Virtual Reality vs. Standard-of-Care for Comfort During Immunizations in Children

• Anxiety using the Venham Situational Anxiety Score[ Time Frame: Anxiety is reported by children immediately following completion of the immunization (within two minutes post-immunization). This scale should take less than one minute to complete. ]
  Level of Situational Anxiety as reported by children using the Venham Situational Anxiety Score. This scale includes 8 sets of 2 images of children which represent differing levels of anxiety. Children point to the child that best represents them in that instance. In each set of 2 images of children, one represents greater anxiety (scored as 1) and one represents lesser anxiety (scored as 0). The points from each set of images are totaled. The minimum score is 0 (least anxious) and maximum score is 8 (most anxious).
• Patient Satisfaction determined by Global Rating Scale[ Time Frame: Satisfaction question is reported by children immediately following completion of the immunization (within 5 minutes post immunization) ]
  Satisfaction from the procedure is determined by asking 4 questions on a global rating scale. This scale goes from 0-10 where 0 represents "not very much" and 10 represents "very much." Questions are developed from previous virtual reality research. "Overall, how satisfied are you with pain management during plastic surgery?" "Overall, how satisfied are you with anxiety management during plastic surgery?" "To what extent did you feel like you went into the virtual world?" "How much fun did you have while playing in the virtual world?" These questions will be analyzed individually not summed.
• Medication Dose[ Time Frame: These will be recorded during the procedure and immediately following the procedure using the patient chart ]
  How much topical or local anesthetics are used and when they are used (24 hour time); how much sedatives are used and when they are used (24 hour time); how much analgesics are used and when they are used (24 hour time).
• Length of time of procedure[ Time Frame: This will be documented during the procedure ]
  Time in minutes from readiness for procedure (availability of child, staff and equipment) until completion of procedure (healthcare practitioner does not need to touch the patient anymore)

Children need routine immunizations which can be a painful procedure associated with pain and anxiety. This is particularly true of children visiting the children's hospital to visit relatives during flu season. No topical anesthetic or oral analgesia is commonly used. Virtual Reality (VR) 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. This study will randomize children (6 - 16 years old) to receive Virtual Reality or standard of care while receiving immunizations. Investigators will measure pain, anxiety and satisfaction.

• Device: Virtual Reality
  Participants wear a Virtual Reality headset that consists of a ASUS phone and a VOX+ Z3 3D Virtual Reality Headset. The phone runs the VR Roller Coaster app to produce the virtual environment.

• Experimental: Virtual Reality
  Participants are distracted by wearing the virtual reality headset and watching a roller coaster app during immunization.
• No Intervention: Control (Standard-of-Care)
  Participants are distracted with Standard-of-Care by doctors, nurses, nurse practitioners, child life specialists and/or parents.