REVIEW
URRENT
C
OPINION
Pokémon Go and augmented virtual reality games:
a cautionary commentary for parents
and pediatricians
Maeve Serino a, Kyla Cordrey b, Laura McLaughlin c, and Ruth L. Milanaik d
Purpose of review
The recent release of Pokémon Go has ushered in a new set of challenges for parents and pediatricians,
highlighting the importance of parents setting guidelines for video game use with their children. Within 1
week of its launch, the game attracted over 65 million users, many of whom are young children. Despite
the potential benefits of the game described in our article, this location-based game format poses specific
threats to the safety and physical wellbeing of children.
Recent findings
Reports have discussed both the benefits and adverse effects of this extremely popular video game. Benefits
include increased exercise, socialization, and outdoor activity. Negative effects include increased risk of
injury, abduction, trespassing, violence, and cost.
Summary
Pediatricians play a key role in counseling parents and children about safety precautions and setting
appropriate limits for impressionable youth. Parents and pediatricians should be aware of this new and
remarkably popular game that appeals to a wide variety of individuals. To protect children from injury,
predators, and inappropriate situations, parents and pediatricians must regulate children’s participation
in this game and maintain vigilance for potentially dangerous circumstances.
Keywords
augmented virtual reality game, injury, Pokémon Go, predators
INTRODUCTION
Pediatricians play a significant role in counseling
parents about major safety issues that result from
living in a technologically advancing world. The
immediate success of Pokémon Go, released on 7 July
2016, is a cultural phenomenon that resulted from
such technological innovations. Within 1 week of its
release, the game attracted over 65 million users and
counting, many of them young children [1 ]. Augmented virtual reality games, like Pokémon Go, are
unique in that they overlay aspects from the physical
and virtual worlds into one cohesive experience.
Parents might not be fully aware of the potential
dangers of these new and exciting innovations, so
it is important for pediatricians to also keep abreast of
these technological advancements. Despite reported
benefits, Pokémon Go’s video game format poses
specific threats to the safety and physical wellbeing
of children.
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A BRIEF HISTORY OF VIDEO GAMES
Since their advent in 1972, video games have
become an increasingly integral component of
childhood [2]. Currently, approximately 3 billion
hours are spent playing video games per week worldwide; in the United States, 183 million people play
computer and video games for at least 1 h a day [3].
In 2007, 98.7% of adolescents reported playing
video games and, by 2009, a typical adolescent
home had on average 2.3 gaming consoles [4,5 ].
Augmented virtual reality games, like Pokémon
Go, have gained significant traction among children, adolescents, and adults alike. These games
are unique in that they combine the physical and
virtual worlds into one interface. Previously, video
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a
Williams College, bHarvard University, cWashington University in
St. Louis and dDevelopmental and Behavioral Pediatrics, Steven and
Alexandra Cohen Children’s Medical Center, New Hyde Park, New York,
USA
Correspondence to Ruth L. Milanaik, DO, Developmental and Behavioral
Pediatrics, Steven and Alexandra Cohen Children’s Medical Center of
New York, 1983 Marcus Avenue, Suite 130, Lake Success, New York,
11042, USA. Tel: +1 516 802 6100; e-mail: RMilanai@northwell.edu
Curr Opin Pediatr 2016, 28:673–677
DOI:10.1097/MOP.0000000000000409
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Office pediatrics
KEY POINTS
Parents and pediatricians can address the potential
benefits and risks of children playing Pokémon Go, a
recently released augmented virtual reality game.
The new, active video game format requires users to
walk around and explore their local environments,
offering potential physical, social, and emotional
benefits to players.
Potential concerning dangers of playing Pokémon Go
include physical harm from distracted walking or
driving, as well as harmful interactions with potential
predators who may use the game to attract children to
isolated locations.
games were a mostly solitary and sedentary activity,
but augmented reality games are breaking this
trend, replacing stationary play with active play
by requiring users to explore their physical
surroundings. Pokémon Go’s initial success moves
this new era of video games toward becoming
mainstream.
