Reducing Anxiety in the Pediatric Emergency Department: A Comparative Trial

Abstract

Background Anxiety among patients in a Pediatric Emergency Department (PED) can be significant but often goes unaddressed. Objective To determine whether exposure to Child Life (CL) or Hospital Clowning (HC) can reduce anxiety in children presenting to a PED. Methods Patients were randomized to CL, HC or control and assessed upon: entry to examination room (T1), prior to physician arrival (T2) and during physician examination (T3), using the modified Yale Preoperative Anxiety Scale (m-YPAS). CL and HC interventions occurred for 5–10 minutes prior to physician entry. Effects were analyzed using mixed ANOVA. Results m-YPAS scores ranged from 23 to 59, with a higher score indicating increased anxiety. Mixed ANOVA on the study sample (n=113) showed a significant interaction between groups (CL, HC, control) and time, p = .02. Further analyses indicated effect of group only at T2 (MCL = 23.8, 95% CI 23.2–24.5; MHC = 25.2, 95% CI 24.2–26.2; Mcontrol = 26.1, 95% CI 24.2–27.9), p = .02. Sub-analysis of patients with T1 m-YPAS score ≥ 28 (n=56) showed a significant interaction between group and time, p = .01. Further analysis showed effect of group only at T2 (MCL = 24.4, 95% CI 23.3–25.6; MHC = 27.0, 95% CI 25.2–28.7; Mcontrol = 29.2, 95% CI 25.6–32.7), p = .003. Conclusion CL services can reduce SA for patients presenting to a PED with heightened anxiety at baseline. This reduction occurred immediately following CL intervention, but was not observed in patients exposed to HC or during physician examination.

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

“…Half of the studies have a sample size of less than 30 patients per group [9,11,13,14,16,18,21,23,29]. In 2 of 28 studies, the evaluators were blinded to both, the study's design, hypothesis [18] and patients or parents group assignment [19].…”

“…One third of the studies targeted specifically the benefits of the intervention of hospital clown for children [17,[19][20][21][22]27,29,30]. 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].…”

“…The age group most highly represented was 2 to 12 year-old (43%) [9][10][11][12][13][14][15][16][17][18][19]21]. The other inclusion criteria of studies were children in good health (children without a history of chronic illness, non-premature birth, non-developmental delay and non-significant hearing or visual impairments), children who had no experience of previous anesthetic and/or first attempt examination with or without sedation and the need to undergo painful procedures.…”

“…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].…”

“…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]. …”