Non-pharmacological and complementary interventions for comfort promotion in pediatric intensive care units: A systematic review

Background Comfort is a fundamental yet often underaddressed aspect of care in pediatric intensive care units (PICUs), where children experience pain, anxiety, and physiological distress from invasive procedures and environmental stressors. Although pharmacological management is essential, it may cause adverse effects. Non-pharmacological and complementary nursing interventions have emerged as adjunctive strategies, but their effectiveness has not been systematically synthesized.Objective This systematic review aimed to evaluate and synthesize the available evidence on the effects of non-pharmacological and complementary nursing interventions on comfort-related outcomes in children hospitalized in PICUs.Methods This systematic review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420261398877). PubMed, Web of Science, CINAHL, and Scopus were searched between May 18 and June 4, 2026. Eligible studies were English-language quantitative intervention studies involving children admitted to PICUs. Two reviewers independently conducted study selection, data extraction, and quality assessment. Due to heterogeneity, a narrative synthesis was performed.Results Six studies involving 492 children were included. Interventions comprised music-based approaches, maternal voice recordings, traditional bathing, and soothing care practices. Music interventions reduced COMFORT Behavior Scale scores and improved physiological parameters. Maternal voice recordings reduced procedural pain, while traditional bathing improved comfort compared with wipe bathing. One study reported reduced midazolam use and shorter mechanical ventilation duration.Conclusions Non-pharmacological and complementary nursing interventions may improve comfort and reduce physiological distress in critically ill children. These low-cost, nurse-led strategies appear to be valuable adjuncts to routine PICU care. Further high-quality randomized controlled trials are needed to strengthen the evidence base.