Pokémon Go is certainly not the first attempt at
an augmented virtual reality game, but it launched
at unprecedented levels and is currently the most
popular in its field. In the summer of 2002, a game
entitled Majestic pioneered this style. Since then,
there have been several attempts to enhance this
style of games. In 2012, Niantic, a Google startup,
developed the direct precursor to the now viral
Pokémon Go game (i.e., Ingress, a science fiction
narrative game). Ingress encouraged users to leave
their houses by integrating the environment into
the game experience. Ingress obtained moderate
success and currently has more than 1 million users
worldwide after 4 years on the market [1 ]. However, Pokémon Go quickly surpassed Ingress in
popularity and had more than 21 million daily users
after a week [6].
The immense popularity of Pokémon Go can be
in part attributed to its consistent and committed
fan base. The Pokémon franchise was developed in
1995 by Nintendo, and the first game was released
for a Game Boy hand-held console in 1996. Pokémon, short for ‘Pocket Monsters’, are Japanese
cartoon characters that are caught by players called
‘Trainers’. These trainers raise and command their
Pokémon and assist them with growing and evolving into stronger versions. Pokémon can be battled
against each other by their trainers and traded in a
fantasy universe. The game was originally made for
young children and was especially popular among
boys, but, as the original population aged, so did the
user demographics. Since its release, Pokémon has
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grown into a media franchise complete with children’s television shows, movies, collectable trading
cards, comic books, and several generations of the
original game. The media franchise’s popularity has
increased dramatically since 1996, but has since
plateaued in the past 5 years. Pokémon remains
popular, though, with the franchise grossing
$1.5 billion to $2 billion annually [7].
Pokémon Go is a GPS location-based, augmented reality game that is a free application available on iPhone and Android devices. The game has a
minimum age requirement of 13 years, but children
younger can play with parental consent. Users of all
ages track and catch Pokémon that are virtually
superimposed onto physical, real-world surroundings, such as neighborhood parks, street corners,
and historical sites. Players attempt to catch Pokémon characters by pointing their phone cameras
and tossing ‘Pokéballs’ at them with their fingers.
Trainers can congregate to fight their Pokémon
against each other at public ’gyms’, which tend to
be real world, often highly trafficked locations.
Unlike the original Pokémon video games, Pokémon Go users explore their personal physical
environment while simultaneously taking part in
the video game’s fantasy world. As such, Pokémon
Go is an ‘exergame’ that encourages activity and
energy expenditure [1 ].
The release of Pokémon Go has increased the
media franchise’s already enormous popularity,
resulting in a massive increase in revenue for
Nintendo. The parent company saw a 23% increase
in stock value after just 1 day [8]. The game appeals
to a broad audience, including young children and
the fan base cultivated in the late-1990s. The number of users has already surpassed many popular
smart phone applications, including Twitter, Instagram, WhatsApp, and Tinder [8,9]. Compared with
typical stationary video games, this game format
offers many possible benefits. However, as exciting
and engaging as this technology is, there are important reasons for concern regarding the safety of
children playing these games unsupervised.
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POTENTIAL BENEFITS OF AUGMENTED
VIRTUAL REALITY GAMES
According to the American Psychological Association, playing video games may increase children’s
social skills, educational development, and overall
health. These games also may boost certain cognitive skills, including spatial navigation, reasoning,
memory, and perception [10 ]. In a 2006 study,
Lanningham-Foster et al. show that, when sedentary
screen time is converted to active screen time,
energy expenditure more than doubles [11]. The
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Pok
emon Go and augmented virtual reality games Serino et al.
active screen time entailed watching a video
tape while walking on a treadmill at 1.5 mph, a
level of exercise similar to that required by
Pokémon Go [11].
Pokémon Go encourages active rather than
sedentary usership and boasts higher levels of exercise, social interaction, and outdoor activity. While
playing, users must continuously walk around to
find new Pokémon and to travel to designated public sites to battle other players with the captured
Pokémon. Players advance in levels depending
on the number of miles traveled, which has resulted
in users walking more than usual to advance in
the game.
The benefits of playing the game are not limited
to health alone as the game promotes active learning throughout local neighborhoods. Pokémon Go
encourages users to visit cultural landmarks by identifying them as ‘PokéStops’, locations advantageous
to their virtual characters. These often include
churches, historical sites, and public art displays,
such as murals and sculptures. When users pass such
stops while playing the game, they are prompted
to turn their phones toward the landmark and
are presented with dialogue boxes on their screens
containing information about the site.
