May be your facility clinical members didn't get adequate hands-on training to use the J-Tip correctly and it could be the reason your patients were not happy nor you received expected results. It's like riding a bicycle, if you don't know how to ride correctly, you may fall and get hurt. With the noise, you should ask CLS to help you or you can let kid knows prior that it will sound similar as opening can of Soda. Have you seen any young kids get scared when they open can of soda? Since they are aware of that sound, they enjoy the soda without blinking their eyes.