Effects of Tablet-Based Augmented Reality on Anxiety, Fear, and Pain During Venipuncture in Children: A Randomized Controlled Trial

Tablet-based augmented reality reduced children’s pain, fear, and anxiety during venipuncture compared with usual care.
*Three-arm randomized controlled trial; Level 2 (OCEBM).

Citation

Özdemir EZ, Özkaya İN, Çiftçi R, Bektaş M. Effects of tablet-based augmented reality on anxiety, fear, and pain during venipuncture in children: a randomized controlled trial. BMC Pediatrics. 2026. doi:10.1186/s12887-026-07214-6

Background

Needle procedures commonly cause distress in children, and drug-based pain control is often impractical for brief blood draws. Digital distraction may help, but evidence for tablet-based augmented reality during routine venipuncture remains limited.

Patients

120 children aged 5–12 years undergoing routine venipuncture at one university hospital blood draw unit. Exclusions included baseline or acute pain, chronic or genetic disease, sensory or visual impairment, inability to sit, analgesic need, and refusal.

Intervention

Tablet-based augmented reality during venipuncture: either fast, colorful, stimulating content or slower, calming content.

Control

Usual care without structured distraction or topical anesthetic cream.

Outcome

Anxiety: Children’s Anxiety Meter–State (0–10). Fear: Child Fear Scale (0–4). Pain: Wong–Baker Faces Pain Rating Scale (0–10). Children, parents, and nurses reported outcomes.

Follow-up Period

Immediately before and after venipuncture.

Results

Outcome	Result
Anxiety	Both augmented reality groups had greater reductions than usual care across reporters.
Fear	Both augmented reality groups had greater reductions than usual care across reporters.
Pain	Both augmented reality groups had lower post-procedure pain than usual care across reporters.
Safety	No augmented reality-related adverse events were observed.

Analyses were complete-case, not intention-to-treat: 5 randomized children were excluded after stopping the intervention. The control reflected local usual care but not optimized care with established distraction or topical anesthetic.

Limitations

Single-center trial with immediate follow-up only. Participants and families could not be fully blinded. Results may not apply to children with chronic illness, neurodevelopmental conditions, sensory impairments, concurrent pain, or to clinics already using topical anesthetic or structured distraction. Novelty effects with repeated use are unknown.

Funding

No external funding; authors reported no conflicts.

Clinical Application

Consider tablet-based augmented reality as an easy, low-risk distraction option for pediatric blood draws, especially where no structured distraction is currently used.