Immersive virtual reality eases kids’ fear of needles

The use of immersive virtual reality (VR) can help reduce fear and anxiety in children who are undergoing immunization in primary care, reports a recent Singapore study.

“Children reported higher pain alleviation and were more willing to undertake subsequent immunization using VR,” the researchers said. “The attending nurses accepted and were willing to use this new technology, perceiving it to be simple to be deployed during childhood immunization.”

The pilot, open-label, randomized controlled trial included 30 children (aged 4–10 years, 63.3 percent boys) who were scheduled for immunization at a public primary care clinic in Singapore. Half (n=15) were given the VR intervention, which involves virtual fantasy story that lasts for 2 minutes; the remaining half (n=15) were designated controls and did not receive VR during the procedure.

In both the per-protocol (PP; median, –1 vs 0; p=0.02) and intention-to-treat (ITT; median, –1 vs 0; p=0.04) analyses, the VR intervention induced a statistically significant decrease in fear, as quantified by the Child’s Fear Scale. The same was true for median change in scores in the Parent’s Anxiety Score (PP: –4 vs 0; p=0.003; ITT: –4 vs 0; p=0.04). [Front Pediatr 2022;10:847257]

On the other hand, the VR intervention was only significantly effective against median pain, as measured by the Faces Pain Scale-Revised, in the PP analysis (0.5 vs 2; p=0.04), but not in the ITT analysis (1 vs 2; p=0.13).

Of note, while the VR intervention led to no significant change in the Nurse’s Anxiety Score (PP: p=0.81; ITT: p=0.51), nurses said that using VR during immunization was simple (median Likert score, 9.5; p=0.01) and acceptable (median, 10; p=0.005), and that they were highly willing to use VR in the next immunization procedure (median, 10; p=0.02).

Children similarly liked the VR intervention. More patients in the VR vs control group said that they were willing to return for future immunizations (73.3 percent vs 40 percent). Parental willingness to return did not differ between arms.

“The clinical outcomes in this study revealed significant decline in anxiety level among children and their parents. Such positive outcome seemed to reduce their apprehension toward future immunization,” the researchers said.

Such finding was in line with that of a previous study, which found that fear tends to be higher than pain in paediatric cancer patients undergoing injections. Reducing fear, therefore, could be a valuable measure in needle procedures. [Eur J Pain 2016;20:223-230]

Importantly, that VR helped make injections more acceptable to kids could have great public health ramifications in the context of the coronavirus disease 2019 (COVID-19).

“In the current COVID-19 pandemic, Singapore has rolled out COVID-19 vaccination for children aged 5–11 years old since January 2022,” the researchers said. “The use of VR has potential impact in mitigating the children’s pain experience and anxiety when they receive their COVID-19 vaccination and reduce vaccine hesitancy among their parents.”