Removing a cast, changing a dressing, or taking out a percutaneous wire are brief procedures, but for some children, they become a significant source of anxiety. Children who arrive already scared tend to stiffen, cooperate less, and perceive any painful stimulus more intensely.
Virtual reality is used precisely as a distraction technique: during the procedure, the child wears a headset and focuses their attention on an immersive environment or a game.
What the Meta-Analysis Shows
A systematic review with meta-analysis published in the Journal of Children’s Orthopaedics included four randomized trials, totaling 624 children with an average age of around 10 years. [1]
The most consistent effect concerned anxiety, with an SMD of −0.55 and no heterogeneity among the included studies. For pain, the reduction was more modest, SMD −0.43, and the results were less uniform. Heart rate also decreased slightly. [1]
Where It Can Be Useful
The headset may be particularly useful for children with strong anticipatory anxiety, especially if they have had a negative experience with a previous procedure. Reducing agitation can make cooperation easier during cast removal, dressing changes, or other outpatient maneuvers.
VR remains a distraction technique. It does not replace analgesia, local anesthesia when indicated, good communication, or a correctly performed procedure.
Practical Limitations
Not all children tolerate the headset. Some dislike the visual isolation, others may experience nausea, or simply prefer a different distraction. Age and temperament matter.
The available evidence is also still limited: four RCTs do not allow for precise definition of which procedures and age groups benefit most. Blinding is also impossible in this type of study, so an effect related to expectations cannot be ruled out. [1]
For now, virtual reality primarily appears to be an additional tool to make some outpatient procedures less stressful. The signal regarding anxiety is more convincing than that for pain.
Disclaimer
This content is for informational purposes only and does not replace an individual clinical evaluation.
References
[1] Alharran AM, AlAyyaf AE, Addar A, Hamdy R, Marwan Y. Virtual reality as a distraction technique in pediatric patients undergoing orthopedic procedures: A systematic review and meta-analysis of randomized controlled trials. Journal of Children’s Orthopaedics. 2026. DOI: 10.1177/18632521251414463. PMID: 41769155.
PubMed: https://pubmed.ncbi.nlm.nih.gov/41769155/
Full text (PMC): https://pmc.ncbi.nlm.nih.gov/articles/PMC12935579/
