Clowns in Paediatric Surgery: Less Anxiety and More Oxytocin? A Pilot Study

Abstract

Hospital stays and medical interventions are accompanied by worries and anxiety in children and parents. Recent studies show that hospital clowns may reduce anxiety and enhance well-being. However, so far studies are based solely on subjective measures and clowns are usually not integrated in medical routine. With this pilot study, we aim to provide both psychological and physiological evidence of positive effects of clowns' interventions in hospitalized children. In a consecutive randomized intervention-control group design with 31 children aged 4 to 13 years, 17 patients were accompanied by a clown prior to surgery or during ward round (intervention group) and 14 were not (control group). Saliva samples for oxytocin measurement were taken from all patients before hospitalization (T1) and prior to surgery or after ward round (T2). Self- and parents-reports were obtained at T1, T2 as well as at time of discharge from hospital (T3) regarding children's anxiety (STAI), worries and well-being. Clowns evaluated their success in cheering up the child. Health professionals were asked for their acceptance of clowns in hospitals. Children in the intervention group had lower anxiety ratings and a higher oxytocin concentration at T2 as compared with T1; the control group showed no changes. Parents rated the well-being of their children higher if their child had clown's contact and were more willing to recommend the hospital. The staff judged the clowns as helpful for patients. Consistent psychological and physiological results suggest the positive impact of a clown's intervention in hospitalized children.

To the Operating Room! Positive Effects of a Healthcare Clown Intervention on Children Undergoing Surgery

“…In contrast with our hypotheses and the findings on the mYPAS, we found that children's self-reported mood was unaffected by the clown intervention. While these results jibe with some previous research [e.g., (34)], it could be that in the present study the divergent findings were a function of the assessment method and, in fact, we found only few correlations between these two measures. Specifically, the mYPAS was evaluated by trained observers while children were asked to rate their own mood, which requires a certain level of introspection [see e.g., (78)].…”

“…Using the Self Assessment Mannequin [SAM; (33)] to measure valence and arousal of emotional states, Fernandes and Arriaga (28) found that children who received a clown intervention reported higher positive affect than those in the control group, but this was regardless of assessment time (i.e., pre-or post-surgical procedure). In contrast, Scheel et al (34) found no difference between their intervention and control group on emotional valence of the SAM, but instead found an increase in children's salivary oxytocin levels from before hospitalization to after the clown intervention. Because oxytocin may be involved in an allostatic function to counteract experienced stress (35), these results suggest that children who interacted with clowns might have been more at ease.…”

Revisit the Effectiveness of Educational Kinesiology on Stress and Anxiety Amelioration in Kindergarteners With Special Needs: A Nonrandomized Trial

“…It was highly correlated with cortisol during a social stress task, and its levels in saliva were negatively associated with anxiety and insecurity 28 . Similar ndings that negative association between higher salivary oxytocin levels and lower anxiety levels were reported in hospitalized children 29 . In youths with anxiety disorder, salivary oxytocin levels were also found to negatively correlate with anxiety symptoms 31 .…”

“…More recent research revealed the association between oxytocin and mental health problems. For instance, high oxytocin levels were reported to associate with low anxiety levels in children and adolescents 28,29 . In agreement, urinary oxytocin levels were found to decrease during a social stress task in children and adolescents 30 .…”

Healthcare Clowning: Use of Specific Complementary and Alternative Medicine for Hospitalized Children

“…A recent German study [16] investigated the ability of clown interventions to induce positive psychological and physiological effects in hospitalized pediatric patients. Thirty-one children (aged 4-13 years) were randomly assigned to a clown group (n = 17) or a control group (n = 14).…”