# Sand-based therapy in pediatrics: a narrative review of traditional and digital sand therapy

## TL;DR

This review explores traditional and digital sand-based therapies for children's emotional and behavioral issues, finding limited evidence for digital versions.

## Contribution

The paper identifies a gap in empirical research on digital sand therapy for pediatric populations.

## Key findings

- Only eight studies met inclusion criteria, all focused on traditional sand therapy with no digital studies included.
- Traditional sand therapy showed significant improvements but had methodological limitations like small samples and lack of objective measures.
- Digital sand therapy platforms exist but have not been empirically tested in pediatric populations.

## Abstract

Sand-based therapies, forms of play therapy, have been used to address emotional, behavioral, and psychosocial difficulties in children. Verbalizations, nonverbal cues, and depictions in the sand are used by therapists to assess client progress. In contrast, digital sand therapy uses digital apps or platforms to facilitate similar therapeutic processes. This narrative review examines the current state of evidence for sand-based therapies in pediatric populations with particular attention to the presence or absence of empirical research on digital sand therapy and their outcome measures.

Inclusion criteria consisted of quantitative or mixed-methods sand-based therapy studies published between 2005 and 2025, involving pediatric populations and published in peer-reviewed journals. Searches were performed using PubMed, Google Scholar, PsycINFO, Scopus, Web of Science, and Embase, Perplexity AI, and the University of British Columbia library.

A total of 130 articles were identified. After screening, eight articles satisfied the inclusion criteria; there were no studies included that used virtual or digital sand-based therapy. All traditional sand-based therapy studies reported significant improvements in experimental groups. However, methodological limitations were common, including small sample sizes, a lack of between group comparisons, and an overall lack of objective outcome measures.

While traditional sand-based therapy studies suggest its potential effectiveness, marked limitations constrain the interpretations of these findings. Despite the promise and strengths of digital alternatives to traditional sand therapy, no empirical studies to date have examined their use in pediatric populations. While digital sandplay and sandtray platforms and applications exist, their clinical effectiveness has not yet been empirically studied.

This review highlights a need for digital sand-based therapy in pediatric populations as well as standardized, objective measures for session analysis. Future research should explore how digital platforms can be used to enable objective sandtray analysis in pediatric populations.