Development of the serious game Puff for respiratory control during anxiety episodes in children

Anxiety is the most prevalent psychological disorder in childhood, often manifesting through symptoms such as muscle tension, gastrointestinal discomfort, and, most notably, impaired breathing regulation (e.g., rapid or shallow breathing). Effectively addressing these symptoms is essential to preserving children’s overall well-being and quality of life. Recent studies have shown that serious games can enhance adherence to respiratory therapies by transforming repetitive exercises into interactive, enjoyable experiences. In this context, the present study introduces the development of a serious game specifically designed to support anxiety managementi n children through the application of the 4-7-8 breathing technique. The game combines the use of a custom-built, additively manufactured breathing device with an immersive digital environment developed in the Unity platform. Altogether, this solution has potential to be an innovative, engaging, and effective tool for respiratory rehabilitation and emotional regulation in children. To confirm its applicability and therapeutic value, future work should involve controlled studies with pediatric participants.