A quasi randomized-controlled trial to evaluate the effectiveness of clowntherapy on children’s anxiety and pain levels in emergency department

Abstract

• Anxiety and fear caused by medical procedures exacerbate children's pain and may interfere with the procedure. • To reduce anxiety, fear, and pain and to facilitate patient's evaluation, different non-pharmacological approaches have been proposed and positive effects of laughter and humor have been reported. What is New: • The presence of clowns in the waiting room and in the ED during medical evaluation and painful procedures helps to reduce children's anxiety.

Humor and Laughing: The Benefit of Hospital Clowns in Pediatrics for Hospitalized Children and their Families: A Review

“…Among the 28 included studies, 18 are randomized prospective and controlled studies and 14 of them have parallels groups design (clowngroup/control-group) [9][10][11][12][13]16,17,[21][22][23][28][29][30]34]. Half of the studies have a sample size of less than 30 patients per group [9,11,13,14,16,18,21,23,29].…”

“…Over half of the studies reported intervention benefits of hospital clown for children and their parents [5,[11][12][14][15]18,[23][24][25][26]28,[31][32][33][34]. Four other studies have evaluated in addition the opinions of health professionals [4,10,13,16]. One study targeted only mother's anxiety [9].…”

“…Working methods of clowns may vary across studies, as their professional training. Over half of studies of clown intervention lasted less than 15 minutes [3,4,12,15,16,21,22,25,[27][28][29][30][31][32][33][34]. For seventy one percent of the studies the intervention is realized by one clown at one visit [4,5,9,11,15,16,19,21,[23][24][25][26][27][28][29][30][31][32][33] and in twenty nine percent of the studies the clowns intervention is realized by two clown at one visit [10,[12][13][14]17,18,22,34].…”

“…Thirty six percent of studies were focused on invasive medical procedures including venous blood sampling, intravenous catheter, burn, wound dressing, immobilization of injured limbs, wound suture and blood tests [15][16]23], medical forensic examiner (allegedly abused children) [5,[24][25], allergy prick skin tests 28, botulinum toxin injections 30, intra-articular corticosteroid injection 20, magnetic resonance imaging 17. Thirty two percent of studies targeted non-invasive procedures [4,19,26,27,29,[31][32][33][34].…”

Feeling happy and carefree: a qualitative study on the experiences of parents, medical clowns and healthcare professionals with medical clowns

“…The presence of a clown has been found to reduce the child’s anxiety (Dionigi, Sangiorgi, & Flangini, 2014; Felluga et al, 2016; Goldberg et al, 2014; Kocherov et al, 2016; Meiri, Ankri, Hamad-Saied, Konopnicki, & Pillar, 2016; Messina et al, 2014; Vagnoli, Caprilli, & Messeri, 2010; Vagnoli, Caprilli, Robiglio, & Messeri, 2005; Weintraub et al, 2014) and feelings of boredom, loneliness and sadness (Finlay, Baverstock, & Lenton, 2014; Mansson, Elfving, Petersson, Wahl, & Tunell, 2013; Meiri et al, 2016). Also, a few studies showed that a clown intervention is able to reduce anxiety in parents (Agostini et al, 2014; Fernandes & Arriaga, 2010; Wolyniez et al, 2013).…”