title: Medical clowns ease anxiety and pain perceived by children undergoing allergy prick skin tests.
abstract: BACKGROUND
  Intervention of medical clowns (MC) during various medical procedures performed in children has been used to relieve anxiety and pain. Their role in allergy skin testing has never been evaluated.
  
  
  OBJECTIVE
  To evaluate whether MC can diminish pain and anxiety perceived by children undergoing allergy skin prick tests (SPT).
  
  
  METHODS
  In a prospective, randomized, controlled, and blinded study, children undergoing SPT were or were not accompanied by MC. All parents and children ≥8 years completed the State-Trait Anxiety Inventory (STAI) before and after SPT. Videotapes recorded during the procedure were scored for anxiety (m-YPAS) for all children and for pain (FLACC) for children 2-7 years old by a psychologist who was unaware of the MC's presence. After SPT, children ≥8 years completed a visual analog score (VAS) for pain.
  
  
  RESULTS
  Ninety-one children (mean age 8.2 years, M/F = 54/37) were recruited of whom 45 were accompanied by clowns. A significant reduction in state-STAI was found in the clowns group, in both parents and children, when compared with the regular group (26.9 ± 6.6 and 32.3 ± 10.0; P = 0.004, and 27.1 ± 4.2 and 34.3 ± 7.6; P = 0.002, respectively). Both m-YPAS and FLACC were reduced in the clowns group compared with the regular one. In the clowns group, m-YPAS positively correlated with both VAS and FLACC (P = 0.000 and 0.002, respectively). m-YPAS was positively correlated with FLACC in the regular group (P = 0.000).
  
  
  CONCLUSIONS
  Medical clowns significantly decrease the level of anxiety perceived by both children undergoing allergy SPT and their parents, as well as the pain perceived by young children.
authors.affiliation: The Allergy and Clinical Immunology Unit, Meir Hospital, Kfar-Saba affiliated with The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Goldberg
authors.forename: T
authors.initials: T
authors.lastname: Stauber
authors.forename: O
authors.initials: O
authors.lastname: Peleg
authors.forename: P
authors.initials: P
authors.lastname: Hanuka
authors.forename: L
authors.initials: L
authors.lastname: Eshayek
authors.forename: R
authors.initials: R
authors.lastname: Confino-Cohen
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis*; D008297:Male; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D012882:Skin Tests / Q000009:adverse effects* / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: anxiety; medical clowns; pain; skin prick test