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Therapeutic Clowns and the Effects They Have on Hospitalized Children

Saba Ashraf's picture

Therapeutic Clowns and the Effects They Have on Hospitalized Children


            When one thinks of hospitals, one of the last things that a person would think of is a clown. However, the use of therapeutic clowns for kids and their families in hospitals has been increasing during the last decade. The job of these therapeutic clowns includes entertaining children and their families in outpatient clinic waiting rooms, distracting families in emergency rooms, comforting parents of children in intensive care units, and distracting small children during frightening medical procedures (3).   Basically, the therapeutic clowns are there to lower the anxiety levels and change the moods of child patients and their families during the stressful periods of a hospital stay. I had heard about such forms of therapy being used on children with cancer, however it was quite surprising and interesting to me to learn that the use of therapeutic clowns is prevalent throughout the pediatric unit in many hospitals located in countries across the globe. In this paper, the question of whether the presence of therapeutic clowns lowers or doesn’t lower the anxiety levels of the children and their families will be evaluated.  The effects therapeutic clowns have on vegetative children as well as children with severe brain damage will also be explored.

            In the United States, there are over 250,000 bedside visits made from the Big Apple Circus Clown Care Units (CCU), consisting of 90 clown doctors, every year (2). In fact, Michael Christensen, who was the cofounder as well as creative director of the Big Apple Circus, created this CCU in 1986 (3). While dressed as a clown, Michael Christensen recalls a time when a doctor had come up to him and said “Clowns don’t belong in hospitals (2).” However, Christensen had responded to that by saying, “Neither do children (2).” Therefore, the main reason as to why the CCU was created was because of the stress and anxiety small children face before going in for surgeries or prolonged hospital stays due to illnesses such as cancer (3). Actually, about 60% of children face anxiety in the preoperative period of a procedure due to feelings of tension, apprehension, nervousness, and worry (4). Being away from one’s home and family members only increases the anxiety children feel. In some cases, children who exhibit high levels of anxiety in the preoperative period will deal with postoperative trouble lasting for 6 months after the surgery/procedure (4). Considering such facts, it becomes clear that the children, at a time in their life where they shouldn’t face such anxiety, need some sort of outlet to decrease the anxiety they are feeling and this is where the therapeutic clowns come in. 

            In order to decrease the level of anxiety the children and their families are feeling, therapeutic clowns, in groups of two to three, are dressed in full clown and doctor costume and have bags filled with magic tricks, puppets, musical instruments, bubble solution, and any other props children find entertaining (3). Usually, therapeutic clowns will have a set schedule each day as to where they will be going in the pediatric department and they tend to stay away from rooms in which a doctor examination is taking place (3). However, there are times when clowns will accompany the children during small procedures to distract the children from what’s going on (2). Once the clowns arrive in a hospital room, therapeutic clowns will do anything from making clown noises out of respirator tubing, blowing bubbles for babies, and joking around with teenagers (3). The point that I find interesting about the way these clowns joke around is that they create more humorous images of certain frightening hospital equipment to lower the children’s anxiety, which may result from being in an unfamiliar, frightening environment. Even when certain children seem to be frightened of these clowns, they still find a way to cheer the child up. In fact there was an instance in a New York hospital where a girl in the waiting room was hiding behind her mother because of her fear of the clowns, but when the clowns started acting frightened towards the girl, she started laughing and chasing them around (3).   This particular instance shows how laughter and a minor disturbance the clowns caused in the waiting room can completely change a child’s attitude. In fact, once a child has shown a change in attitude and behavior, the therapeutic clowns decide it is time to leave, so they make sure there is some decrease in the child’s anxiety and change in mood before they move on (3).  

          Apart from entertaining the children, therapeutic clowns are also known to perform magic tricks and cheer up the family members of these hospitalized children in the waiting room or hospital room (2).   In fact, therapeutic clowns in a New York hospital were found to distract and comfort a family who had a child in a coma (3). Something that I had found very amusing was that while these clowns sang and slightly touched the girl in a coma, she started breathing more rapidly and her eyelids fluttered for a short period (3). Some clowns have even said that children have come out of coma while the clowns had been in the room (3).   Even in very serious places in the hospital such as the intensive burn unit, the clowns are seen wearing sterile gowns and caps (3). Despite the fact that the children are unable to touch the toys and props, the clowns continue their duty to make the children laugh (3). Because certain injuries seen in the intensive care units are so serious and debilitating, these are the specific places in the hospitals that the therapeutic clowns seem to be emotionally overwhelmed (3). 

