VR distraction for children's procedural pain: what the evidence shows, and what it doesn't
Meta-analyses and randomized trials point the same way: less pain and anxiety when a child is absorbed in VR during a needle procedure. Here is what the evidence shows, where it is weak, and what a ward needs to make it work.
Few things in a children's hospital are as routine, or as dreaded, as a needle. Immersive VR distraction is one of the better-studied ways to make it easier: meta-analyses and randomized trials point the same way, with less pain and less anxiety when a child is absorbed in a virtual world during the procedure.
The direction is consistent. The certainty is not as high as the headlines suggest, and VR works on top of standard comfort care, not instead of it. Both halves of that sentence matter if you are deciding whether to bring VR into a ward.
Needle procedures: where the evidence is strongest
Most studies look at IV placement, blood draws and venipuncture, the procedures children face most often.
The pooled picture. A 2022 meta-analysis update in Paediatric Anaesthesia covered 26 articles. For VR distraction it found a standardized mean difference of −0.67 for pain (95% CI −0.89 to −0.45, 21 studies) and −0.74 for anxiety (95% CI −1.00 to −0.48, 10 studies), both p < .001[1]. An SMD around 0.7 is usually read as a medium effect. A 2024 meta-analysis in Nursing Reports, limited to needle procedures, pooled 21 studies with 2,663 participants. On the 0–10 Wong-Baker faces scale, pain was lower with VR by 1.83 points as rated by children, 2.61 by parents and 2.71 by nurses, with high heterogeneity between studies[2].
Selected randomized trials:
| Trial | Setting and children | Result with VR |
|---|---|---|
| Gold et al., JAMA Network Open, 2021[3] | IV placement, Children's Hospital Los Angeles; 107 patients aged 10–21 | Self-reported pain 1.09 vs 2.19 and anxiety 1.78 vs 3.28 on 0–10 scales (unadjusted means) |
| Wong & Choi, JAMA Network Open, 2023[4] | Venipuncture; 149 children aged 4–12 | Lower pain (β −0.78, p < .001) and anxiety (β −0.41, p = .03); procedures also shorter, 4.43 vs 6.56 minutes (p = .03) |
| Chan et al., Journal of Pediatrics, 2019[5] | Two trials in Australian hospitals: IV or venipuncture in the emergency department, venipuncture in outpatient pathology; children aged 4–11 | Lower pain in both settings (differences of 1.78 and 1.39 points on a faces scale); minor adverse events evenly split between groups |
| Özalp Gerçeker et al., Journal of Clinical Nursing, 2020[6] | Blood draw; 136 children aged 5–12 | Lower pain with two different VR games; fear and anxiety fell with VR and rose in the control group |
One detail from the Gold trial is worth knowing: standard care included simple distraction and numbing cream, and many children in the VR group declined standard care, so the trial did not test VR on top of numbing cream specifically[3].
Beyond needles: the same direction
- Burn care. A 2022 meta-analysis of 10 studies with 445 children found a moderate reduction in pain during burn wound care (SMD 0.60, 95% CI 0.28 to 0.93). Only one study measured anxiety, so there is no pooled anxiety estimate[7].
- Dentistry. A 2023 meta-analysis in the Journal of Dentistry pooled 12 randomized trials with 818 participants and found lower anxiety (SMD −1.74) and pain (SMD −1.57). The authors flag very high heterogeneity and possible publication bias, so the size of the effect is less certain than the direction[8].
What the evidence does not show
- Certainty is low. The Cochrane review of VR distraction for acute pain in children (17 randomized trials, 1,008 children aged 4–18) rated the evidence as low or very low certainty, because of study limitations and indirectness[9]. Children cannot be blinded to wearing a headset, and many trials are small.
- Heterogeneity is high. Games, headsets, ages and comparison groups vary widely, which is why the meta-analyses agree on direction more than on size[2][8].
- It is an adjunct, not a replacement. The trials compare VR with or alongside usual comfort measures. Nothing here supports dropping topical anaesthetic, comfort positioning or a trained team.
- Short-term outcomes only. The studies measure pain and anxiety around the procedure, not longer-term outcomes such as fear of the next visit.
The hardware limit: formal and physical
The trials above included children from 4 years old. Today's most common standalone headsets were not designed for most of them, and that limit is both formal and physical.
Formal. In 2023 Meta lowered the minimum age for Quest headsets from 13 to 10, with parent-managed accounts for 10- to 12-year-olds. It has set no policy for children under 10, and its safety guidance says Quest headsets are not toys and that younger children face greater risks of injury and adverse effects than older users[10]. Using a Quest with a 6-year-old therefore falls outside the manufacturer's intended use, which matters for a hospital's liability and procurement, and for any vendor building a medical device on that hardware.
Physical. A headset only works well when its lenses line up with the user's eyes. The Meta Quest 3 adjusts the distance between its lenses from 53 to 75 mm, and Meta says it works best between 56 and 70 mm[11]. The Quest 3S has just three settings, 58, 63 and 68 mm[12]. Children's eyes sit closer together: the average interpupillary distance is about 52.6 mm at age 6, 53.4 mm at 7 and 54.6 mm at 8. On those figures, only about 44% of 6-year-olds, 56% of 7-year-olds and 71% of 8-year-olds fall within even the Quest 3's lower limit[11]. Below it, children may see an off-centre or blurred image, with eye strain and weaker depth perception, and a headset of around half a kilogram sits heavily on a small head[12]. Most trials do not report how well the headset fitted, so this can quietly affect who benefits and who drops out[11].
