A quasi randomized-controlled trial to evaluate the effectiveness of clowntherapy on children's anxiety and pain levels in emergency department

Eur J Pediatr. 2016 May;175(5):645-50. doi: 10.1007/s00431-015-2688-0. Epub 2016 Jan 12.


The aim of the study is to investigate if the presence of medical clowns during painful procedures in the emergency department (ED) affects children's anxiety and pain. Forty children (4-11 years) admitted to the ED with the need of painful procedures were prospectively enrolled. They were randomly assigned to the clown group, where children interacted with clowns or to the control group in which they were entertained by parents and ED nurses. The children's anxiety was assessed by the Children's Anxiety and Pain Scales; pain was evaluated with the Numerical Rating Scale and Wong-Backer Scale, according to the children's age. Staff and clown's opinions were evaluated by means of dedicated questionnaires. Children's anxiety levels in the clown group were significantly lower than those compared with the control group, while children's pain levels did not change between the two groups.

Conclusion: The presence of clowns in the ED before and during painful procedures was effective in reducing children's anxiety.

What is known: • Anxiety and fear caused by medical procedures exacerbate children's pain and may interfere with the procedure. • To reduce anxiety, fear, and pain and to facilitate patient's evaluation, different non-pharmacological approaches have been proposed and positive effects of laughter and humor have been reported. What is New: • The presence of clowns in the waiting room and in the ED during medical evaluation and painful procedures helps to reduce children's anxiety.

Keywords: Anxiety; Clown therapy; Emergency department; Procedural pain.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Anxiety / etiology
  • Anxiety / therapy*
  • Child
  • Child, Preschool
  • Emergency Service, Hospital*
  • Female
  • Follow-Up Studies
  • Humans
  • Laughter Therapy / methods*
  • Male
  • Pain / complications*
  • Pain / diagnosis
  • Pain Management / methods*
  • Pain Measurement
  • Prospective Studies
  • Surveys and Questionnaires
  • Treatment Outcome