          What I found really astounding while researching the roles of therapeutic clowns was that children in a vegetative state or those who had extreme disabilities were able to respond to the therapeutic clowns based on the changes they exhibited in their skin temperature, sweat level, and heart and breathing rate (1).  A study had been performed in a hospital located in Canada in which the eight children being studied exhibited conditions such as severe cerebral palsy, traumatic brain injury, and brainstem stroke (1). When the children were exposed to television, which seemed to be similar to the clowns because it also happened to be loud and colorful, no physiological changes or changes in mood were seen (1). However, when they were exposed to two clowns, each one of them displayed a different physiological change (1). The children’s skin, heart, and breathing signals had all changed with exposure to the clowns (1). The children that were able to speak or show emotions exhibited positive changes in their mood by smiling and laughing when they were visited by the clowns (1). However, those children that were unable to speak showed physiological changes, but the medical team was unable to tell whether these changes were showing happiness or sadness because these emotions look different for every child physiologically (1). Therefore, there is more research needed so that happy and sad physiological changes in different individuals can be distinguished (1). 

          A study was conducted in Anna Meyer Children’s Hospital located in Florence, Italy to test the effectiveness of therapeutic clowns while anesthesia, which causes much anxiety in small children, was given to child patients (4). Forty children, in the range of 5 to 12 years old, were assigned to 1 of 2 groups including the clown group and a control group (4). The clown group was made up of children who would be accompanied by parents and therapeutic clowns before entering the operation room and while anesthesia was being given to them (4). The control group would be comprised of children who would only be accompanied by a parent before the operation and while anesthesia was being given (4). In the clown group, the clowns would accompany the child about 30 minutes before they would enter the operation room and then stayed about 15 minutes in the operation room with the child (4). Of course, the clowns would continue to play magic tricks, games, have puppet shows, etc. in the waiting room as well as operation room for the children. Using the Modified Yale Preoperative Anxiety Scale, the state anxiety of the children would be measured (4). This scale consists of five categories, measured on a scale of 4, including activity, emotional expressivity, state of arousal, vocalization, and use of parents (4). When the state anxiety of the children was measured in the waiting room and operation room, the children in the clown group maintained the same degree of anxiety in both rooms (4). However, the children in the control group had a much higher anxiety level in the operation room than the waiting room (4). In the waiting room and operation room, the state anxiety of the children in the clown group was much lower than those in the control group (4). Using this empirical data, it was also noticed that the prescience of clowns decreased anxiety in children. 

          In a New York hospital, parents were asked to rate the therapeutic clowns on a scale from 1 to 5, 5 meaning the parents liked the therapeutic clowns the most (3). Out of 40 parents, 38 had chosen 5 and 2 had chosen 4 (3). Basically, even the parent’s views on the clowns were unanimous and it was obvious the clowns helped lower their anxiety. In fact, even when ill infants visit the hospital and are unable to really communicate with the clowns, the CCU is known to cheer up their parents, so “less stress is communicated to the infants (2).”

          I think what’s important to notice is that it is obvious that both parents and children feel positive about the therapeutic clowns. Although I have not personally encountered these therapeutic clowns in a hospital, I can only imagine what laughter and a positive attitude can do for the children and parents’ anxiety and moods. The major effects these clowns have on a child’s emotion and anxiety is especially seen in the effects they have on patients with severe brain damage and those that are in a vegetative state. One idea that was reinforced for me by researching about the therapeutic clowns was that something as simple as laughter is sometimes capable of completely changing a person’s attitude and anxiety levels. This relates to the general idea that laugher has so many positive effects on the human body. Many children are not used to being hospitalized, so when they are, these clowns offer another way for the children to emotionally express themselves.   These clowns also attempt to create a more friendlier and fun environment out of a hospital, which is seldom thought of in that way. Lastly, they also seem to empower hospitalized children, which are the most powerless group in the hospital. Even though all the parents didn’t respond with a 5 when asked to rate how much they preferred the clowns in the New York hospital, there were no parents who rated a 0,1,2, or 3. This is saying that overall the clowns must have been successful in lowering the stress and anxiety of the parents and their hospitalized children or at least making them happier.  


Works Cited

1) Kingsnorth, Shauna. “Physiological and Emotional Responses of Disabled Children to

Therapeutic Clowns: A Pilot Study” Oxford Journals. (2010): 1-10. Web. 

10 May 2010. <>


2) Koller, Donna, and Camilla Gryski. “The Life Threatened Child and the Life

Enhancing Clown: Towards a Model of Therapeutic Clowning.” Oxford Journals. (2007): 1-9. Web. 10 May 2010. <>


3) Miller Van Blerkom, Linda. “Clown Doctors: Shaman Healers of Western

 Medicine.” Medical Anthropology Quarterly. 9.4 (1995): 462-475. Web.

 10 May 2010. <>


4) Vagnoli, Laura. “Clown Doctors as a Treatment for Preoperative Anxiety in

   Children: A Randomized, Prospective Study.” Official Journal of the American

   Academy of Pediatrics. 116.4 (2005): e563-e567. Web. 10 May 2010.




silver's picture

hospital clowns

I work as ahospital clown and never think of myself as
clown Therapist,
I am simply there to bring laughter too thoughs who need it.
but if my work with kids brings about Therapeutic efeckt.
than that is wonderfull. so thanks for your article it
gives me somthing to ponder.