AMXRA Guidelines on Extended Reality (XR) and Children: Considerations for Safe and Effective Application Development and Use.

The extended reality (XR) revolution has ushered in the adoption of head-mounted displays (HMDs), including among children. While well-studied clinical uses of XR hold promise for positive outcomes in pain management, behavioral change, and social connection, unsupervised use and improper implementation of immersive technologies in young populations raise significant concerns. Current age limit recommendations are based primarily on privacy laws and fail to address the potential physical, cognitive, emotional, and other psychosocial implications of XR for children. Commercially available HMDs are ill-suited for young users, leading to discomfort and suboptimal immersive experiences. Further, XR experiences challenge young children's ability to differentiate reality from fantasy, resulting in safety hazards and the potential for confabulated memories. Concerns extend to immersive social experiences, where the impact on mental health and safety is not yet fully understood. While acknowledging the risks, embracing XR technologies with thoughtful consideration is necessary to maximize their potential benefits for all youth, especially those facing adversity and isolation. Balancing accessibility and safety are essential as current and future XR technologies become integrated into children's daily lives. This manuscript represents AMXRA's official position on the responsible use of XR in children and will address the three major components of childhood development - physical, cognitive, and psychosocial - as they relate to the use and development of immersive technologies, in homes, schools, and clinics.