Virtual reality (VR) is a novel tool that is reported to reduce children’s pain and anxiety during medical procedures. However, prior studies only measured subjective pain and anxiety and did not include objective outcomes on coping or examine its effect on caregiver distress. Addressing these limitations would develop the growing literature on the beneficial effects of VR during pediatric procedures. The primary objective was to determine whether engagement with VR improves child and caregiver coping during venipuncture procedures in the PED. Secondarily, this study evaluated effects of engagement with VR on pain and anxiety, as well as caregivers’ own anxiety. This prospective, randomized, controlled trial compared engagement with VR to standard care with child life specialists (CL) during venipuncture. A reference group was observed, without VR or CL, to serve as an active control. Eligibility criteria were > age 7 and receiving a venipuncture procedure in the PED (e.g. blood draw or intravenous line placement). Children randomized to VR played a game using a commercially available VR headset with guidance from CL. The control group received support from CL and distraction of the child’s choosing. The reference group received no formalized form of support (e.g. parents, nurses). During the procedures, an independent evaluator used a standardized scale (CAMPIS-SF) to rate patient and caregiver coping and distress behaviors, and are reported as a proportion of total behaviors (range 0-1.0). Pain and anxiety was rated using a visual analog scale (range 0-10). ANOVA identified differences in age, coping, distress, pain and anxiety, and fisher’s exact test identified differences in sex, race, and ethnicity. Out of 55 eligible patients, 15 patients (15 caregivers) were randomized to VR, 20 patients (15 caregivers) were randomized to CL, and the reference group had 20 patients (17 caregivers). (Table 1). There were no significant differences in coping, distress, pain, or anxiety between VR and CL for both children and caregivers. However, coping was significantly higher in CL and VR compared to the reference group. Caregiver’s perception of their child’s anxiety was significantly higher in the reference group compared to CL and VR. (Table 2) There was no significant presence of cybersickness side effects in the VR group (p=0.31) Similar levels of coping, pain and anxiety were observed between the two intervention groups, which may be attributed to the presence of child life specialists during these procedures. Children’s coping was high in CL and VR, suggesting both are beneficial modes of support. Absence of formal procedural support results in lower levels of coping and greater anxiety. This study may be limited by a small sample size. In summary, VR may be a useful and tolerable tool to enhance coping during medical procedures for children and caregivers.


Coping, distress, pain and anxiety scores for children and caregivers.

Change in pain and anxiety scores (calculated as during procedure - pre-procedure) ranges from -10 to 10. A negative number signifies reduced pain or anxiety during the procedure.