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Acute Procedural Pain in Children

Intervention With the Hospital Clown

Kristensen, Helle Nygaard, RN, MCN*,†,‡; Lundbye-Christensen, Søren, PhD‡,§; Haslund-Thomsen, Helle, PhD†,‡,∥; Graven-Nielsen, Thomas, DMSc; Elgaard Sørensen, Erik, PhD†,‡

doi: 10.1097/AJP.0000000000000625
Original Articles

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 (HCs) 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 with standard care on the experience of pain in children receiving venipuncture.

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

Results: Without the clown present, the mean pain score (2.7±2.8) was not significantly different between the 2 age groups. Children aged 7 to 15 years had lower pain scores when the clown was present compared with the control group (P=0.025). Children aged 4 to 6 years had higher pain scores with the clown present, although the difference was 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 of children receiving venipuncture with the presence of an HC indicates a pain relieving effect for children older than 6 years. However, future studies should carefully study the effects on younger children where mixed effects may be present.

*Department of Pediatric

Clinical Nursing Research Unit

§Unit of Clinical Biostatistics

Clinic for Anesthesiology, Child Diseases, Circulation and Women, Aalborg University Hospital

Departments of Clinical Medicine

Health Sciences and Technology, Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg, Denmark

Supported by The Danish Child Cancer foundation, Copenhagen, Denmark; The North Denmark Region Health Science Foundation, Aalborg, Denmark; The Clinical Nursing Research Unit, Aalborg University Hospital, Denmark. The Danish National Research Foundation (DNRF121), Aalborg University, Denmark supports center for Neuroplasticity and Pain (CNAP). The authors declare no conflict of interest.

Reprints: Helle Nygaard Kristensen, RN, MCN, Søndre Skovvej 15, Aalborg 9000, Denmark (e-mail:

Received December 3, 2017

Received in revised form April 16, 2018

Accepted April 19, 2018

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