As the line for flu shots at the Menlo Park City School District (MPCSD) vaccine clinic grew, it became a potential breeding ground for kids’ worries and tears. But when children peeked into the wide open space of the Hillview Middle School Performing Arts Center, their attention shifted from the needles to their schoolmates playing video games and wearing VR headsets.

A volunteer from the Stanford Chariot Program slipped a VR headset on Nicole, a third-grader with nut allergies and anxiety from being scratched by an EpiPen as a toddler. At past vaccine clinics, her parents had to hold her down for shots. “It’s brutal for parents, especially when you have kids with needle fears,” said her mother, Michelle Fong. 

Nicole’s parents watched in amazement as she settled into the chair next to the pharmacist all on her own. The VR game whisked her from the buzzing auditorium and into outer space, where she blasted cheeseburgers with a tilt of her head. Meanwhile, the clinician prepared her arm and administered the vaccine. 

“I am so proud of myself,” Nicole said later. “I didn’t cry and I didn’t even feel the shot!” 

Transforming the vaccine experience for kids 

Space Burgers is one of dozens of apps developed by clinicians and researchers at the Stanford Chariot Program, which uses immersive technology to reduce children’s anxiety and pain during medical procedures, from anesthesia to blood draws. In one VR game, kids slide a penguin down an icy mountain and jump for gems with a nod of their heads. In another app, patients squeeze a rubber chicken when chickens pop their heads onto a tablet screen. The games launch quickly, keep kids’ bodies relatively still, and run on a continuous loop. 

“The applications that we've created are really fun and engaging and make the pain feel like almost nothing at all,” said Thomas Caruso, a pediatric anesthesiologist at Stanford Medicine Children’s Health and co-director of the Stanford Chariot Program. “We’re building these positive experiences to prevent vaccine hesitation, so that their next trip to the clinic is a happier one.” 

During the four-hour clinic hosted by MPCSD, Safeway clinicians administered 561 vaccines to more than 200 people. Pharmacist Sara Sharkas, who has experience delivering injections at other clinics, was initially skeptical when she saw the rubber chicken attached to Chariot’s Buddy Base – a portable suite of devices including a tablet and VR headset loaded with novel apps specifically designed for children undergoing needle pokes for vaccinations, blood draws, and other minor procedures.

“Typically, I see a lot of screaming, yelling, and fidgeting,” Sharkas said. “I thought that kids who have a strong fear of needles have a fear of needles no matter what. But I was really surprised to see that they’re genuinely distracted and the games helped calm them down.”

The Chariot research team also offered patients at the clinic the group’s latest invention – a vibrating device called Buddy Guard that straps onto the patient's arm and pairs with a video game called Whack-A-Chicken. The device buzzes each time the patient taps on a chicken when it pops up on the screen. As the nurse approaches with a needle, more chickens frantically appear on the screen, and the patient feels more buzzing. The vibrations help lessen the pain patients feel with needle injections. The device is being featured in two clinical studies at Packard Children’s Hospital. The goal is to expand the library of distraction video games that the Buddy Guard is compatible with and make it available at more clinics. 

The Oct. 5 clinic marked the Chariot team’s third time volunteering their time and technology at an MPCSD vaccine clinic. “The Chariot Program has been amazing and a true gift for our students,” said MPCSD nurse Lianne Jemelian. She sees kids who play the apps cry less, don’t run away, and complete their appointments more quickly.

“My kids were a little bit nervous before we came,” said Heather Freeland, a mother of two. “But then my daughter was offered the VR headset and she held my hand and played the penguin game. She didn't even flinch. She was totally distracted.” 

Jemelian said she plans to organize future clinics, believing they send a message to parents in the district that student health and safety remains a priority for the district, and because it benefits the entire community. “I have heard so many positive comments from parents, and have seen so many parents mouth the words ‘Thank you!’ as they were leaving the clinic, having had a less traumatic visit than anticipated,” she said. “This alone will surely bring families back for the clinic next year.” 

Easing anxiety for others 

At the Stanford Medicine Children’s Health Lucile Packard Children’s Hospital, the Chariot team brings VR headsets, robotic dogs, and other tech tools to patients in need of distraction, physical therapy, and education. Their research has found that VR and other immersive technologies are effective therapeutic tools for children, including those suffering from chronic pain, undergoing procedures ranging from anesthesia to cast removals.

Thus far, the Chariot Program has distributed Buddy Bases to seven Stanford Children’s Health clinics throughout the Bay Area. However, Caruso’s long-term vision extends even further. In a unique agreement with the Stanford Office of Technology Licensing (OTL), he and his fellow co-directors of the Stanford Chariot Program launched the non-profit Invincikids to license Chariot software and make it freely available to all pediatric patients. Today, Invincikids offers immersive experiences designed by Chariot to pediatric patients at over 40 prominent children’s hospitals and universities across more than 10 countries. 

“The Stanford Chariot Program is a community program,” Caruso said. “We are funded entirely through this community and because of the generosity of this community, we're at the vaccine clinic today to help these children.”