Medical clowning in hospitalized children: a meta-analysis

Medical clowning in hospitalized children: a meta-analysis

Kasem Ali Sliman, R. Meiri, N. Pillar, G.
World Journal of Pediatrics
BACKGROUND: Medical clowning has been proven effective in reducing pain, anxiety, and stress in many sporadic, usually small-scale studies. Our meta-analysis aims to evaluate the efficiency of medical clowns in reducing pain and anxiety in hospitalized pediatric patients and their parents in different medical fields. METHODS: A thorough literature search was conducted from different databases, and only randomized controlled trials (RCTs) were included with children aged 0 to 18 years old. A total of 18 studies were included, and 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 medical clown compared with the controls (- 0.76 on anxiety score, P < 0.001). Preoperative anxiety was lower in 512 children (nine studies) with clown interventions than in the controls (- 0.78, P < 0.001). The pain scale was completed by 338 participants (six studies), indicating a trend toward reduced pain during procedures performed while the clown was acting compared to controls (- 0.49, P = 0.06). In addition, medical clown significantly (- 0.52, P = 0.001) reduced parental anxiety in 489 participants in ten studies; in six of the ten studies, with a total of 380 participants, medical clown significantly reduced parental preoperative anxiety (P = 0.02). CONCLUSION: Medical clowns have substantial positive and beneficial effects on reducing stress and anxiety in children and their families in various circumstances in pediatrics. Copyright © 2023. The Author(s).

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Type of intervention

Early Intervention


Mental Health Problems and Disorders

Anxiety Problems

Anxiety and Anxiousness

Biological Risk Factors, Diseases and Symptoms

Somatic Disease

Medical Procedures


Psychosocial Treatments

Relaxation Interventions

Age group

Infants and Toddlers (0-2 years)

Preschool Aged Children (3-5 years)

School Aged Children (6-12 years)

Adolescents (13-18 years)

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