Issue: January 2021
Disclosures: The authors report no relevant financial disclosures.
December 29, 2020
2 min read

Clowns improve well-being of hospitalized children, studies show

Issue: January 2021
Disclosures: The authors report no relevant financial disclosures.
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Doctors dressed as clowns have been shown to improve symptoms and the psychological well-being of hospitalized children, according to a systematic review published in The BMJ.

“As clinicians strive to minimize the psychological burden during the hospitalization process, mainly in pediatrics settings, they must be aware of the scientific evidence available to help them incorporate appropriate laughter and play into clinical practice,” Luís Carlos Lopes-Júnior, BScN, RN, OCN, PhD, an adjunct professor and researcher at the Federal University of Espírito Santo Health Sciences Center in Brazil, told Healio Primary Care.

Clown doctor visits patient
According to the authors of a systematic review, clown doctors significantly improved pediatric patients’ anxiety, pain, cancer-related fatigue, emotional well-being and stress. Photo source: Adobe Stock

Children and adolescents who require hospitalization represent a special challenge for the health care system and health professionals due to the illness itself and the treatment process,” he said. “Hospitalized children and adolescents with acute or chronic disorders are also stressed by the separation from their parents, the hospital environment, the fear of painful treatments and the uncertainty of the treatment outcome.”

Lopes-Júnior and colleagues noted that the first documented use of hospital clowning dates back to 1908 in Parisian newspaper, which depicted an illustration of clowns and children in a London hospital ward.

To determine the effect of “clown doctors” on patients, Lopes-Júnior and colleagues reviewed 13 randomized and 11 nonrandomized controlled trials with 1,612 children and adolescents. Seventeen trials were conducted in Europe, four were done in South America, two were done in Asia and one was conducted in Canada. The clown doctors usually used improvisation, juggling, magic, music, puppetry and/or storytelling to complement a patient’s existing care. Some studies used validated methods (eg, Yale Preoperative Anxiety Scale and Posttraumatic Stress Disorder Symptoms Scale) to rate responses, whereas others used one or several biomarkers to measure the effect on children.

The researchers reported that pediatric patients who had been visited by a hospital clown reported significant improvements in anxiety (13 studies), pain (nine studies) and cancer-related fatigue (three studies). Pediatric patients who had a visit from a hospital clown also reported significant improvements in emotional well-being (four studies) and stress (four studies).

In addition, clown doctors led to significant improvements in intraoperative serum cortisol levels (one study) and decreases in pain from strabismus surgery (one study). Also, both pain and fear significantly improved in patients visited by a clown vs. those who were not (one study).

“The results support the continued investigation of complementary treatments for better psychological adjustment during the hospital admission process in pediatrics,” Lopes-Júnior said.

He encouraged the continued use of clown doctors amid the pandemic when the visits can be conducted safely or via telehealth.

“Contact is essential to allow a better interpersonal relationship between the child or adolescent and the clown, especially due to the social and emotional rupture of family members, friends,” Lopes-Júnior said.