Clown Intervention May Reduce Pain, Health Care Utilization in Children

Researchers investigated the effectiveness of clown intervention for relieving pain in young children.

Clown intervention for children aged 2 to 7 years may be effective for reducing acute pain, the duration of crying, and the length of hospital stay, according to study findings published in the Journal of Clinical Nursing.

For the systematic review and meta-analysis, researchers from Jilin University in China searched publication databases through December 2020 for randomized clinical trials of clown intervention for acute pain among children. A total of 9 trials were included in the qualitative synthesis and 8 trials in the quantitative synthesis.

Collectively, the trials comprised 852 children and adolescents aged 2 to 17 years. The children had pain related with respiratory pathologies, surgery with anesthesia, intravenous cannulation, allergy skin prick tests, blood exams or venipuncture, and cavity filling.

The clown intervention was found to significantly reduce pain scores (standardized mean difference [SMD], -0.77; 95% CI, -1.06 to -0.47; P <.001; I2, 70%). Stratified by age, the clown intervention was more effective for children aged 2 to 7 years (SMD, -0.26; 95% CI, -1.36 to -0.36; P <.001; I2, 7%) than for those aged over 7 years (SMD, -0.86; 95% CI, -0.76 to 0.23; P =.300; I2, 0%).

The clown intervention significantly reduced the duration of crying after the procedure (SMD, -0.93; 95% CI, -1.72 to -0.13; P =.020; I2, 86%) and tended to decrease crying prior to the procedure (SMD, -1.24; 95% CI, -2.63 to 0.15; P =.08; I2, 95%).

In 2 studies, the clown intervention decreased hospital stay (P =.041) and postoperative nursing time (P =.017).

There was no relationship between the clown intervention and serum cortisol (SMD, 0.35; 95% CI, -0.61 to 1.30; P =.470; I2, 82%).

This study was limited by the low quality of the underlying studies.

“To more comprehensively assess the effectiveness of clown intervention in alleviating pain in children, a larger-scale and higher methodological quality randomized controlled trials are needed in the future, and these trials should take into account different age groups, cultural backgrounds and specific populations, such as people with cancer and other forms of chronic pain,” the study authors noted.


Ding Y, Yin H, Wang S, et al. Effectiveness of clown intervention for pain relief in children: A systematic review and meta-analysis. J Clin Nurs. Published online January 5, 2022. doi:10.1111/jocn.16195