Virtual Reality Program May Reduce Anxiety Before Pediatric Surgery

Presurgery anxiety affects an estimated 50% to 75% of children undergoing surgery and can complicate anesthesia induction, increase postoperative pain, and prolong recovery. Sedation is often used to manage this anxiety, but it can carry risks in pediatric patients. As a nonpharmacological alternative, researchers have evaluated a virtual reality program designed to reduce anxiety before elective surgery.

Researchers at Virginia Commonwealth University (Richmond, VA, USA) developed a custom virtual reality experience for children ages 6 to 15 scheduled for elective surgery at a U.S. children’s hospital. The program used a Meta Quest headset to immerse participants in either an interactive children’s room or a calming beach scene. It was implemented over nine months as a quality improvement initiative and subsequently evaluated through retrospective analysis.

The study included 80 children who completed the virtual reality session before surgery. Distress, fear, heart rate, and blood pressure were measured before and immediately after each session. Children, parents, and nurses were also surveyed about their experience with the program, which received positive ratings from most participants.

Median self-reported distress decreased from 3.0 to 1.0 on a 0–10 scale, while median fear declined from 1.0 to 0.0 on a 0–4 scale. Both changes were statistically significant. Clinically meaningful improvements were observed for distress in 46 of 80 children, or 57.5%, and for fear in 44 of 80 children, or 55.0%.

Physiologic measures also declined following the virtual reality session. Heart rate decreased by an average of 5.8 beats per minute, while systolic blood pressure fell by 4.1 mmHg. The findings were published on November 5 in PLOS Digital Health. However, the authors noted that the absence of a control group means the observed changes cannot be attributed to virtual reality alone.

The researchers concluded that virtual reality was feasible and safe to implement in this real-world clinical setting. They also noted that reductions in anxiety may partly reflect natural changes over time, particularly among children with the highest anxiety levels at baseline. Controlled studies were identified as the next step for determining the independent effect of the intervention.

“Sometimes, the best support we can offer a child before surgery isn't a medicine at all. For me, one of the most meaningful parts of this study was seeing how positively children and families engaged with the VR experience. As a pharmacist, I value exploring safe, nondrug approaches that may help support children through the anxiety and uncertainty surrounding surgery,” said Walaa S. Abu Rukbah, first author.

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