Pokémon Go also contains a social aspect that
enhances the users’ experiences. Individuals can
play against nearby players, potentially initiating
conversation with neighbors and others who share
a common interest in the game. The game also
allows users to play together while not in geographic
proximity, so friends can compete across the nation.
The intense fan base spans age, sex, and culture, and
creates a sense of unity among players.
In addition to these physical and social benefits,
the game has further been reported to have a
positive impact on mood [12]. Users have described
the game as a source of escapism, providing a distraction from reality in a unique way. The game
presents an alternative world in which problems are
momentarily forgotten [13]. In addition, the game
has anecdotally been reported as therapeutic for
users suffering from mental health disorders. Several
first-person accounts posted on social media sites
have emphasized how the game’s immediate reward
system has provided an incentive to interact with
others and to increase their activity, actions that
otherwise were difficult for individuals with depression and other psychological conditions [12]. The
game may also offer motivation and distraction
for children with special needs who are hesitant
to venture outside [14]. These reports of mood
improvement are supported by studies examining
the benefits of outdoor play. A brief 10-min excursion has measurable positive effects on mood, and a
90-min nature walk reduces activity levels in the
brain associated with mental illness [15,16]. However, outdoor time playing of Pokémon Go may not
be the same as much of the time outdoors is spent
looking at the phone screen.
ADVERSE CONSEQUENCES OF
AUGMENTED VIRTUAL REALITY GAMES
The near-ubiquitous use of video games has led to a
great deal of research examining their effects on
mental, physical, and emotional health. Violent
video games have been shown to lead to an increase
in aggression and desensitization toward violence,
whereas video games overall have contributed to
less self-control, increased risk for depression, and
decreased empathy. In some cases, pathological
gaming may lead to depression, anxiety, social phobias, and a decreased performance in school. The
sedentary lifestyle facilitated by video games leads to
increases in obesity. As a result, video games are
often condemned for an association with aggressive
behaviors and unhealthy lifestyles [5 ].
The new release of Pokémon Go has already
witnessed reports of negative economic consequences. Although the application is free, the cost
of playing the game can be significant, as it uses a
considerable amount of phone data, requiring GPS
and a strong online connection. Due to the nature of
the game, which involves users leaving their homes
in search of Pokémon, a Wi-Fi connection is often
not available. The heavy data usage can lead to
unexpectedly large cell-phone bills for parents at
the end of the month. In addition, there is the
option for in-app purchasing; for example, to set
a ‘lure’ for other players, users must pay around $1.
Without sufficient monitoring, costs can easily
accumulate [7].
Physical harm is also a potentially negative
consequence of the game. Players have been hurt
chasing Pokémon due to inattention to surroundings while walking. Some even play the game while
driving, which poses a similar or even more significant risk than texting while driving [17 ,18]. In
response to the tendency of users to focus on the
game rather than their surroundings, the New York
Police Department released a statement reminding
everyone to be alert, ‘particularly when using any
hand-held electronic device’ [19].
Other concerns for children playing Pokémon
Go have been raised. For example, some public
spaces designated for Pokémon use have been
described as either inappropriate or dangerous.
Areas that are highly populated with Pokémon
Go characters that are generally recognized as
unsuitable for the game include the National
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September 11 Memorial in New York, the United
States Holocaust Memorial Museum in Washington
District of Columbia, and the former concentration
camp Auschwitz in Poland. Although the game may
promote active learning about these historical sites,
many find that observing others play a video game
in these areas of reverence and reflection is disrespectful [20]. Furthermore, the game’s playing
spaces are not limited to public areas. Occasionally,
Pokémon and designated ‘fighting’ areas can be
found in private spaces, like people’s homes. In
these instances, players often congregate outside
private property or, at the risk of trespassing, even
venture into backyards in search of a Pokémon [17 ].
Children engrossed in the excitement of the
game might forget that it is inappropriate to enter
someone else’s property and might potentially
endanger themselves.
Most concerning, the location-based feature and
interactive aspect of the game can even lead to
instances of crime. Recently, the game facilitated
a first-degree robbery and felony. Criminals took
advantage of the lure function that notifies users
of nearby Pokémon and attracted unsuspecting
players to an isolated location. The police department handling the case issued a warning, ‘If you use
this app (or other similar type apps) or have children
that do, we ask you to please use caution when
alerting strangers of your future location.’ [18]. This
geo-locating feature is a new threat to children
in particular, as it has the potential to provide
predators with information regarding children’s
locations. One user commented how the public
‘gyms’ and ‘lure’ function could allow potential
predators to cultivate a false sense of security and
familiarity in children [21]. The combination of
proximity, shared common interest, and ability to
attract players to an isolated location puts children
playing Pokémon Go in a uniquely vulnerable situation. It is therefore vital that parents set clear rules
and guidelines for children playing Pokémon Go.
