To explore the effects of breathing exercises on enema-related anxiety, fear, and pain in children. A randomized controlled trial (RCT) design was adopted. Children aged 6-12 (n = 106) were randomly assigned to an intervention group (n = 53) and a control group (n = 53). The intervention group received breathing exercises. Comparisons of pain, fear, and anxiety scores both between and within the two groups were conducted using independent samples t-tests. Cohen's d formula was used to calculate the effect size of the difference between the two group averages. The intervention group received breathing exercises followed by an enema, while the control group received a standard enema procedure. Significant time, group, and time × group interactions were found for anxiety (d = 1.84), fear (d = 1,36), and pain (d = 1.23) (p < 0.001). The intervention group showed greater reductions in anxiety, fear, and pain compared to the control group (p < 0.001). Within-group analyses showed significant reductions in anxiety (d = 0,83), fear (d = 0,69), and pain (d = 0,43) scores in the intervention group (p < 0.001), while they increased in the control group. Breathing exercises are effective in reducing children's anxiety, fear, and pain levels associated with enemas. Breathing exercises can be recommended as an effective, non-pharmacological nursing intervention for children. Clinical Trials number: NCT05508022.
