Stanford Medicine Children's Health establishes one of the nation’s largest VR programs tailored for pediatric care, helping to ease pain and anxiety in more kids and in more places

By Stacy Rollo

Tyler Millikan of Visalia, California, was admitted to Lucile Packard Children's Hospital Stanford in June 2018 after suffering a severe leg injury in a roll-over motor vehicle accident. At Packard Children’s, he underwent eight surgeries, two blood transfusions and several IV placements. Throughout his hospital experience, there was one thing that stuck out for Tyler and his family. There was a distinct "before" and "after" when it came to Tyler’s ability to manage his stress and anxiety in the hospital, and it all had to do with a set of VR goggles.

Virtual reality (VR) has become a promising option for helping calm and distract patients during medical procedures. In fact, a growing body of research suggests that VR actually helps reduce fear, anxiety and pain. Stanford Medicine Children's Health is among the very first to begin researching the impact of VR on anxiety levels, specifically in hospitalized pediatric patients.

Tyler gave the VR treatment a thumbs up. According to his parents, getting the various IVs in Tyler’s arm was a stressful and difficult time for the whole family. Tyler’s care team introduced a VR headset for one of the more challenging IVs that had to be inserted deep into Tyler's arm. Tyler’s stepfather, Brad Ralls, commented that a more minor procedure that Tyler had undergone previously without the VR headset was “much more” traumatic than the challenging IV insertion with the VR headset. With VR, Tyler “barely knew what was happening,” Ralls reported.

National leader in scaling VR use in the hospital

As one of the first institutions to pilot VR capabilities in pediatric clinical settings, Lucile Packard Children's Hospital Stanford and its growing network of outpatient locations has expanded its VR program to help young patients in more places beyond the hospital. With over 150 use cases per month, Stanford Medicine Children's Health is home to one of the nation's largest VR programs—one that actually tailors the experience for pediatric patients who are undergoing both routine and complex procedures.

That means children who are going to their allergy, orthopedic, or gastrointestinal specialist or who are a patient in one of the network’s regional surgical clinics can use VR to lessen their fear, stress and pain. The technology is also being used to help women in labor during their epidural placement.

VR doesn’t just benefit children in the hospital. It can also improve how doctors, nurses and clinicians care for their patients.

"As a pediatric head and neck surgeon, I frequently take care of children with airway disorders. I also perform airway endoscopy in my clinic on a daily basis, which can be downright scary for young patients," said Douglas R. Sidell, MD, assistant professor of otolaryngology. “Virtual reality has had a dramatic and positive impact because patients are able to focus on the VR application instead of the procedure. This means less patient motion during the exam, which allows me to perform a more thorough and uninhibited laryngoscopy or swallow study.”

Stanford innovation used in first-of-its-kind VR unit for national launch

The Starlight Foundation, which focuses on bringing technology and entertainment to hospitalized children, has tapped Stanford experts for insight into implementing virtual and augmented reality tools and immersive technologies tailored for children. Sam Rodriguez, MD, pediatric anesthesiologist and co-founder of the Stanford Chariot program, advised Starlight Foundation’s design of a first-of-its-kind VR unit called the Starlight Xperience. The unit was piloted at Lucile Packard Children's Hospital Stanford, one of a few sites around the country to receive the technology. The Starlight Xperience will be distributed free of charge to children’s hospitals throughout the country. The Starlight Foundation supported Chariot through grants in 2017 and 2018, which allowed the program to develop custom software applications and expand the reach of the Chariot program to the entire hospital and to some outpatient clinics.

More than a game

Using technology as distraction therapy is not a new concept. But what separates Stanford's VR programming is that it includes special considerations for the medical environment. Stanford University's science, technology, medical, research and clinical teams have tapped neighboring Silicon Valley experts to adapt existing VR technologies and create new experiences that address the unique needs of young hospital patients.

Currently, an ongoing study that aims to examine the correlation between anxiety and pain is being conducted on hundreds of patients who are between the ages of 6 and 18 years old. In Stanford’s tailored VR experience, the clinician can adjust the orientation of the game in real time, including changing the so-called “cognitive load” of the content to adapt the experience to a particular phase of a procedure. This customized approach allows providers to maximize distraction efforts before and during minor medical procedures such as IV placement, wound care, and cast or surgical pin removal. This tailored experience includes using faster music, more colors or increased game play. The VR experience was also reoriented so that the child could play while lying in bed or in other positions unique to a clinical setting.

“We’ve published case studies showing that new, customized VR experiences decrease patients’ anxiety and their perception of pain,” said study co-author Thomas Caruso, MD, clinical associate professor of anesthesiology, perioperative and pain medicine at Stanford Medicine Children's Health. “The randomized trial is ongoing, and we are currently expanding use of the technology into new clinical settings, including with laboring mothers for epidural placements.”

Caruso and Rodriguez note that while further studies are needed to quantify the anxiety-reducing and pain-reducing effects of VR technology, their case series demonstrates the feasibility of using this VR experience in a wide variety of clinical settings as a non-pharmacological treatment that can safely distract patients while limiting their movement.

Smiling through an IV poke

There’s no easy cure-all for managing pain or anxiety, but immersive and mobile technologies hold great promise. Molly Pearson, a Child Life therapist, says VR has been a tremendous help in easing patients’ anxiety and pain in the hospital's surgical and imaging centers as well as in the emergency department. "We use the VR googles before placing in an IV, and it's amazing how quickly even the most anxious kids are transported temporarily. They escape their surroundings to the point they don't even realize we've completed the procedure," she said. Another exciting benefit is that VR is being used in the hospital as a replacement for pain medication in some cases. "I had a 10-year-old patient use VR with only a local anesthetic so the patient could be awake during a treatment that usually requires full general anesthesia," she said. "Instead, the patient was able to walk out the door the same day."

What is most exciting to the teams across Stanford Medicine Children's Health is the idea of transforming a very stressful experience into something that's actually fun while improving the quality and safety of treatments. There are practitioners across the organization who are seeing great results.

"Kids who were crying or trying to run away from a shot ask if they can have one in hopes that they’ll get to use the VR device," said Rebecca L. Seekamp, MD, a primary care physician at Stanford Family Medicine in Palo Alto. "We can't make shots painless, but we can change the experience to minimize fear and pain. That is powerful!"