Medical Clowning in Hospitalized Children: A META-analysis and a Review of the Literature

Background: Medical clowning (MC) has proven effectiveness in reducing pain, anxiety, and stress, in many sporadic, usually small-scale studies.

Objective: The aim of our meta-analysis is to evaluate efficiency of MC in reducing pain and anxiety in hospitalized pediatric patients.

Methods: A thorough literature search was conducted from different databases. Only Randomized Controlled Trials (RCTs) were included with children aged 0 to 18 years old. A total of 18 studies were included, a statistical analysis was performed on the combined data.

Results: A total of 912 children (14 studies) showed significantly reduced anxiety when procedures were performed with a MC compared to control, (−0.76 on anxiety score, P<0.0001). Preoperative anxiety was lower in 512 children (9 studies) with clown intervention compared to control (-0.78, p=0.0007). Pain scale was completed by 338 participants (6 studies), indicating a trend toward reduced pain during procedures performed while clown was acting compared to controls (-0.49, p=0.06).

Conclusions: MC is associated with substantial positive and beneficial effects on reducing stress and anxiety in hospitalized children and their families in various circumstances in pediatrics.