Background: Pain relief is necessary for all ill children. Nowadays many drugs and techniques are used for relief of pain. Cooling the site of injection and local pressure are two of the used techniques. We decided to compare the effect of topical cooling and local pressure of the injection site before intramuscular injection on pain severity in children.

Methods and materials: Ninety children between 5 to 12 years old in Neyshabour city clinics were selected randomly and divided into 3 groups. group 1: topical or manual pressure, group 2: topical cooling, group 3: control group. Data were collected by the completion of questionnaire and observation sheets and pain measured with Oucher scale and visual analog scale. Data analysis was done with SPSS software.

Results: Mean of pain severity on Oucher pain scale, in topical pressure group was 26.8 ± 1.1, in topical cooling 39.2 ± 1.54 and routine injection 86.7 ± 1.06. Cruscal Valise exam showed, severity of pain in group 1(topical pressure) was significantly less than the other two groups (p<0/0001). There was significant difference between the two test groups and control group in mental responses, so that it was lesser in the group 1 (topical pressure) than the others.

Conclusion: Application of manual compression to intramuscular injection site, compared with topical cooling and routine injection could decrease pain intensity and mental responses in children.