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Effectiveness of clown intervention for pain relief in children: A systematic review and meta-analysis
Yiwen Ding1, Huiru Yin1, Shuo Wang1
1School of Nursing, Jilin University, Changchun, China.
Insights
Clown intervention effectively reduces pain and crying in children aged 2-7 years undergoing medical procedures. This non-pharmacological approach also shortens hospital stays, though its impact on cortisol levels requires further study.
Area of Science:
- Pediatric medicine
- Pain management
- Non-pharmacological interventions
Background:
- Pain during medical procedures is common in children.
- Inadequate pain management leads to stress and prolonged hospitalization.
- Clown intervention shows potential but research findings are conflicting.
Purpose of the Study:
- To assess the effectiveness of clown intervention for pediatric pain relief.
- To evaluate its impact on cortisol levels, crying duration, and hospital stay length.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials.
- Searched multiple databases (PubMed, Embase, PsycINFO, etc.) up to December 2020.
- Assessed risk of bias using Cochrane tool; PRISMA guidelines followed.
Main Results:
- Nine studies with 852 children included.
- Clown intervention significantly reduced pain compared to standard care.
- More effective in children aged 2-7 years; reduced crying and hospital stay duration.
- No significant difference observed in cortisol levels.
Conclusions:
- Clown intervention is a promising method for acute pediatric pain relief, particularly for ages 2-7.
- It may reduce crying duration and hospital length of stay.
- Further high-quality trials are needed to confirm effects across diverse populations and age groups.
Background:
Pain is common in children receiving medical procedures, and there is a lack of adequate awareness and management. In addition, children who undergo medical procedures involving pain may also experience stress, crying and prolonged hospitalisation. Clown intervention is a promising nonpharmacological intervention. However, studies on the effectiveness of clown intervention in pain management have reported conflicting findings.
Objective:
To evaluate the effectiveness of clown intervention in relieving pain in children, as well as its effects on cortisol levels, crying duration and length of hospital stay.
Design:
Systematic review and meta-analysis of randomised controlled studies.
Data Sources:
PubMed, Web of Science (SCI), Embase, PsycINFO, the Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Weipu (VIP), Wanfang Data and SinoMed were systematically searched from inception date to December 31, 2020.
Review Methods:
Two reviewers independently used the Cochrane risk of bias tool to assess the risk of bias of the included studies. Meta-analysis was conducted when data were available, otherwise, a narrative description was provided. Data were analysed using Review Manager 5.3. The review process is reported according to PRISMA.
Results:
Nine studies including 852 children met the inclusion criteria. The results showed that compared with standard care, clown intervention was beneficial for relieving pain. Further subgroup analysis showed that it was more effective with children aged 2-7 years. The duration of crying after the procedure and the length of stay were shortened, but there was no significant difference in cortisol levels.
Conclusion:
Clown intervention may be a promising way to relieve acute pain in children, especially those aged 2-7 years. It also seems to shorten the duration of crying and the length of hospital stays, but the effect on cortisol levels is still uncertain. More high-quality randomised controlled trials are needed to confirm these results and take into account different age groups, cultural backgrounds and specific populations.
