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

Sinat Phal, Sophie Tardieu, Marine Alessandrini and Stephanie Gentile

Introduction: Laughter and humor have been reported as an effective way to achieve physiological and psychological health-related benefits to reduce pain and increase stress tolerance during medical evaluation and painful procedures.
Objective: This literature review examines the effect of clown intervention in reducing anxiety, pain for pediatric patients before preoperative or during invasive medical procedures and evaluate methodological points used to assess the impact of clown intervention.
Methods: The search via PubMed was conducted on publications from 2005 to 2016. All studies published in English, in French and in Spanish were included, focusing on clown therapy intervention visits for children less than 18 years present on the pediatrics services. We analyzed for each publication: population targeted, medical service categories, medical procedure, measurement tools for anxiety, pain and other clinical outcomes, data focused on methodological points including design and analysis of clinical trial, population size, sample size calculation and statistical analysis.
Results: We selected 54 studies based on title relevance. After reading their abstracts we selected 28 publications, most were randomized prospective and controlled studies (n=18, 64%). The total studies sample was distributed considering the following children age groups: from 2 to 12-year-old (n=12, 43%), from 5 to 18 year-old (n=9, 32%) and from 0 to 18 year-old (n=7, 25%). The main result showed that the impact of clown intervention had a positive effect in clown group compared with control group. 10 studies showed the positive impact on reducing children’s anxiety and 7 studies on reducing parent’s anxiety before surgery. 5 studies described reduced pain perception during medical invasive procedure and/or postoperative period. This review provided some empirical evidences of the effect of clown interventions on anxiety and/or pain reduction in pediatric hospitals, and demonstrated that more evidence-based studies are needed in the future.