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THE ROLES OF PARENTS AND
PEDIATRICIANS
Parents and pediatricians should be aware of the
risks accompanying augmented reality games, like
Pokémon Go. Although the game offers benefits and
opportunities for fun, adult supervision is highly
recommended, especially for young children.
Parents should be wary of the potentially severe
consequences that may result from children interacting with nearby strangers. Parents should be
aware that children who are under the age of
13 years can bypass the minimum age requirement
without parental consent by simply misreporting
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their age. Parents should clearly communicate the
possibility of predators and set guidelines for
interactions with strangers, along with taking the
opportunity to have a broader discussion about
violence and abduction concerns.
It is important that children do not go unaccompanied to various sites in pursuit of Pokémon
characters. Parents must set rules and boundaries,
specifically regarding where, when, and with whom
their children may play the game. Children need to
have an understanding that, even though the game
may suggest going to private areas, this act is still
considered trespassing. Parents ought to have conversations with children about injury prevention
and the importance of remaining alert and aware
at all times, especially when in busy areas or while
crossing streets. Furthermore, parents of adolescents
must emphasize the danger of using a hand-held
device to play the game while driving. It is against
the law in a number of states, and children must be
fully aware of the danger of distracted driving. In
addition, due to the cost associated with the game,
parents should discuss expectations and set limits
on their children’s data usage. Parents can also
prohibit in-app expenditure, using settings available
on smart phones.
CONCLUSION
Pediatricians can educate parents on these risks and
facilitate the above conversations. Parents can be
cautioned about the possibility of interaction with
other unfamiliar game users, and pediatricians can
reiterate the importance of being more aware of
their surroundings. Augmented reality games can
encourage positive behaviors, such as exercise and
socialization. They have the potential to be a
gateway for discussion about safety topics that are
necessary for rising adolescents living in an increasingly technological world. Pokémon Go has the
potential to be an exciting new way for parents to
spend time with their children and share in their
interests. In addition, when used in a proper
and appropriate setting, it may give children the
confidence to explore their surroundings, develop
relationships, and engage in physical activity.
However, it is imperative that rules and guidelines
be clearly defined to ensure the continuing safety
and wellbeing of all children.
Acknowledgements
The authors confirm that this article has not been published in its current form or a substantially similar form (in
print or electronically, including on a web site), that it has
not been accepted for publication elsewhere, and that it is
not under consideration by another publication.
Volume 28 Number 5 October 2016
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Pok
emon Go and augmented virtual reality games Serino et al.
Financial support and sponsorship
The authors received no funding for this work from any of
the following organizations: National Institutes of
Health (NIH), Welcome Trust, Howard Hughes Medical
Institute (HHMI), and other(s).
Conflicts of interest
There are no conflicts of interest.
REFERENCES AND RECOMMENDED
READING
Papers of particular interest, published within the annual period of review, have
been highlighted as:
&
of special interest
&& of outstanding interest
1. Bogost I. The tragedy of Pokémon Go. The Atlantic 11 July 2016. http://
www.theatlantic.com/technology/archive/2016/07/the-tragedy-of-pokemongo/490793/. [Accessed 13 July 2016].
This article details history of Augmented Reality Games, including Ingress, the
predecessor to Pokémon Go.
2. Wolf MJ. Before the crash: early video game history. Detroit, MI: Wayne State
University Press; 2012.
3. McGonigal J. Gaming can make a better world. [Video]. TED March 2010.
https://www.ted.com/talks/jane_mcgonigal_gaming_can_make_a_better_
world/transcript?language=en. [Accessed 13 July 2016].
4. Ferguson CJ. The good, the bad, and the ugly: a meta-analytic review of
positive and negative effects of violent video games. Psychiatr Q 2007;
78:309–316.
5. Bailin A, Milanaik R, Adesman A. Health implications of new age technologies for
&&
adolescents: a review of the research. Curr Opin Pediatr 2014; 26:605–619.
