Children who used a virtual reality (VR) headset before surgery showed reduced self-reported distress and fear, along with lower heart rate and blood pressure, according to a new study published November 5th in the open access journal PLOS Digital Health by Dayanjan Wijesinghe of Virginia Commonwealth University, US, and colleagues.
Pre-surgery anxiety affects an estimated 50-75% of children undergoing surgery and is linked to difficult anesthesia induction, postoperative pain, and prolonged recovery. Pharmacological sedation is commonly used to help manage this anxiety but carries risks. Non-pharmacological alternatives such as therapeutic play, music therapy, and VR have shown promise but have limited real-world implementation data.
In the new study, researchers created a custom VR experience, which used a Meta Quest headset and immersed users in either an interactive children's room or a calming beach scene. The experience was then provided, over the course of nine months, to 80 children aged 6-15 scheduled for elective surgery at a US children's hospital. Self-reported distress and fear, heart rate, and blood pressure were recorded before and immediately after each session, and children, parents, and nurses were surveyed about their experience.
Median self-reported distress fell from 3.0 to 1.0 on a 0-10 scale, and fear from 1.0 to 0.0 on a 0-4 scale (both p<0.001), with 46 of 80 children (57.5%) and 44 of 80 (55.0%) meeting a threshold for clinically meaningful improvement in each measure. Heart rate fell by an average of 5.8 beats per minute and systolic blood pressure by 4.1 mmHg (both p<0.001). Most children, parents, and nurses rated the experience positively.
The authors note that with no control group, the changes in distress and fear cannot be attributed to VR alone and may partly reflect natural changes over time, particularly among children with the highest initial anxiety. However, they conclude that VR was feasible and safe to implement in this real-world setting and was accompanied by clinically meaningful reductions in anxiety.
"With continued research and thoughtful implementation, VR is a promising candidate for inclusion in compassionate, family-centered pediatric care, pending confirmatory controlled research— helping more children approach medical procedures with confidence and calm," the authors say.
Walaa S. Abu Rukbah, first author, says, "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, non-drug approaches that may help support children through the anxiety and uncertainty surrounding surgery."
Dayanjan S. Wijesinghe adds, "In a busy children's surgical unit, a short virtual reality session proved easy for nurses to run, was safe, and was very popular: nine in ten children wanted to use it again, and nearly every parent would recommend it. Children's self-reported distress and fear were lower after the session than before it. Because this was a quality-improvement project without a comparison group, we cannot yet say how much of that improvement comes from virtual reality itself, and a controlled trial is the essential next step."
"We treated this as an improvement project rather than a one-off experiment. Over nine months we kept refining the program based on what children, parents and nurses told us. What struck me most was how readily the nursing staff took it on: every one of the 29 nurses involved said they would recommend it for other children."
"The children who were most anxious before the session showed the largest drops afterwards. That is encouraging, but some of it probably reflects a statistical effect called regression to the mean, and only a controlled trial can separate the two."
In your coverage, please use this URL to provide access to the freely available paper in PLOS Digital Health: https://plos.io/4hqblri
Citation: Abu Rukbah WS, Vadlamudi N, Garrett S, Alshammari S, Wijesinghe DS (2026) Virtual reality as a non-pharmacological intervention for pediatric preoperative anxiety: A quality improvement initiative and retrospective analysis. PLOS Digit Health 5(11): e0001219. https://doi.org/10.1371/journal.pdig.0001219
Author countries: Saudi Arabia, United States
Funding: The author(s) received no specific funding for this work.
