Acute Procedural Pain in Children: Intervention with the Hospital Clown

INTRODUCTION: Hospitalized children often describe needle-related procedures as the worst pain possible and such procedures may be emotionally traumatic. The use of hospital clowns related to painful medical procedures in children may offer pain relief, but this has not been systematically evaluated. The objective of this study was to assess the effect of a therapeutic clown in comparison to standard care on the experience of pain for children receiving venipuncture.

METHODS: A sample of 116 children aged 4-15 years consecutively admitted to the hospital was allocated to either the experimental (presence of hospital clown) or control group (standard care) prior to venipuncture. Self-reported pain after the procedure was assessed using the FACES Pain Scale combined with a 0-10 Numerical Rating Scale. Separate analysis was done in age groups from 4-6 (N=37) and 7-15 (N=74) years.

RESULTS: Without the clown present, the mean pain score (2.7±2.8) was not significantly different between the two age groups. Children aged 7-15 years had lower pain scores when the clown was present compared to the control group (P=0.025). Children aged 4-6 years had higher pain scores with the clown present although the difference is not statistically significant (P=0.054). Children with pain (N=49) or previous experiences with venipuncture (N=56) did not score pain significantly differently.

DISCUSSION: Assessing the pain experience in children receiving venipuncture with the presence of a hospital clown indicates a pain relieving effect for children older than 6 years. However, future studies should carefully study the effects for younger children where mixed effects may be present.