Background <p>Immersive virtual reality (VR), delivered via a head-mounted display (HMD), is increasingly used with children, including in pediatric settings. Understanding factors that shape its impact is essential, with the sense of presence considered a key determinant of experience quality. Preliminary evidence indicates that goal-directed engagement may enhance presence, yet this association has not been investigated in children. In this exploratory follow-up analysis of a published randomized controlled trial (RCT), we aimed at examining children’s presence experiences in different VR conditions during an ingrown toenail surgery under local anesthesia. Forty patients aged 10 – 17 years (<i>M</i>_age = 13.70, <i>SD</i>_age = 1.79, 18% female) were randomized to either a focused VR group with a specific task (<i>n</i> = 20), or an exploratory VR group without a task (<i>n</i> = 20). Patients’ self-reported sense of presence, assessed with the <i>Igroup Presence Questionnaire</i> (IPQ) and user experience (immersion, enjoyment, comfort) were analyzed using Bayesian independent <i>t</i>-tests. Analyses provided moderate evidence that focused VR elicited higher spatial presence and involvement than exploratory VR, weak (anecdotal) evidence (Bayes factor: 1–3) for a difference in realism, and no group differences in immersion, enjoyment, or comfort. No technology-related adverse effects were observed. Compared to no task, goal-directed VR appears to enhance the sense of presence in children in the context of pediatric surgery. This underscores the potential to optimize the experience of presence through targeted design. Consistent enjoyment, immersion, and comfort across conditions support the feasibility and acceptability of VR applications in children.</p>