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A Comparison of Nonpharmacologic Interventions on the Emotional State of Children in the Emergency Department

Antonelli, Elena, BSc*; Vagnoli, Laura, MSc*†; Ciucci, Enrica, PhD; Vernucci, Chiara, BSc*; Lachi, Federica, BSc*; Messeri, Andrea, MD*

doi: 10.1097/PEC.0000000000000900
Original Articles

Objectives The majority of children and adolescents presenting to the emergency department are in pain and require painful procedures. This randomized study was to investigate the efficacy of 3 different nonpharmacologic interventions (clowns, dogs, and musicians) to reduce pain and analyze the perception of positive and negative affects after the presence of these activities in a short-stay observation unit (SSOU).

Methods Participants were composed of 105 children (54 boys and 51 girls; aged 3–16 years) assigned randomly to an experimental group (N = 57) that was composed of patients who were present in the SSOU. They received one of the following nonpharmacologic interventions: clowns (n = 18), dogs (n = 24), or musicians (n = 15) or they were assigned to a control group (CG) (N = 48) that consists of the patients who were present in the SSOU without the presence of nonpharmacologic interventions.

Results Differences among the groups did not emerge; in fact, the 3 interventions have a similar influence in a different way on a child's well-being. No significant main effect about pain emerged for both groups across age and sex.

Conclusions The presence of different nonpharmacologic interventions (clowns, dogs, and musicians) seemed to empower positive affect in children but did not influence the self-reported pain.

From the *Pain Therapy & Palliative Care and

Pediatric Psychology Service, Meyer Children's Hospital; and

Department of Education and Psychology, University of Florence, Florence, Italy.

Disclosure: The authors declare no conflict of interest.

Reprints: Laura Vagnoli, MSc, Pain Service and Palliative Care, Meyer Children's Hospital, Via G. Pieraccini 24, 50139 Florence, Italy (e-mail:

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