👩⚕️ Virtual Reality (VR) is already being used in both clinical and educational contexts with young children, particularly for therapeutic distraction, neurodevelopmental interventions and immersive learning. These uses typically occur in supervised, controlled settings, but until now, guidance on safe and developmentally appropriate XR use in children has remained fragmented.
🛠️ Despite this growing body of applied research, hardware manufacturers do not provide official usage guidelines for pediatric or clinical use. As a result, clinicians and researchers have been making careful decisions based on emerging evidence and expert consensus. The American Medical Extended Reality Association (AMXRA), a multidisciplinary group focused on clinical and ethical XR use in healthcare, recently addressed this gap with a comprehensive, age-specific guideline published in J Med XR, a timely and practical contribution to standardizing XR safety in children.
This week’s #SundayResearchDive reviews the AMXRA guidelines and applies them directly to NutriVRTEA, our VR-based nutritional education pilot for children and adolescents with autism spectrum disorder. The program uses stylized virtual environments and hand-tracked interactions to teach food classification through short, supervised sessions. This comparison provides a concrete example of how to apply emerging XR standards to real-world pediatric research.
🧠 AMXRA Guidelines – What They Recommend
📌 Article: Marks et al., 2025 – AMXRA Guidelines on Extended Reality and Children (J Med XR)
📌 Developed by a multidisciplinary panel from Yale, Stanford, NHGRI, CHLA, and others
📌 Focus: Safe and developmentally appropriate use of XR in children under 18
📌 Link: https://www.liebertpub.com/doi/10.1089/jmedxr.2024.0054
🔍 Key recommendations by age group:
- Under 6: XR only in research/clinical settings; partial immersion only.
- 7–12 years: Max 10–15 min per session, no social VR, low sensory load, full adult supervision.
- 13–17 years: Max 20 min; social VR allowed with safeguards; avoid intense or disturbing content.
📌 Across all ages:
- Use pediatric-appropriate fit (IPD, strap, weight)
- Avoid joystick locomotion for young users
- Disable data tracking; ensure GDPR/LOPD-GDD compliance
- Monitor closely for discomfort, overstimulation, or confusion
✅ A Practical Contribution: Translating AMXRA Guidelines into a Compliance Checklist
Although the original AMXRA article offers detailed age-based recommendations, it does not present them as a compliance table. To support clinical researchers and developers, we translated the narrative recommendations into a practical, protocol-level compliance tool, and applied it to NutriVRTEA.
Below is the resulting four-column format we propose as a practical tool for protocol evaluation:
- Column 1: Guideline domain
- Column 2: AMXRA recommendation
- Column 3: NutriVRTEA compliance for 7–12 yrs
- Column 4: NutriVRTEA compliance for 13–17 yrs
🧭 The AMXRA document functions primarily as a safety and ethics framework. It does not provide recommendations on clinical outcomes or educational content design, which remain the responsibility of each research team based on their population and objectives.
📋 NutriVRTEA vs. AMXRA guidelines – Full Compliance Checklist
| Guideline Domain | AMXRA (7–12 yrs) | AMXRA (13–17 yrs) | NutriVRTEA Implementation | Status |
| Session duration | 10–15 min | Up to 20 min | <10 min of headset use per session | ✅ Fully aligned |
| Breaks / pacing | Regular breaks encouraged | Regular breaks encouraged | Structured 30-min sessions with pacing and decompression | ✅ Fully aligned |
| Supervision | Close adult supervision with screen visibility | Supervision recommended in social contexts | All sessions supervised by trained professionals | ✅ Fully aligned |
| Movement boundaries | Seated or bounded area | Same | Standing, bounded play zone with free locomotion in supervised setting | ✅ Fully aligned |
| Interaction type | Simple gestures, no joystick | Broader input acceptable with oversight | Hand tracking only; no controllers or joysticks | ✅ Fully aligned |
| Sensory load | Limited sensory engagement | Avoid overstimulation | Stylized visuals, clear feedback, no excess stimuli | ✅ Fully aligned |
| Content realism | Avoid photorealism | Photorealism acceptable with caution | Symbolic, cartoon-style design | ✅ Fully aligned |
| Social/multiplayer use | Not recommended | Allowed with safeguards | No multiplayer or online functions | ✅ Fully aligned |
| Data collection | Disabled | Disabled or with explicit consent | No headset data collection; pseudonymized local storage | ✅ Fully aligned |
| Privacy & legal compliance | GDPR + parental consent | GDPR + assent/legal safeguards | GDPR + LOPD-GDD compliant protocol | ✅ Fully aligned |
| Psychosocial appropriateness | Developmentally safe, no anxiety triggers | Promote positive, age-appropriate content | Co-designed for TEA; mildly adapted feedback to ensure clarity and engagement | ✅ Fully aligned |
| Headset ergonomics | Pediatric IPD, secure fit | Same | Meta Quest 3 with Elite Strap tested with children | ✅ Fully aligned |
| Adverse effects monitoring | Record symptoms (e.g., nausea, fatigue) | Same | Post-session checklist and observation | ✅ Fully aligned |
🚀 Final Thoughts: From Guidelines to Practice
As XR continues to expand into pediatric clinical and educational settings, ensuring ethical and developmentally appropriate implementation is no longer optional — it’s foundational. The AMXRA guidelines offer a much-needed framework, but their true value lies in how they’re applied on the ground. By turning recommendations into actionable checklists and aligning real protocols like NutriVRTEA, we contribute to building a safer, more transparent, and replicable foundation for immersive health innovation.
#SundayResearchDive #VRforHealth #Pediatrics #XRethics #Neurodiversity #DigitalHealth #AMXRA #NutriVRTEA #ClinicalResearch
