Abstract
Introduction. Anxiety and pain are common in pediatric patients undergoing healthcare procedures, with potential short- and long-term consequences. Virtual reality (VR), including immersive and non-immersive modalities, is increasingly used as a non-pharmacological intervention; however, the available evidence is heterogeneous and fragmented.
Objective. This scoping review aims to systematically map the characteristics, contexts, and reported outcomes of VR interventions for the management of anxiety and pain in pediatric healthcare settings.
Inclusion criteria. This review will consider studies involving pediatric populations (0–18 years) exposed to VR interventions (immersive, semi-immersive, or non-immersive) for anxiety and/or pain management in healthcare contexts.
Methods. This protocol follows the PRISMA-ScR guidelines and the Arksey and O’Malley framework, refined by Levac et al. A comprehensive search will be conducted in MEDLINE (PubMed), Scopus, and Web of Science, along with grey literature sources. Two independent reviewers will perform study selection and data charting using a standardized extraction form. Extracted data will include study characteristics, population details, VR type and devices, clinical settings, intervention features, and outcomes.
Data synthesis. Results will be synthesized descriptively using tables and figures to map the evidence. A narrative synthesis will be conducted to summarize key findings, identify patterns across VR modalities, populations, and settings, and highlight knowledge gaps. Where appropriate, findings will be stratified by age group, type of VR intervention, and clinical context.
References
Addab, S., Hamdy, R., Thorstad, K., Le May, S., & Tsimicalis, A. (2022). Use of virtual reality in managing paediatric procedural pain and anxiety: An integrative literature review. Journal of Clinical Nursing, 31(21–22), 3032–3059. https://doi.org/10.1111/jocn.16217
Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. https://doi.org/10.1080/1364557032000119616
Bai, F., Xue, Y., Zhang, Q., Cheng, H., & Guo, J. (2025). Efficiency of immersive virtual reality game technology on pain management in children with limb fractures: A randomized controlled trial. Journal of Pediatric Nursing, 81, 68–73. https://doi.org/10.1016/j.pedn.2025.01.007
Camacho-Cruz, J., Palacios-Ariza, M. A., Orrego-Celestino, L., Valbuena-Velandia, N., Paez-Castellanos, L., Bolaños, J. M., & Pradilla, I. (2023). Effectiveness of non-immersive virtual reality in the management of procedure-related pain in preschool children: A randomized clinical trial. European Journal of Pediatrics, 182(9), 4103–4112. https://doi.org/10.1007/s00431-023-05070-5
Critical Appraisal Skills Programme., 2026. CASP Checklist: CASP Systematic Review Checklist [online] Available at: https://casp-uk.net/casp-tools-checklists/systematic-review-checklist/ Accessed: 02-January-2026.
Faina, F., Giusti, G. D. (2025). Use of Virtual Reality for anxiety and pain management in pediatric patients: a scoping review protocol. https://doi.org/10.17605/OSF.IO/AQN58
Ferraz-Torres, M., San Martín-Rodríguez, L., García-Vivar, C., Soto-Ruiz, N., & Escalada-Hernández, P. (2022). “Passive or interactive virtual reality? The effectiveness for pain and anxiety reduction in pediatric patients”. Virtual Reality, 26(4), 1307–1316. https://doi.org/10.1007/s10055-022-00633-7
Gerards, M., Miller, J., Doshi, D., Hoyer, A., Flöttmann, N., & Barthlen, W. (2025). Virtual reality for distraction during painful procedures in pediatric surgery: A randomized clinical trial. Journal of Pediatric Nursing, 82, 116–122. https://doi.org/10.1016/j.pedn.2025.03.001
