This study investigated whether a clown doctor intervention could reduce preoperative anxiety in children hospitalized for minor surgery and in their parents. A randomized controlled trial was conducted with 77 children and 119 parents: the clown group consisted of 52 children accompanied in the preoperating room by their parents (n = 89) and two clowns while the comparison group consisted of children accompanied by the parents only. The clown intervention significantly reduced the children’s preoperative anxiety: children benefited from the clown’s presence and showed better adjustment than children in the comparison group. Mothers in Comparison Group showed higher anxiety.
AdamsMJewellAP (2007) The use of complementary and alternative medicine by cancer patients. International Seminars in Surgical Oncology4(10): 1–7.
2.
BarnesPMBloomBNahinRL (2008) Complementary and alternative medicine use among adults and children: United States, 2007. National Health Statistics Reports, Report no. 12, 13December. Hyattsville, MD: National Center for Health Statistics.
3.
BennettMPLengacherC (2008) Humor and laughter may influence health: III. Laughter and health outcomes. Evidence-Based Complementary and Alternative Medicine5(1): 37–40.
4.
BertiniMIsolaEPaoloneG. (2010) Clowns benefit children hospitalized for respiratory pathologies. Evidence-Based Complementary and Alternative Medicine. Epub ahead of print 15 March 2011. DOI: 10.1093/ecam/neq064.
5.
BrewerSGleditschSLSyblikD. (2006) Pediatric anxiety: Child life intervention in day surgery. Journal of Pediatric Nursing21(1): 13–22.
6.
CaldasJCPais-RibeiroJLCarneiroSR (2004) General anaesthesia, surgery and hospitalization in children and their effects upon cognitive, academic, emotional and socio-behavioural development: A review. Paediatric Anaesthesia14(11): 910–915.
7.
ChahalNManlhiotCColapintoK. (2009) Association between parental anxiety and compliance with preoperative requirements for pediatric outpatient surgery. Journal of Pediatric Health Care23(6): 372–377.
8.
DionigiAFlanginiRGremigniP (2012) Clowns in hospitals. In: GremigniP (ed.) Humor and Health Promotion. New York: Nova Science Publisher, pp. 213–228.
9.
FernandesSArriagaP (2010) The effects of clown intervention on worries and emotional responses in children undergoing surgery. Journal of Health Psychology15(3): 405–415.
10.
GolanGDobijaNLazarA. (2007) Clowns as a treatment for preoperative anxiety in children: A randomized controlled trial. Anaesthesia107: A1394.
11.
HansenLKKibaekMMartinussenT. (2011) Effect of a clown’s presence at botulinum toxin injections in children: A randomized, prospective study. Journal of Pain Research4: 297–300.
12.
HeHGJahjaRLeeTL. (2010) Nurses’ use of non-pharmacological methods in children’s postoperative pain management: Educational intervention study. Journal of Advanced Nursing66(11): 2398–2409.
13.
KainZNCaldwell-AndrewsAA (2005) Preoperative psychological preparation of the child for surgery: An update. Anesthesiology Clinics of North America23(4): 597–614.
14.
KainZNCaldwell-AndrewsAAKrivutzaDM. (2004) Interactive music therapy as a treatment for preoperative anxiety in children: A randomized controlled trial. Anesthesia and Analgesia98(5): 1260–1266.
15.
KainZNMaclarenJMayesLC (2009) Perioperative behavior stress in children. In: CoteCJLermanJTodresID (eds) A Practice of Anesthesia for Infants and Children. Philadelphia, PA: Saunders Elsevier, pp. 25–36.
16.
KainZNMayesLCCicchettiDV. (1995) Measurement tool for preoperative anxiety in young children: The Yale Preoperative Anxiety Scale (YPAS). Child Neuropsychology85(1): 203–210.
17.
KainZNMayesLCWangSM. (1998) Parental presence during induction of anesthesia versus sedative premedication: Which intervention is more effective?Anesthesiology89(5): 1147–1156.
18.
KaranciANDirikG (2003) Predictors of pre and postoperative anxiety in emergency surgery patients. Journal of Psychosomatic Research55(4): 363–369.
19.
KesslerJMarchantPJohnsonMI (2006) A study to compare the effects of massage and static touch on experimentally induced pain in healthy volunteers. Physiotherapy92(4): 225–232.
20.
KollerDGryskiC (2008) The life threatened child and the life enhancing clown: Towards a model of therapeutic clowning. Evidence-Based Complementary and Alternative Medicine5(1): 17–25.
21.
LamontagneLLHepworthJTSalisburyMH. (2003) Optimism, anxiety, and coping in parents of children hospitalized for spinal surgery. Applied Nursing Research16(4): 228–235.
22.
LiHCW (2007) Evaluating the effectiveness of preoperative interventions: The appropriateness of using the children’s emotional manifestation scale. Journal of Clinical Nursing16(10): 1919–1926.
23.
McCannMEKainZN (2001) The management of preoperative anxiety in children: An update. Anesthesia and Analgesia93(1): 98–105.
24.
McGheePE (2010) The Lighter Path to Resilience and Health. Bloomington, IN: AuthorHouse.
25.
PölkkiTPietilaAMVehvilainen-JulkunenK. (2008) Imagery-induced relaxation in children’s postoperative pain relief: A randomized pilot study. Journal of Pediatric Nursing23(3): 217–224.
26.
SmerlingAJSkolnickEBagiellaE. (1999) Preoperative clown therapy for pediatric patients. Anesthesia and Analgesia88(2): 243–256.
27.
SpielbergerCD (1983) Manual for the State-Trait Anxiety Inventory (“Self-Evaluation Questionnaire”). Palo Alto, CA: Consulting Psychologists.
28.
StargattRDavidsonAJHuangGH. (2006) A cohort study of the incidence and risk factors for negative behavior changes in children after general anesthesia. Paediatric Anaesthesia16(8): 846–859.
29.
TenerDLangNOfirS. (2011) The use of medical clowns as a psychological distress buffer during anogenital examination of sexually abused children. Journal of Loss & Trauma17(1): 12–22.
30.
VagnoliLBastianiCTurchiF. (2007) Preoperative anxiety in pediatrics: Is clown’s intervention effective to alleviate children discomfort?Algia Hospital2(2): 114–119.
31.
VagnoliLCaprilliSRobiglioA. (2005) Clown doctors as a treatment for preoperative anxiety in children: A randomized, prospective study. Pediatrics116(4): 563–567.
32.
WarrenB (2008) Healing laughter: The role and benefits of clown-doctors working in hospitals and healthcare. In: WarrenB (ed.) Using the Creative Arts in Therapy and Healthcare. London and New York: Routledge, pp. 213–228.
33.
WrayJKirstyLDearmunN. (2011) Parental anxiety and stress during children’s hospitalisation: The StayClose study. Journal of Child Health Care15(3): 163–174.
34.
WrightKDStewartSHFinleyGA. (2007) Prevention and intervention strategies to alleviate preoperative anxiety in children. Behavior Modification31(1): 52–79.
35.
YipPMiddletonPCynaAM. (2009) Non-pharmacological interventions for assisting the induction of anaesthesia in children. Cochrane Database of Systematic Reviews3: CD006447.
