- Anxiety is often high among children undergoing needle-based procedures.
- New research reveals that virtual reality headsets may act as a distraction.
- When distracted, children reported significantly lower anxiety — and pain — levels.
- The approach could also be used to help calm nervous parents.
Individuals of all ages can be anxious about needles, although this fear is particularly prevalent among children.
Distraction tools, such as toys, can help reduce feelings of anxiety and pain among infants undergoing needle-based procedures.
And now, new research finds that virtual reality (VR) devices may be an even more effective distraction aid, leading to greater positive outcomes.
What the study involved
Led by The Chinese University of Hong Kong and published in JAMA Network, the study builds on prior explorations into the benefits of distraction during venipuncture (a common needle-based procedure).
“Previous [studies] were just distractions with cartoons or games,” Cho Lee Wong, Associate Professor in The Nethersole School of Nursing at The Chinese University of Hong Kong and co-author of the study, explained to Healthline.
A total of 149 children aged 4-12 undergoing venipuncture where a needle punctures the skin took part in the research and were divided into control and intervention groups.
The control group received ‘standard’ care during the procedure, involving comforting words and an explanation by a medical professional of what was happening.
Meanwhile, those in the intervention group received standard care but were also provided with a VR headset to wear during the procedure.
For children aged 4-7, the VR involved watching a cartoon character undergo venipuncture and explain why the procedure was necessary. For children aged 8-12, the character explained the process in more detail — and they also played an interactive game where they took on the role of ‘doctor’.
“Our VR integrates distraction and procedural information,” noted Wong. “We think it’s important to prepare and let patients know what is going on and what should be expected, [as] it also helps ease their anxiety about the procedure.”
Furthermore, Wong shared, “we found that children had no difficulty understanding the content. The procedure was not difficult to understand, and we also told them in simple, age-appropriate language.”
The key findings
The children self-reported their feelings of anxiety using a visual scale, while the researchers used the self-reported Faces Pain Scale to gauge their pain levels.
Compared to the control group, those in the VR group experienced reported significantly lower amounts of pain and greatly reduced anxiety.
The average venipuncture procedure time was also much faster in the VR group just under 4:30 minutes compared to the control group just over 6:30 minutes.
In addition, the researchers monitored the children’s heart rates and cortisol levels to obtain further insights into their physiological reactions to anxiety and pain.
However, while the VR group showed a smaller increase in heart rate and a greater decrease in cortisol (the stress hormone), the amounts were not statistically significant.
Interestingly, the researchers noted that providing an additional gameplay element in the 8-12-year-old VR group did not lower stress levels further.
“Our results found that the additional element of gameplay made no difference — despite other studies having found interactive games to have greater effect than passive viewing of VR content,” revealed Wong.
“This may be because children aged 8-12 did not have as high levels of anxiety as younger children, so the effects were less pronounced,” Wong shared. “This aspect may require further research.”
How anxiety and pain are linked
With one being cognitive and the other physical, it can be easy to consider anxiety and pain separate entities.
But the two are very much linked, explained Dr. Christopher A. Kearney, Distinguished Professor and Chair of Psychology at the University of Nevada, Las Vegas.
“Pain and anxiety share key response sets that include physiological, cognitive, and behavioral components,” he told Healthline. “Shared physiological components can include hyperventilation, heart racing, and jitteriness.”
Meanwhile, Kearney continued, “shared cognitive components can include fear of negative consequences and worry about physical or emotional harm; and shared behavioral components can include withdrawal and constant reassurance-seeking.”
So how exactly does pain influence anxiety, and vice versa?
“To understand [this], it is crucial to try to appreciate how our body senses pain,” Dr. Zishan Khan, a Psychiatrist with Mindpath Health, stated to Healthline.
“Pain is experienced after nerve endings are activated by some sort of a stimulus, such as an injection by a needle into one’s skin,” he explained. “These nerve endings trigger impulses that travel through the spinal cord to higher levels of our brain.”
“Depending on the portion of the brain that is activated,” Khan continued, “the body will have different responses — such as stress responses when the hypothalamus is triggered.”
When stress responses kick off, this “leads to an influx of cortisol and adrenaline into our blood,” he said. “This release ends up causing an inflammatory response that our body experiences as pain.”
Furthermore, Khan shared, “anxiety can affect the body’s nerves directly and disrupt their functioning. This results in them being hyper-stimulated, thus exaggerating the sensation of pain.”
Last but not least, “the anticipation one has of potentially experiencing pain can cause one to feel anxious,” he revealed.
“The more anxious one feels, the more likely they are to experience worsening pain due to the previously mentioned factors. This can easily become a vicious cycle.”
The role of distraction
As this study — and others — have shown, distraction can be crucial in reducing children’s anxiety levels. There are a few key factors behind its efficacy.
“[Distraction] involves the active participation of a patient in a task requiring cognitive or behavioral functioning,” shared Dr. Karla Molinero, MS, Medical Director for Newport Healthcare in Utah.
“When the mind is focused on a distraction, it allows people to develop thoughts and feelings concerning that distraction — such as a toy’s color, shape, and feel,” she told Healthline.
As a result of the brain being focused on other things, Molinero said, it is less likely to register pain.
Biological aspects may also be at play.
Kearney noted that “distraction may help reduce activity in certain areas of the brain associated with pain processing.”
“[When distracted], the body is more relaxed and not releasing stress hormones that could increase sensitivity to pain,” added Molinero.
How anxiety differs between children and adults
While adults experience stress and anxiety around medical procedures, but children can often feel it more acutely.
“Children do not have abstract thinking and instead can have more irrational thoughts,” explained Molinero.
“They may imagine scenarios that their arm may fall off if a needle is placed in it, or they may turn into a zombie,” she continued. “Their magical thinking can allow for endless worrying thoughts and scenarios when they become fearful.”
Furthermore, Kearney revealed, “young children tend to focus more on the physical aspect of pain because of their less-developed cognitive coping mechanisms.”
“They are also less able to understand the rationale for why pain is being introduced to the body,” he noted. In contrast, “adults may understand that short-term pain will lead to long-term gain.”
Khan stated that another notable difference revolves around children’s reduced ability to recognize and express emotions.
“Children often find it more difficult to vocalize their feelings, whereas many adults can more easily verbalize that they are anxious,” he said. “Because their brains are better developed, many adults are also better at recognizing when they’re responding unreasonably to a stressor.”
How to calm an anxious child
VR is yet to be widely used in needle-based medical procedures as a distraction tool. So what can parents do in the meantime to help calm an anxious child?
According to Kearney, Khan, and Molinero, some of the best approaches include:
- Let them know they’re not alone
- Engage them in conversation
- Provide them with a stuffed toy for comfort
- Give them an interactive toy to play with
- Play videos on an iPad
- Listen to soothing music
- Practice slow breathing techniques together
- Gently explain what’s going on
- Praise them during and after the procedure
New research has found that VR may help in decreasing feelings of anxiety among children undergoing needle-based procedures.
And less anxiety can result in reduced pain.
“Anxiety can make people hypersensitive to pain, which makes them focus on the pain even more,” stated Molinero.
In addition to benefiting children, Wong notes that VR may also be a beneficial tool for parents — and this is an area he and his team are now exploring.
“We found that parents are also very anxious about the procedure, and their anxiety can have negative impacts on their children,” Wong revealed.
“Therefore, we are considering developing a VR intervention that can both engage and distract parents and children during invasive procedures.”
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