Needles frighten many children, and the distress can make blood tests, vaccinations and other procedures harder for everyone involved. A systematic review and meta-analysis in the Journal of Advanced Nursing looked at whether virtual reality (VR) can help.
The researchers searched eight databases for randomised controlled trials published up to 28 February 2022. They screened 2269 articles and pooled the results of 27 studies, which together included 2224 paediatric patients having needle-related procedures. In these trials VR was offered as a distraction while the procedure took place.
Compared with groups who did not use VR, the groups who did reported significantly less pain, anxiety and fear. A subgroup analysis also found that VR had advantages over conventional and other distraction methods.
The limits are straightforward. This research looks at distress during the procedure itself. It does not address whether a child's fear of needles is lower afterwards. The authors conclude that paediatric patients undergoing needle-related procedures would benefit from VR for managing pain, anxiety and fear.
For parents, that is encouraging news about a very common worry. If a child's fear of needles is getting in the way of healthcare, a conversation with your GP or a psychologist is a good place to start.
What the review set out to do
Fear of needles is common in childhood, and it affects how children cope with the procedures that medical care involves. Distraction is one of the long-standing ways of helping, and virtual reality (VR) is a newer form of it. This systematic review and meta-analysis, published in the Journal of Advanced Nursing, set out to evaluate how effective VR is in managing pain, anxiety and fear in paediatric patients undergoing needle-related procedures.
How it was done
The review was limited to randomised controlled trials. A librarian designed the search, which covered eight databases: the Cochrane Library, PubMed, Web of Science, EMBASE, CINAHL, CBM, CNKI and Wanfang. It looked for articles in English or Chinese up to 28 February 2022.
Two researchers screened the articles independently, working through 2269 in the first pass. Risk of bias in the included trials was assessed using the Cochrane Handbook for Systematic Reviews. Results were then combined using either a fixed-effects or a random-effects model, with the choice decided by a test of heterogeneity, which checks how much the trials differ from one another. The pooled figure reported is a mean difference between the VR group and the non-VR group.
A randomised controlled trial assigns people by chance to one approach or another, which makes the groups comparable at the start. A meta-analysis then pools the results of many such trials, so that a conclusion rests on thousands of participants and not on a single small study. Trials in a review rarely match exactly. The heterogeneity test is the review's way of checking how much they vary, and it is why the choice between a fixed-effects and a random-effects model was made after the data were examined and not before.
What it found
The meta-analysis included data from 27 studies representing 2224 participants. Compared with the non-VR group, the VR intervention group significantly reduced pain, anxiety and fear in paediatric patients who underwent puncture-related procedures. A subgroup analysis showed that VR has advantages over conventional and other distraction methods.
The authors concluded that paediatric patients undergoing needle-related procedures would benefit from VR interventions for pain, anxiety and fear management. They suggest that future clinical interventions could incorporate VR into puncture procedures as an effective method of reducing negative emotions in children who are eligible for VR distraction.
What it means, and what it does not
The finding is useful for the settings where children have blood tests, vaccinations and similar procedures, because it suggests VR can make the experience easier while it is happening. Distress at that moment matters. A child who gets through a procedure with less fear is less likely to dread the next one, although this review does not itself test that.
That point shows the limit of what the abstract reports. The outcomes concern pain, anxiety and fear around a procedure. The review does not report whether a child's underlying fear of needles was lower at a later date, and it is not a study of treating needle phobia. Treating a phobia is a different task from distracting someone through a procedure.
For families, the practical message is a sound one: how a needle procedure is handled can be improved, and VR is one of the options being studied. If fear of needles is causing a child to avoid healthcare, speak with your GP or a psychologist.