Anxiety is often high among children undergoing needle-based procedures. In this Healthline article, Mindpath Health’s Zishan Khan, MD, discusses how VR headsets may act as a distraction, lowering anxiety and pain.
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,” says Cho Lee Wong, Associate Professor in The Nethersole School of Nursing at The Chinese University of Hong Kong and co-author of the study.
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’.
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.
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.
“Pain and anxiety share key response sets that include physiological, cognitive, and behavioral components,” says Dr. Christopher A. Kearney, Distinguished Professor and Chair of Psychology at the University of Nevada, Las Vegas. “Shared physiological components can include hyperventilation, heart racing, and jitteriness.”
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,” says Dr. Zishan Khan, a psychiatrist with Mindpath Health.
“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.”
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.
“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,” says Dr. Karla Molinero, MS, Medical Director for Newport Healthcare.
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.”
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.
Furthermore, Kearney revealed, “young children tend to focus more on the physical aspect of pain because of their less-developed cognitive coping mechanisms.”
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