Gerçeker, G. Ö., Salmal, N., & Bektaş, İ. (2025). The effect of active and passive virtual reality distractions on phlebotomy-related emotional behavior, pain, anxiety, and fear in children: A randomized controlled trial. Journal of Pediatric Nursing, 83, 190–198. https://doi.org/10.1016/j.pedn.2025.05.005
Hoag, J. A., Karst, J., Bingen, K., Palou-Torres, A., & Yan, K. (2022). Distracting Through Procedural Pain and Distress Using Virtual Reality and Guided Imagery in Pediatric, Adolescent, and Young Adult Patients: Randomized Controlled Trial. Journal of Medical Internet Research, 24(4), e30260. https://doi.org/10.2196/30260
Huang, Z.-E., Qiu, X., Fu, Y.-Q., Zhang, A., Huang, H., Liu, J., Yan, J., & Yi, Q.-F. (2024). Clinical internship environment and caring behaviours among nursing students: A moderated mediation model. Nursing Ethics, 31(8), 1481–1498. https://doi.org/10.1177/09697330231225393
Kilic, U., Büyük Tural, E., Oruc, M. A., & Aydın Avci, I. (2024). The effect of VR headsets used during burn dressing in children on satisfaction and anxiety level of their parents. Journal of Pediatric Nursing, 75, e152–e158. https://doi.org/10.1016/j.pedn.2024.01.006
Levac, D., Colquhoun, H., & O’Brien, K. K. (2010). Scoping studies: Advancing the methodology. Implementation Science, 5(1), 69. https://doi.org/10.1186/1748-5908-5-69
Mascheretti, S., Forni, D., Lampis, V., Fumagalli, L., Paquin, S., Andlauer, T. F. M., Wang, W., Dionne, G., Brendgen, M. R., Vitaro, F., Ouellet-Morin, I., Rouleau, G., Gouin, J.-P., Côté, S., Tremblay, R. E., Turecki, G., Garon-Carrier, G., Boivin, M., & Battaglia, M. (2023). Adolescent anxiety and pain problems: A joint, genome-wide investigation and pathway-based analysis. PLOS ONE, 18(5), e0285263. https://doi.org/10.1371/journal.pone.0285263
Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P., Stewart, L. A., & PRISMA-P Group. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews, 4(1), 1. https://doi.org/10.1186/2046-4053-4-1
Ouzzani, M., Hammady, H., Fedorowicz, Z., & Elmagarmid, A. (2016). Rayyan—A web and mobile app for systematic reviews. Systematic Reviews, 5(1), 210. https://doi.org/10.1186/s13643-016-0384-4
Pérez-Pozuelo, J. M., Hernández-Iglesias, S., Pereira-Afonso, M. R., Checa-Peñalver, A., García-Valdivieso, I., López-González, Á., & Gómez-Cantarino, S. (2025). Effectiveness of non-pharmacological methods in reducing pain in pediatric patients and the role of nursing. Systematic review. Frontiers in Pediatrics, 13, 1729847. https://doi.org/10.3389/fped.2025.1729847
Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Scoping Reviews (2020). Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z, editors. JBI Manual for Evidence Synthesis. J Reitze, A., Voigt, M., Klawonn, F., Dusch, M., Grigull, L., & Mücke, U. (2024). Impact of virtual reality on peri-interventional pain, anxiety and distress in a pediatric oncology outpatient clinic: A randomized controlled trial. BMC Pediatrics, 24(1), 501. https://doi.org/10.1186/s12887-024-04952-3
Ryu, J.-H., Han, S.-H., Hwang, S. M., Lee, J., Do, S.-H., Kim, J.-H., & Park, J.-W. (2022). Effects of Virtual Reality Education on Procedural Pain and Anxiety During Venipuncture in Children: A Randomized Clinical Trial. Frontiers in Medicine, 9, 849541. https://doi.org/10.3389/fmed.2022.849541
Tas, F. Q., van Eijk, C. A. M., Staals, L. M., Legerstee, J. S., & Dierckx, B. (2022). Virtual reality in pediatrics, effects on pain and anxiety: A systematic review and meta-analysis update. Paediatric Anaesthesia, 32(12), 1292–1304. https://doi.org/10.1111/pan.14546
Yusefi, A. R., Sarvestani, S. R., Kavosi, Z., Bahmaei, J., Mehrizi, M. M., & Mehralian, G. (2022). Patients’ perceptions of the quality of nursing services. BMC Nursing, 21(1), 131. https://doi.org/10.1186/s12912-022-00906-1

This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2026 Fabrizio Faina, Gian Domenico Giusti