This article provides an in depth review of current research on technology,
including the benefits and negatives of video games.
6. Molina B. Report: ‘Pokemon Go’ downloads top 15 million. USA Today 13 July
2016. http://www.usatoday.com/story/tech/gaming/2016/07/13/report-poke
mon-go-downloads-top-15-million/87022202/. [Accessed 15 July 2016].
7. Isaac M. Times reporter descends into Pokemania. New York Times 12 July
2016. http://www.nytimes.com/2016/07/12/insider/how-pokemon-go-augmented-a-reporters-reality.html. [Accessed 13 July 2016].
8. Price R. ‘Pokémon Go’ is already bigger than Tinder, and it’s about to overtake
Twitter. Business Insider 11 July 2016. http://www.businessinsider.com/
pokmon-gobigger-than-tinder-overtake-twitter-similarweb-data-stock-pricenintendo-niantic-2016-7. [Accessed 13 July 2016].
&&
9. Barylick C. Pokemon Go app surpasses Twitter’s daily user base, sees more
engagement than Facebook. PowerPage 14 July 2016. http://www.powerpage.org/pokemon-go-app-surpasses-twitters-daily-user-base-sees-more-en
gagement-than-facebook/. [Accessed 16 July 2016].
10. Granic I, Lobel A, Engels R. The benefits of playing video games. Am Psychol
&
2014; 69:66–78.
This article details the benefits of video games.
11. Lanningham-Foster L, Jensen B, Foster R, et al. Energy expenditure of
sedentary screen time compared with active screen time for children. Pediatrics 2006; 118:1831–1835.
12. Lampen C. The surprising health benefits to playing ‘Pokemon Go’ that all the
haters should hear. Tech.Mic 11 July 2016. https://mic.com/articles/148322/
pokemon-go-has-mental-health-benefits#.3I3ipYFNe. [Accessed 15 July
2016].
13. Gabbatt A, Levin S. The joys of Pokémon Go: exercise, the outdoors and ‘fullon escapism’. The Guardian 12 July 2016. https://www.theguardian.com/
technology/2016/jul/12/pokemon-go-exercise-outdoors-escapism. [Accessed 15 July 2016].
14. Louv R. Resisting the call of the virtual. The New York Times 13 July 2016.
http://www.nytimes.com/roomfordebate/2016/07/12/pokemon-go-get-outtahere/connecting-to-pokemon-go-isnt-a-real-connection-to-nature. [Accessed
15 July 2016].
15. Anxiety and Depression Association of America Staff. Exercise for stress and
anxiety. Anxiety and Depression Association of America; July 2015 ; http://
www.adaa.org/living-with-anxiety/managing-anxiety/exercise-stress-and-anxi
ety [Accessed 15 July 2015]
16. Bratman GN, Hamilton JP, Hahn KS, et al. Nature experience reduces
rumination and subgenual prefrontal cortex activation. Proc Natl Acad Sci
U S A 2015; 112:8567–8572.
17. Tsukayama H. Pokemon Go’s unexpected side effect: injuries. The Washing&
ton Post 10 July 2016. https://www.washingtonpost.com/news/the-switch/
wp/2016/07/08/pokemon-gos-unexpected-side-effect-injuries/. [Accessed
15 July 2016].
This article details the negative consequences of Pokémon Go.
18. Yuhuas A. Pokemon Go: armed robbers use mobile game to lure players into
trap. The Guardian 11 July 2016. https://www.theguardian.com/technology/
2016/jul/10/pokemon-go-armed-robbers-dead-body. [Accessed 15 July
2016].
19. Jula M. Pokémon Go players take their hunt to the streets of New York. The
New York Times 11 July 2016. http://www.nytimes.com/2016/07/12/nyre
gion/pokemon-players-take-their-hunt-to-the-streets-of-new-york.html?_r=1.
[Accessed 15 July 2016].
20. Bromwich JE. Where Pokémon should not go. The New York Times 12 July
2016. http://www.nytimes.com/2016/07/13/technology/where-pokemonshould-not-go.html. [Accessed 15 July 2016].
21. LaMagna M. Should you let your kids play Pokémon Go? MarketWatch
15 July 2016. http://www.marketwatch.com/story/do-your-kids-playpokemon-go-what-to-watch-out-for-2016-07-11. [Accessed 15 July
2016].
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