Clown helps child with anxiety and pain in hospital

A red nose and then a child’s smile. Children accompanied by hospital clowns report less anxiety and pain when undergoing medical procedures than children accompanied by their parents. This is according to research by psychologist Heike Gerger of Erasmus MC University Medical Center Rotterdam.

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Source Cliniclowns. Photography Ditta van Gent

Anxiety and pain in the hospital are detrimental in the short and long term. They potentially impede smooth medical treatment. Furthermore, anxiety and pain during the hospital stay create a negative experience that children can carry with them for a long time. Having a clown present when undergoing medical procedures helps the children coping with pain and anxiety, according to research by psychologist Heike Gerger of the Department of General Practice of Erasmus MC in the Netherlands in collaboration with Laura Caci and Thea Zander-Schellenberg from Switzerland.

Gerger: ‘Of course every parent wants to protect his or her child. With well-meaning comments such as: ‘It’s not so bad or everything is fine’, they try to calm their children. But if parents themselves are tense, the child notices this right away. This does not improve the situation.’

psychologist Heike Gerger. Jonathan Vos Photography


The effect of the hospital clown is similar to other methods that aim to reduce anxiety and pain. Think of a nurse that is distracting the child’s attention or the presence of animals. ‘Different activities which distract the children’s attention from the medical treatment are effective’, Gerger said.

Worldwide, clowns have been active in hospitals for years. Usually, they work for external organizations, separate from hospitals. They are rarely part of the health care system, such as in Israel.

Valuable addition to care

Gerger analyzed 28 existing studies from 9 different countries. The studies compared the effect of clowns with other methods of reducing pain and anxiety, such as sedative or anxiolytic medication, other distraction methods and parental presence. The children underwent medical procedures such as blood sampling or preparatory procedures for a surgery.

Gerger sees clowns as a valuable addition to care. They focus on what the child needs in a particular situation. That’s where their strength lies, she knows from conversations with nurses, parents and clowns. ‘It’s not just the laughter that evokes positive feelings. Clowns rather establish a relationship with the child which creates the feeling of trust and support in children.’


She hopes that in the future, as part of person-centered hospital care, hospital clowning will become one option for preoperative treatment that parents can choose from. ‘It improves mood and energy in many situations. But not everyone may feel for this form of distraction. Therefore, let parents and children choose between a clown, medication or other interventions which might involve distraction to reduce anxiety and pain.’

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