How Young is Too Young for Virtual Reality? Determining Usability and Acceptability in Ages 2-6 in the Emergency Department

• Time of demonstration required by child measured in seconds[ Time Frame: Recorded during Stage 1 of intervention, before child puts headset on. Up to 120 seconds. ]
  Length of Time (seconds) the demonstration took until the child was ready to wear the VR headset
• Mood/Behaviors during Handling of VR rated 1-100 on a Visual analogue scale[ Time Frame: Recorded during Stage 3 of intervention. Up to 1 minute while child handles and puts on headset. ]
  Rated 1-100 on a Visual analogue scale from extremely negative to extremely positive by the research assistant.
• Time using VR in minutes[ Time Frame: Recorded during Stage 5 of the procedure. Up to 10 minutes. ]
  Length of Time (Minutes) the child was using the VR set on their head (up to 10 minutes)
• Willingness to Return VR as measured by a three point scale[ Time Frame: Recorded during Stage 6 of the procedure ]
  The research assistant will record willingness to return VR as measured by a three point scale: - Give away the headset after requested to do so once - Give away the headset after requested to do so several times - Want to continue playing and does not give the set away
• Patient experience questions as measured by a 4 point scale and open ended question[ Time Frame: Immediately after the intervention (within 10 minutes) ]
  The research assistant will ask the patient four questions on a four point scale: How easy or hard it was to wear the VR goggles [1-very hard …………. 4-very easy] How easy or hard it was to see the video [1-very hard …………. 4-very easy] Do they want their parents to also try the VR goggles [1-not at all …………. 4-yes, immediately] Would they like to play again with the VR goggles [1-not at all …………. 4-yes, immediately] One open ended question will be asked about any problems with VR.
• Parent experience questions as measured by a 4 point scale and open ended question[ Time Frame: Immediately after the intervention (within 10 minutes) ]
  The research assistant will ask the patient two questions on a four point scale: How easy or hard it was for your child to wear the VR goggles [1-very hard …………. 4-very easy] Do they want their child to try the VR goggles next time they need a procedure in the hospital [1-not at all …………. 4-yes, immediately] One open ended question will be asked about any problems with VR.

Children who present to the emergency department often require painful procedures (intravenous catheterization, laceration repair, fracture reduction, etc.). Virtual reality (VR) has been presented as a way of managing pain and anxiety in children undergoing painful procedures but most studies are limited to children 6 or older. The present study seeks to determine the youngest age (2-6) of future subjects in research of VR and clinical care. Virtual Reality is an immersive experience using sight, sound, and position sense. Using VR may enhance distraction during the painful procedure and may reduce attention to pain. Investigators will instruct and observe children age 2-6 in using a VR device and document how easy the device is to use for the child. The children will have the opportunity to select an application and play with the device for 10 minutes before being asked about their experience with the device. Parents/Guardians will also be asked about their child's experience with the device.

• Device: Virtual Reality
  Stage 1 : Demonstration of the use of the VR headset by the research assistant (anticipated 1-2 min) Stage 2 : Child will choose the application they would like to see - they will be shown 3 pages of the three applications offered - see Fig 1 (anticipated 1-2 min) Stage 3 : Handling of the VR headset by the child (anticipated 1 min) Stage 4 : Applying the headset on the eyes of the child with software application (anticipated 1 min) Stage 5 : The child use the VR set and application (up to 10 minutes) Stage 6 : Removal of the headset (anticipated 1 min) Stage 7 : Questionnaire to child (interview - 2 minutes) Stage 8 : Questionnaire to parents/guardians (interview - 2 minutes)

• : Children Aged 2-6
  Children 2 to 6 years of age who are arriving with a guardian to the Emergency Department with a low acuity condition (Canadian Triage scale (CTAS) 4 or 5) and are waiting to be seen by the doctor, or are waiting for test results.