Effectiveness Not Established

Medical Clowning

for Anxiety

Medical clowning is the use of trained clowns in the healthcare setting to distract, empower, and relieve stress or other symptoms among pediatric patients and their families through humor and laughter.

Research Evidence Summaries

Meiri, N., Ankri, A., Hamad-Saied, M., Konopnicki, M., & Pillar, G. (2016). The effect of medical clowning on reducing pain, crying, and anxiety in children aged 2–10 years undergoing venous blood drawing—A randomized controlled study. European Journal of Pediatrics, 175, 373–379. 

Study Purpose

To compare the use of medical clowning with the use of local anesthetic cream or the use of no intervention on pain in children undergoing a procedure

Intervention Characteristics/Basic Study Process

The study authors evaluated the use of a trained medical clown with the application of an anesthetic cream or no intervention on the effect on children’s pain and anxiety associated with a procedure. The control group underwent a blood draw/venipuncture without any intervention. The medical clown group had the clown distract and entertain the child from 10 minutes before as well as during and after the procedure. The final group had children given a local anesthetic containing a mixture of lidocaine and prilocaine 50 minutes prior to the blood draw/venipuncture. Duration of crying was measured by an independent observer, pain level was assessed by the child using the visual analog scale (VAS) for pain, and pain and anxiety were also assessed from the parents' perspective using VAS for pain and anxiety during a follow-up phone call.

Sample Characteristics

  • N = 100   
  • AGE = 2–10 years
  • MALES: 53%, FEMALES: 47%
  • CURRENT TREATMENT: Immunotherapy
  • KEY DISEASE CHARACTERISTICS: Unknown

Setting

  • SITE: Single site   
  • SETTING TYPE: Multiple settings    
  • LOCATION: Carmel Medical Center

Phase of Care and Clinical Applications

  • PHASE OF CARE: Multiple phases of care
  • APPLICATIONS: Pediatrics

Study Design

  • Randomized, controlled trial

Measurement Instruments/Methods

  • Visual analog score (VAS) for pain ratings by children and parents, similar VAS for anxiety rated by parents
  • Observation of duration of crying by an independent trained observer
  • Wong-Baker FACES Pain Rating scale used for the children

Results

The duration of the child crying was significantly shorter with the clown group than in the control group (p = 0.01). The duration of crying prior to the procedure was significantly shorter in the clown group compared to the EMLA cream group (p < 0.05) and control group (p < 0.01). The child’s assessment of pain was significantly less in the EMLA group compared to the control group (p = 0.04), but no difference existed between the clown and control groups. The parent’s assessment of the child’s pain was lowest in the clown group (p < 0.05 between all groups). Parent’s assessment of future anxiety was significantly lower in the clown group than the EMLA group or control group (p < 0.05).

Conclusions

The use of the medical clown had a positive effect on parents’ anxiety for future venipuncture as well as anticipatory crying duration and perception of pain in children.

Limitations

  • Baseline sample/group differences of import
  • Risk of bias (no blinding)
  • Possible differences in children’s diagnoses and reason for venipuncture

Nursing Implications

Nurses should be aware of alternative methods such as the use of a medical clown for distracting or controlling children’s pain. Although medicine is shown to have a significant effect on the child’s pain, these methods can assist with both children and parents’ anxiety and management of pain.

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