title: Fear of clowns in hospitalized children: prospective experience.
abstract: Medical clowns (MC) have become an integral part of the pediatric staff of hospital wards. While several studies have demonstrated the huge benefits of MC, there are almost no data regarding fear of clowns, a known phenomenon that means an irrational fear of clowns. In the current study, we sought to examine the prevalence of fear of clowns in pediatrics wards, and to characterize the affected children. The clinical work of three certified MCs was prospectively assessed. Every child with fear of clowns was noted, data were retrieved from the medical records, and the parents/child completed a specific questionnaire with a research assistant. Fear of clowns was defined as crying, anxiety response or effort to avoid contact with the MCs in small children, while in older children, it was determined if the child either reported fear of MCs or made actions to avoid clowns' intervention. A total of 1160 children participated in the study. All were hospitalized in the department of pediatrics or the pediatric emergency medicine department at Carmel Medical Center, and were exposed to a MC intervention session. Of the 1160 children, 14 children experienced fear of clowns (1.2%). The average age of children who experienced fear of clowns was 3.5 years (range 1-15). Interestingly, most of the children demonstrating fear of clowns were girls (12 out of 14, 85.7%). We found no association between fear of clowns and specific diagnosis, fever, clinical appearance, religion, or ethnicity.
  
  
  CONCLUSIONS
  The prevalence of fear of clowns in the general pediatric hospitalized population was 1.2%, with a significant predominance of girls (85.7%). Children who experienced significant fear of clowns also experienced significant fear of encountering or thinking about a MC visit. Fear of clowns can affect children at any age (range 1-15), any ethnicity, religion, or degree of illness. Further large scale studies are required to better understand this unique phenomenon of fear of clowns. What is Known: • Fear of clowns is a phenomenon known for more than several decades and related to the increased use of clowns as negative characters in horror movies and TV shows. • The increased use of medical clowns in hospital wards and corridors increases the significance of defining and characterizing this phenomenon in hospital wards. What is New: • The study is novel by giving new data related to the extent of fear of clowns in pediatrics wards and giving demographic characteristic of children experiencing fear of clowns.
authors.affiliation: Department of Pediatrics and Pediatric Emergency Medicine, Carmel Medical Center and Technion Faculty of Medicine, Haifa, Israel. noam44@gmail.com.
authors.forename: Noam
authors.identifier: http://orcid.org/0000-0003-4339-5607
authors.initials: N
authors.lastname: Meiri
authors.affiliation: Department of Pediatrics and Pediatric Emergency Medicine, Carmel Medical Center and Technion Faculty of Medicine, Haifa, Israel.
authors.forename: Zeev
authors.initials: Z
authors.lastname: Schnapp
authors.affiliation: Department of Pediatrics and Pediatric Emergency Medicine, Carmel Medical Center and Technion Faculty of Medicine, Haifa, Israel.
authors.forename: Amichi
authors.initials: A
authors.lastname: Ankri
authors.affiliation: Department of Pediatrics and Pediatric Emergency Medicine, Carmel Medical Center and Technion Faculty of Medicine, Haifa, Israel.
authors.forename: Itay
authors.initials: I
authors.lastname: Nahmias
authors.affiliation: Department of Pediatrics and Pediatric Emergency Medicine, Carmel Medical Center and Technion Faculty of Medicine, Haifa, Israel.
authors.forename: Amnon
authors.initials: A
authors.lastname: Raviv
authors.affiliation: Department of Pediatrics and Pediatric Emergency Medicine, Carmel Medical Center and Technion Faculty of Medicine, Haifa, Israel.
authors.forename: Omer
authors.initials: O
authors.lastname: Sagi
authors.affiliation: Department of Pediatrics and Pediatric Emergency Medicine, Carmel Medical Center and Technion Faculty of Medicine, Haifa, Israel.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Hamad Saied
authors.affiliation: Department of Pediatrics and Pediatric Emergency Medicine, Carmel Medical Center and Technion Faculty of Medicine, Haifa, Israel.
authors.forename: Muriel
authors.initials: M
authors.lastname: Konopnicki
authors.affiliation: Department of Pediatrics and Pediatric Emergency Medicine, Carmel Medical Center and Technion Faculty of Medicine, Haifa, Israel.
authors.forename: Giora
authors.initials: G
authors.lastname: Pillar
mesh_terms: D000293:Adolescent; D001007:Anxiety; D002648:Child; D002673:Child, Hospitalized / Q000523:psychology* / Q000706:statistics & numerical data; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005239:Fear / Q000145:classification / Q000523:psychology*; D005260:Female; D006801:Humans; D007223:Infant; D027641:Laughter Therapy; D008297:Male; D010290:Parents; D010698:Phobic Disorders / Q000453:epidemiology / Q000523:psychology*; D015995:Prevalence; D011446:Prospective Studies; D012737:Sex Factors; D013315:Stress, Psychological; D011795:Surveys and Questionnaires
keywords: Coulrophobia; Fear of clowns; Medical clown