title: A quasi randomized-controlled trial to evaluate the effectiveness of clowntherapy on children's anxiety and pain levels in emergency department.
abstract: The aim of the study is to investigate if the presence of medical clowns during painful procedures in the emergency department (ED) affects children's anxiety and pain. Forty children (4-11 years) admitted to the ED with the need of painful procedures were prospectively enrolled. They were randomly assigned to the clown group, where children interacted with clowns or to the control group in which they were entertained by parents and ED nurses. The children's anxiety was assessed by the Children's Anxiety and Pain Scales; pain was evaluated with the Numerical Rating Scale and Wong-Backer Scale, according to the children's age. Staff and clown's opinions were evaluated by means of dedicated questionnaires. Children's anxiety levels in the clown group were significantly lower than those compared with the control group, while children's pain levels did not change between the two groups.
  
  
  CONCLUSIONS
  The presence of clowns in the ED before and during painful procedures was effective in reducing children's anxiety.
  
  
  BACKGROUND
  • Anxiety and fear caused by medical procedures exacerbate children's pain and may interfere with the procedure. • To reduce anxiety, fear, and pain and to facilitate patient's evaluation, different non-pharmacological approaches have been proposed and positive effects of laughter and humor have been reported. What is New: • The presence of clowns in the waiting room and in the ED during medical evaluation and painful procedures helps to reduce children's anxiety.
authors.affiliation: Division of Child Neuropsychiatry Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Felluga
authors.affiliation: Departement of Pediatrics, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.|Departement of Pediatrics, University of Trieste, Trieste, Italy.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Rabach
authors.affiliation: Departement of Pediatrics, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy. martaminute@gmail.com.|Departement of Pediatrics, University of Trieste, Trieste, Italy. martaminute@gmail.com.
authors.forename: Marta
authors.initials: M
authors.lastname: Minute
authors.affiliation: Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
authors.forename: Marcella
authors.initials: M
authors.lastname: Montico
authors.affiliation: Departement of Pediatrics, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Giorgi
authors.affiliation: Division of Child Neuropsychiatry Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
authors.forename: Isabella
authors.initials: I
authors.lastname: Lonciari
authors.affiliation: Departement of Pediatrics, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.|Departement of Pediatrics, University of Trieste, Trieste, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Taddio
authors.affiliation: Departement of Pediatrics, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
authors.forename: Egidio
authors.initials: E
authors.lastname: Barbi
mesh_terms: D001007:Anxiety / Q000209:etiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D027641:Laughter Therapy / Q000379:methods*; D008297:Male; D010146:Pain / Q000150:complications* / Q000175:diagnosis; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Anxiety; Clown therapy; Emergency department; Procedural pain