Therapeutic clowns in pediatrics: a systematic review and meta-analysis of randomized controlled trials

Eur J Pediatr. 2016 Oct;175(10):1353-60. doi: 10.1007/s00431-016-2764-0. Epub 2016 Sep 8.


Children and/or their parents are in fear and anxiety when admitted to hospitals or undergo invasive surgeries or investigations. Clown therapy has been shown as an effective measure in reducing this hospital fear and anxiety. Hence, we carried out a systematic compilation of the existing evidence on the clinical utility of hospital clowns in pediatric population. Electronic databases were searched with an appropriate search strategy, and only randomized controlled trials comparing the effect of clown therapy with standard care in children were included. The key outcome measures were as follows: extent of anxiety and pain felt by children and extent of state and trait parental anxiety. Random effect model was applied when moderate to severe heterogeneity was observed. Forest plot, I(2) statistics and risk of bias were evaluated using RevMan 5.3 software. A total of 19 studies were found eligible to be included in the systematic review and 16 for meta-analysis. The pooled SMD [95 % CI] for child anxiety score was -0.83 [-1.16, -0.51] favoring clown therapy. Similarly, a statistically significant reduction {SMD [95 % CI] -0.46 [-0.7, -0.21]} in the state anxiety was observed amongst parents.

Conclusion: We found that hospital clowns play a significant role in reducing stress and anxiety levels in children admitted to hospitals as well as their parents.

What is known: • Trials with clown doctors in pediatric population have shown conflicting results in allaying anxiety amongst children undergoing either hospitalization or invasive procedures What is new: • This is the first systematic review and meta-analysis on hospital clowns • We found out that hospital clowns reduce anxiety amongst children before undergoing either hospitalization or invasive procedures.

Keywords: Children; Hospital clowns; Medical clowns.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Anxiety / prevention & control*
  • Child
  • Child, Hospitalized / psychology*
  • Female
  • Hospitalization
  • Humans
  • Laughter Therapy*
  • Pain Management / methods*
  • Pain Management / psychology
  • Pain Measurement
  • Parents / psychology*
  • Pediatrics
  • Randomized Controlled Trials as Topic
  • Stress, Psychological / prevention & control*