Immersive virtual reality during pediatric vaccination: a quasi-experimental study of pain, fear, and care experience.

BACKGROUND: Vaccination is a common source of childhood pain and fear and may negatively affect future immunization experiences. Although virtual reality (VR) has shown promise in pediatric needle-related procedures, evidence from routine vaccination in primary care remains limited. OBJECTIVES: To assess preliminary between-group differences in children's self-reported pain and fear during pediatric vaccination, comparing immersive VR with usual care, and to describe acceptability and safety indicators. METHODS: This quasi-experimental, non-randomized controlled study included 100 child-caregiver dyads from three Portuguese primary care centers: 50 in the VR group and 50 in the usual-care group. The main clinical outcomes, pain and fear, were assessed before and after vaccination using age-appropriate measures. Post-vaccination outcomes were analyzed using baseline-adjusted analyses of covariance. In the VR group, children, caregivers, and nurses rated ease of use and willingness to recommend; nurses recorded VR-related adverse effects. RESULTS: Adjusted post-vaccination pain was lower in the VR group than in the usual-care group (mean difference = -1.94, 95% CI [-2.99, -0.88], p < 0.001), as was fear (mean difference = -0.78, 95% CI [-1.29, -0.27], p = 0.003). Ease-of-use and recommendation ratings were favorable. VR-related adverse effects occurred in 6% of children, were mild and transient, and required no intervention. CONCLUSION: Immersive VR was associated with lower post-vaccination pain and fear during routine pediatric vaccination in primary care. Favorable VR experience and safety indicators support further evaluation of VR as a complementary nonpharmacological strategy aligned with atraumatic, child- and family-centered nursing care.