreated in pediatric patients. It has also been determined that pain may not be assessed adequately or regularly in hospitalized children. Appropriate, explicit, and frequent assessment of pain is vital to pain management. Since pain is a subjective experience, self-reporting is preferred whenever possible. At the same time, consideration of physiological parameters and caregiver reports can complement pain assessment (Gai et al., 2020).

Pain and anxiety have numerous physiological, mental and emotional effects. Therefore, assessment and management of pain and anxiety during such procedures are of great importance (Ballard et al., 2019). Unassessed and poorly managed procedural pain and anxiety can have short- and long-term consequences for patients. It can increase the resources required to perform a medical procedure, take up more of healthcare professionals' time, and reduce satisfaction with the procedures. Therefore, clinical guidelines emphasize the importance of assessing and managing procedural pain and anxiety in pediatric patients (Hedén et al., 2020; Karlsson et al., 2016; Wong & Choi, 2023). The European Society of Pediatric Anesthesia recommends pharmacological and non-pharmacological methods for the effective management and prevention of acute procedure pain and anxiety in children (Zielinska et al., 2019). Emotions such as pain and anxiety in children not only negatively affect their comfort levels during medical procedures, but are also associated with negative consequences such as escape attempts and post-traumatic stress symptoms (Eijlers, Utens, et al., 2019).

Another negative experience caused by medical procedures, other than anxiety and pain, is fear (Czech et al., 2021). Fear and pain levels have been found to be positively related to each other in children undergoing medical procedures (Hedén et al., 2020). Fear is a normal response to threat or danger that usually decreases with age (Hyde et al., 2019). Both fear and pain can be learned and remembered from previous experiences (Pavlova et al., 2022). It is important to consider fear when determining pain associated with medical procedures (Hedén et al., 2020). In a study, children reported that they wanted to have influence, be informed, scream loudly, squeeze something hard, and cope with fear and pain while undergoing medical procedures (Kleye et al., 2021). Enemas are one of the procedures that can cause pain and fear in children (Zago et al., 2024) and are a common method used to treat constipation (Peña et al., 2021).

Constipation is common in children, there are several different treatments for constipation, including behavioral changes and medications. In addition to these treatment methods, enemas are a method that can temporarily solve the problem of constipation and relieve the child (Ho & How, 2020). However, enemas require patient compliance because of rare and potentially dangerous complications such as bowel perforation (Cirocchi et al., 2020). Determining the level of fear, pain, and anxiety associated with enemas in children is important for children's adaptation and for planning intervention programs that will control the potential negative experience.

What is the Children's Fear Scale level before the enema?

What is the Wong-Baker FACES® Pain Rating Scale level before the enema?

What is the Children's Anxiety Meter-State level before the enema?

What is the Children's Fear Scale level after the enema?

What is the Wong-Baker FACES® Pain Rating Scale level after the enema?

What is the Children's Anxiety Meter-State level after the enema?

Are children's fear, pain, and anxiety levels before and after enemas related to age, sex, and clinical features such as hospitalization experience, enema experience, and analgesic use in the last 6 h?