Clowns Help Children with Respiratory Infections Get Well Faster

Study examines humor as a therapeutic modality for hospitalized children

By Jacob Schor, ND, FABNO

About The Author

Jacob Schor ND, FABNO, is a graduate of National College of Naturopathic Medicine and now practices in Denver. He served as president to the Colorado Association of Naturopathic Physicians, and is now on the board of directors of the Oncology Association of Naturopathic Physicians and is recognized as a Fellow by the American Board of Naturopathic Oncology. He serves on the editorial board for the International Journal of Naturopathic Medicine. In 2008, he was awarded the Vis Award by the American Association of Naturopathic Physicians. His writing appears often in Naturopathy Digest and Naturopathic Doctor News and Review.

Reference

Bertini M, Isola E, Paolone G, Curcio G. Clowns benefit children hospitalized for respiratory pathologies. Evid Based Complement Alternat Med. 2011;2011:879125.

Design

A randomized, controlled trial in which half of the participants underwent the experimental intervention and the other half did not. The experimental and control group were matched by age, family’s socioeconomic and cultural background, and disease state. The study was carried out in the Pediatrics Department of San Camillo Hospital in Rome, Italy, during 2008.

Participants

Forty-three children with respiratory pathologies participated in the study; 21 children were in the experimental group (13 boys and 9 girls). Mean age was 7 years 9 months. The control group had 22 children (13 boys and 9 girls), and their mean age was 7 years 6 months. The diagnosed pathologies of participants were similar between both groups and included pharyngitis, tonsillitis, tracheitis and laryngo-tracheitis, pneumonia, bronchitis, and broncho-pneumonia.

Study Intervention

During their hospitalization the experimental group, in groups of 7 or 8 participants at a time, interacted with 2 clowns who were experienced with working with hospitalized children. Each clown sessions lasted 3 hours.

Outcome Measures

Assessments made to measure the effect of the clown sessions included duration of stay in the hospital, duration of the fever period, and time taken to achieve clinical recovery.

Physiological measurements were recorded before and after the clown sessions and included systolic and diastolic blood pressure, heart rate, breath rate, and body temperature. Pain levels were evaluated using both subjective and objective rating scales by both self evaluation and evaluation by nursing staff.

Key Findings

Symptoms of illness disappeared earlier in the children who participated in the clown therapy compared to the control group that did not. The clown interaction also led to significantly lower diastolic blood pressure and respiratory frequency. Systolic blood pressure and heart rate also declined but did not reach significance. Pain and self-evaluations by patients and evaluations by nursing staff also showed non-significant improvements. The authors conclude: “Thus, humor can be seen as an easy-to-use, inexpensive and natural therapeutic modality to be used within different therapeutic settings.”

Up to this point most of the data on laughter and healing has focused on only immune function, in particular the effect of laughter on allergic and autoimmune responses with very little if any measurement of effect on acute infectious illnesses.

Practice Implications

Being in a hospital can be a unique and terrifying experience for a young child. This is especially true of children who must undergo anesthesia and surgery. While keeping the parents—in particularly the child’s mother—present decreases anxiety, the children often require anti-anxiety medications.1,2 A number of hospitals employ clowns to decrease anxiety in their young patients. A series of studies tell us this is effective at decreasing anxiety in a number of hospital situations.3-6

This appears to be the first paper that demonstrates a significant therapeutic benefit from clown interventions. In this case, there was an apparent faster recovery from illness.

The study’s authors posit that the laughter anDuring their hospitalization the experimental group of children interacted with 2 clowns who were experienced with working with hospitalized children. Assessments made to measure the effect of the clown sessions included duration of stay in the hospital, duration of the fever period and time taken to achieve clinical recovery.d good humor engendered by the clowns reduced stress and anxiety levels and led to improved immune, endocrine, and in particular adrenal function, resulting in faster recovery. Up to this point most of the data on laughter and healing has focused on only immune function—in particular the effect of laughter on allergic and autoimmune responses—with very little if any measurement of effect on acute infectious illnesses. The results of this study suggest a wider application of humor and laughter to a wider range of medical conditions.

References

1. Messeri A, Caprilli S, Busoni P. Anaesthesia induction in children: a psychological evaluation of the efficiency of parents' presence. Paediatr Anaesth. 2004 Jul;14(7):551-6.
2. Caprilli S, Messeri A, Busoni P. [Preoperatory anxiety in children: psychological evaluation of premedication and parental presence efficacy]. Pediatr Med Chir. 2004 May-Jun;26(3):169-74.[Article in Italian]
3. Fernandes SC, Arriaga P. The effects of clown intervention on worries and emotional responses in children undergoing surgery. J Health Psychol. 2010 Apr;15(3):405-15.
4. Vagnoli L, Caprilli S, Robiglio A, Messeri A. Clown doctors as a treatment for preoperative anxiety in children: a randomized, prospective study. Pediatrics. 2005 Oct;116(4):e563-7.
5. Vagnoli L, Caprilli S, Messeri A. Parental presence, clowns or sedative premedication to treat preoperative anxiety in children: what could be the most promising option? Paediatr Anaesth. 2010 Oct;20(10):937-43.
6. Kingsnorth S, Blain S, McKeever P. Physiological and emotional responses of disabled children to therapeutic clowns: a pilot study. Evid Based Complement Alternat Med. 2011;2011:732394.

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