Our recommendation. Use Quest-class headsets for children aged 10 and over, in line with the manufacturer's guidance; this group is covered by the evidence too, since the Gold trial enrolled patients aged 10 to 21[3]. For younger children, choose hardware designed or approved for their age, and check fit, not just the age on the box. Screen before every session for fit, a clear and stable image and any sign of motion sickness, and keep sessions short and supervised. When you evaluate a pilot, record the headset model and how well it fitted, so hardware problems are not mistaken for the intervention not working.
What it takes to work on a real ward
The trials show what VR can do under study conditions. Getting the same result in daily practice depends on five practical things:
- Start before the needle. In the Gold trial, children began playing a few minutes before the procedure and kept going until access was achieved[3]. The headset has to be ready when the child arrives, not found halfway through.
- Match content and hardware to age. Follow the hardware limits above: Quest-class headsets from age 10, age-appropriate hardware for younger children, and content a frightened child can use without instructions.
- Plan hygiene between children. Wipeable face interfaces or disposable covers, and a cleaning step that fits the hospital's infection-control rules.
- Fit the nurse's workflow. If starting VR takes more than a few seconds, it will not be used on a busy shift. Parents should still be able to stay close and talk to the child.
- Measure what the trials measured. A faces pain scale before and after, procedure time and staff time give a ward its own evidence within weeks.
One more check for buyers in Europe: software marketed to reduce patients' pain or anxiety may qualify as a medical device under the EU MDR, so ask any vendor about the regulatory status of their product.
Exploring VR for paediatric procedures?
At Kucharski Consulting we build VR applications for healthcare, and we are developing a VR distraction experience for children's procedures. If you work in paediatrics, nursing or hospital innovation and will be at MEDICA 2026 in Düsseldorf, we would be glad to show you what we are building.
Sources
- Tas FQ, van Eijk CAM, Staals LM, Legerstee JS, Dierckx B. "Virtual reality in pediatrics, effects on pain and anxiety: a systematic review and meta-analysis update." Paediatric Anaesthesia, 2022. pure.eur.nl
- Cáceres-Matos R, Castillo-García M, Magni E, Pabón-Carrasco M. "Effectiveness of Virtual Reality for Managing Pain, Fear, and Anxiety in Children and Adolescents Undergoing Needle-Related Procedures: Systematic Review with Meta-Analysis." Nursing Reports, 2024. doaj.org
- Gold JI, SooHoo M, Laikin AM, Lane AS, Klein MJ. "Effect of an Immersive Virtual Reality Intervention on Pain and Anxiety Associated With Peripheral Intravenous Catheter Placement in the Pediatric Setting." JAMA Network Open, 2021. jamanetwork.com
- Wong CL, Choi KC. "Effects of an Immersive Virtual Reality Intervention on Pain and Anxiety Among Pediatric Patients Undergoing Venipuncture." JAMA Network Open, 2023. pubmed.ncbi.nlm.nih.gov
- Chan E, Hovenden M, et al. "Virtual Reality for Pediatric Needle Procedural Pain: Two Randomized Clinical Trials." Journal of Pediatrics, 2019. em-consulte.com
- Özalp Gerçeker G, Ayar D, Özdemir EZ, Bektaş M. "Effects of virtual reality on pain, fear and anxiety during blood draw in children aged 5–12 years old: A randomised controlled study." Journal of Clinical Nursing, 2020. ideas.repec.org
- Smith KL, Wang Y, Colloca L. "Impact of Virtual Reality Technology on Pain and Anxiety in Pediatric Burn Patients: A Systematic Review and Meta-Analysis." Frontiers in Virtual Reality, 2022. frontiersin.org
- Yan X, Yan Y, Cao M, et al. "Effectiveness of virtual reality distraction interventions to reduce dental anxiety in paediatric patients: a systematic review and meta-analysis." Journal of Dentistry, 2023. hub.hku.hk
- Lambert V, et al. "Virtual reality distraction for acute pain in children." Cochrane Database of Systematic Reviews, 2020. cochranelibrary.com
- Road to VR, "Meta to Reduce Quest's Minimum Age Restriction to 10 Years," 19 June 2023. roadtovr.com
- Pochwatko G. "Interpupillary Distance Constraints in Pediatric VR: Implications for Psychology and Psychotherapy." arXiv preprint, 2026 (children's IPD values based on MacLachlan and Howland, 2002). arxiv.org
- Road to VR, "Meta Announces Quest 3S" (specifications: IPD settings and 514 g weight). roadtovr.com
Kucharski Consulting is developing a product in this area. We have no relationship with the authors of the studies cited, and all figures come from the public sources above. This article was prepared with the help of AI tools for research and drafting; all facts were checked against the linked sources, and the opinions are our own. The cover image is an illustration. Published 26 Oct 2026.