Hospitalization or emergency department visits can be profoundly distressing experiences for children, often involving not only physical discomfort but also significant psychological stress (Claridge et al., 2023). Separation from family members, exposure to unfamiliar surroundings, and undergoing painful or invasive medical procedures frequently lead to intense emotional reactions, including fear, anxiety, helplessness, and loneliness (Claridge et al., 2023; Correale et al., 2022). These negative emotions may interfere with a child's sense of security and disrupt their connection to their social environment, ultimately compromising treatment adherence and overall well-being (Or et al., 2025). Among the most frequently observed psychological and behavioral responses in hospitalized children are heightened anxiety, excessive crying, irritability, anger, and even aggression—each of which can adversely affect both immediate and long-term health outcomes (Goldsworthy et al., 2023; Günay, 2017; Yaldız & Şener, 2024). In response to these challenges, nonpharmacological interventions have gained growing recognition as essential components of holistic pediatric care (Pérez-Pozuelo et al., 2025). Evidence-based strategies such as distraction techniques, therapeutic play, and guided imagery are now widely implemented to mitigate procedural anxiety and enhance children's coping abilities during medical encounters (Moran & Wilson, 2024).

In recent years, immersive technologies like virtual reality (VR) and augmented reality (AR) have created new opportunities for distraction-based approaches in pediatric healthcare. These technologies help engage children's senses and support emotional control during medical procedures (Coşkun & Çiğdem, 2025; Ferraz-Torres et al., 2023; Hess et al., 2025). Immersive technology generally refers to digital systems that make users feel more involved by providing strong sensory experiences. While some researchers focus on how much or how high-quality the sensory input is (Slater, 2009), others highlight the way these technologies make the line between the real and virtual world less clear, creating a feeling of immersion (Lee et al., 2012). VR creates a completely virtual environment, while AR adds digital elements—like images, videos, or sounds—on top of the real world in real time (Tang et al., 2020). This allows users to stay aware of their surroundings while interacting with digital content. VR has been widely used around the world to reduce children's stress during medical procedures such as blood draws and port access (Gerçeker et al., 2021; Hundert et al., 2021; Menekli et al., 2022; Semerci et al., 2021). More recently, AR has become a promising alternative because it is easier to use in busy hospital settings and helps children stay engaged while still seeing what is around them (Arjomandi Rad et al., 2022; Mott et al., 2008; O'Connor et al., 2023a). AR has also been shown to capture children's attention, improve their experience in the hospital, and help them take part in their care. For example, Mott et al. (2008) found that AR reduced pain during burn dressing changes, especially when the procedures were longer. Similarly, Chamberland et al. (2024) reported that AR helped lower children's anxiety before surgery and was well accepted by patients. These findings suggest that AR can be a useful non-drug method to reduce distress during medical procedures.

Distraction techniques work by diverting the child's attention away from painful procedures and redirecting it toward an engaging task, thereby alleviating pain, anxiety, and fear (DeMore & Cohen, 2005). Given the growing interest of children in smartphones, tablets, and computer-based games, technology-driven interventions have increasingly gained prominence in pediatric healthcare settings (Kerimoglu Yildiz et al., 2022). In particular, the customizable, gamified, and remotely accessible features of AR position it as a sustainable and scalable tool, especially for children with limited access to conventional psychosocial support services (Dey et al., 2023). This systematic review aims to investigate the psychological and physiological effects of AR-based interventions on pediatric patients by synthesizing the existing evidence on their therapeutic effects on anxiety, pain, and behavioral responses, and to provide guidance for future research.