Nature in Waiting Rooms: How Biophilic Design Calms Children in Hospitals

For most children, a trip to the hospital is not just about the needle, the scan, or the examination. It begins the moment they walk through the door, into an unfamiliar world of corridors, waiting areas, and lobbies that hum with anxiety. A new scoping review published in Discover Psychology argues that these often-overlooked non-clinical spaces, the transitional zones between the entrance and the treatment room, may be among the most powerful tools available for reducing pediatric stress, and that nature, deliberately woven into their design, is the key ingredient.

The review, led by Charline Stella Samuel of the Manipal School of Architecture and Planning at Manipal Academy of Higher Education in India, together with colleagues from Manipal Institute of Technology, set out to systematically map what is known about biophilic design, the practice of integrating natural elements, materials, and patterns into built environments, as a form of positive distraction in pediatric healthcare settings. Positive distraction, a core concept within Supportive Design Theory, refers to environmental features that gently capture attention and reduce stress by engaging the senses without demanding effortful concentration. In children, who are particularly sensitive to environmental stimuli, the theory holds that such distractions can meaningfully buffer the fear and anticipatory uncertainty that accompany medical visits.

To build the evidence base, the team conducted a scoping review guided by the PRISMA-ScR 2018 reporting framework, a standardized protocol for transparent systematic searches. They queried the Scopus database and supplemented the results with manual screening of reference lists, ultimately identifying 34 peer-reviewed studies that met their inclusion criteria. Because the included studies varied widely in methods and measures, the authors performed a descriptive quantitative and theory-driven synthesis rather than a meta-analysis, supported by bibliometric mapping, keyword co-occurrence analysis, and a classification of outcome domains. This approach allowed them to chart not only what has been studied, but where the field is heading.

The headline finding is that stress reduction is the most consistently reported outcome across the literature. When children encounter natural elements in healthcare spaces, whether living plants, daylight, natural materials, water features, or imagery of landscapes, the most reliable measured effect is a lowering of stress and anxiety. Cognitive benefits, such as improved attention and mood, and physiological responses, such as changes in heart rate or other stress markers, were also reported, though somewhat less consistently. In other words, the emotional calming effect of nature appears to be the most robust signal in the existing evidence.

Perhaps the most practically important insight from the review concerns how nature is delivered. Interventions involving real nature and multisensory engagement, designs that stimulate sight, sound, touch, and even smell simultaneously, showed stronger restorative benefits than strategies relying on a single sense. A potted plant in a corner may help, but a waiting area that combines greenery with natural light, the sound of water, and tactile natural materials appears to do considerably more. This aligns with a growing body of environmental psychology suggesting that restorative experiences deepen when multiple sensory channels are engaged, giving the nervous system a richer alternative to the clinical cues that trigger apprehension.

The review also identifies clear emerging themes. Interest in virtual reality and technology-supported nature exposure is growing rapidly, offering a way to bring immersive natural experiences into spaces where living greenery is impractical. Sustainability-oriented outcomes are likewise gaining traction, with researchers increasingly framing nature-integrated healthcare design not only as a therapeutic tool but as a contribution to greener, more child-centered built environments. The authors explicitly connect their findings to the United Nations Sustainable Development Goal 3, on good health and well-being, and Goal 11, on sustainable cities and communities, positioning biophilic pediatric design at the intersection of public health and sustainable architecture.

What makes this review distinctive is its focus on non-clinical spaces. Most research on healing environments has concentrated on patient rooms and treatment areas, where medical outcomes are easiest to measure. Yet waiting areas, corridors, lobbies, and play areas are where children and families spend much of their time in a healthcare facility, often during the most anxious moments, before a procedure or while awaiting results. These shared, transitional spaces are also where design interventions can be implemented relatively cheaply and without disrupting clinical operations, making them an attractive target for hospitals seeking low-risk, high-benefit improvements.

The theoretical framing matters as well. By situating biophilic design within Supportive Design Theory, the authors argue that nature should not be treated as a decorative afterthought but as a broader environmental strategy within which positive distraction operates as a key mechanism supporting children’s emotional regulation. This framing has practical implications: rather than asking whether a particular plant or mural reduces anxiety, designers and healthcare administrators can ask whether the environment as a whole provides the sensory engagement, sense of control, and social support that the theory identifies as stress-buffering. Nature becomes one powerful instrument within a larger design philosophy.

The methodological diversity of the 34 included studies is both a strength and a limitation, and the authors are candid about this. Because the studies span different designs, measures, and settings, the synthesis is descriptive rather than statistical, and the review cannot quantify effect sizes for specific interventions. The scoping approach, however, is well suited to a young and heterogeneous field, revealing where evidence is strong, where it is thin, and where future research should concentrate. The authors’ use of keyword co-occurrence mapping and bibliometric analysis adds a quantitative layer that helps visualize the intellectual structure of the literature, showing clusters of research around stress, restoration, and design features.

For hospital administrators, architects, and pediatric healthcare planners, the message is timely and actionable. Children are uniquely vulnerable to the stress of healthcare environments, and the spaces they pass through before reaching a clinician shape their emotional state long before any procedure begins. The evidence synthesized in this review suggests that investing in nature-integrated design, prioritizing real, multisensory natural elements wherever feasible, and extending biophilic thinking beyond patient rooms into waiting areas, corridors, lobbies, and play spaces can deliver measurable benefits for children’s emotional well-being. As virtual and technology-mediated nature experiences mature, even facilities with limited space or budgets may find accessible pathways to bring the restorative power of the natural world into the most anxious corners of pediatric care.

Subject of Research: Biophilic design as a positive distraction strategy in non-clinical spaces of pediatric healthcare environments

Article Title: Nature as a positive distraction in non-clinical spaces of pediatric healthcare environments

Article References: Samuel, C. S., Rama Devi, N., Vincent, S., Chourasia, U., & M, L. M. (2026). Nature as a positive distraction in non-clinical spaces of pediatric healthcare environments. Discover Psychology. https://doi.org/10.1007/s44202-026-00922-1

Image Credits: AI Generated

DOI: 10.1007/s44202-026-00922-1

Keywords: biophilic design, pediatric healthcare, positive distraction, non-clinical spaces, stress reduction, Supportive Design Theory, scoping review, environmental psychology, multisensory engagement, virtual reality, sustainable development goals, healthcare architecture