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

Pediatric healthcare environments are often associated with elevated stress levels, anxiety, and discomfort in children due to unfamiliar settings, medical procedures and anticipatory uncertainty. Spatial design becomes important in healthcare environments as children are particularly sensitive to environmental stimuli. Within this context, Supportive Design Theory (SDT) identifies positive distraction (PD) as a key mechanism for reducing stress through sensory and environmental engagement. Nature, through biophilic design (BD), offers a promising strategy to support children’s emotional well-being; however, its role within non-clinical spaces- waiting areas, corridors, lobbies, and play areas which serve as shared and transitional areas remains underexplored. This study presents a PRISMA-ScR 2018 guided scoping review examining BD as a positive distraction strategy in these transitional healthcare environments. A comprehensive search of the Scopus database, supplemented by manual reference screening identified 34 peer-reviewed studies meeting the inclusion criteria. Given the methodological diversity of the included studies, a descriptive quantitative and theory-driven synthesis was conducted, supported by bibliometric mapping, keyword co-occurrence mapping and outcome domains classification. Findings indicate that stress reduction was the most consistently reported outcome, followed by cognitive and physiological responses. Interventions involving real nature and multisensory engagement showed stronger restorative benefits than a single-sensory strategy. Emerging themes highlighted increasing interest in virtual reality, sustainability-oriented outcomes and technology-supported nature exposure. Overall, the review positions BD as a broader environmental strategy aligned with SDT, within which positive distraction functions as a key mechanism supporting child’s emotional regulation. The study contributes to Sustainable Development Goal 3 (Good Health and Well-Being) and Sustainable Development Goal 11 (Sustainable Cities and Communities) by advocating nature-integrated and child-centered built environments.