Skip to main content
Article thumbnail
Location of Repository

Effects of clown doctors on child and caregiver anxiety at the entrance to the surgery care unit and separation from caregivers

By Patrícia Arriaga and Catarina Pacheco


This study investigated the effects of hospital Clown Doctors intervention on child and\ud caregiver preoperative anxiety at the entrance to the surgery care unit and separation\ud from caregivers. A total of 88 children (aged 4-12 years) were assigned to one of the\ud following two groups: Clown Doctors intervention or control group (standard care).\ud Independent observational records using the modified Yale Preoperative Anxiety Scale\ud instrument assessed children’s anxiety, while the State-Trait Anxiety Inventory\ud measured caregiver’s state anxiety. In addition, caregivers assessed the children’s\ud functional health problems by completing the Functional Status Questionnaire. Although\ud no effects of Clown Doctors were found on children’s anxiety, results showed that both\ud low functional health problems and Clown Doctors intervention were significant\ud predictors of lower caregiver anxiety. Caregivers also reported being very satisfied with\ud their intervention. Overall, this study demonstrated the positive role of Clown Doctors\ud for caregivers at a specific pediatric hospital setting.peer-reviewe

Topics: Children -- Surgery, Preoperative care, Caregivers, Hospitals, Physicians
Publisher: Centre for Resilience & Socio-Emotional Health
Year: 2016
OAI identifier:
Provided by: OAR@UM

Suggested articles


  1. (2008). A comparison of preoperative anxiety in female patients with mothers of children undergoing surgery. doi
  2. (2013). A practice of anesthesia for infants and children (5th Ed.). doi
  3. (1997). Adaptação do State-Trait Anxiety Inventory (STAI) Form Y para a população portuguesa: Primeiros dados.
  4. (1998). Alguns dados normativos do Inventário de Estado Traço de Ansiedade – Forma Y (STAI-Y) de Spielberger, para a população portuguesa. Revista Portuguesa de
  5. (2013). Anesthesia induction using video glasses as a distraction tool for the management of preoperative anxiety in children. doi
  6. (2007). Answering the call for a standard reliability measure for coding data. doi
  7. (1989). Assessment of children's health status: Field test of new approaches. Medical Care, 27(3 Suppl), doi
  8. (2014). Benefits and barriers of clown care: A qualitative phenomenographical study of parents with children in clown care services. doi
  9. (2013). Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. doi
  10. (2005). Clown doctors as a treatment for preoperative anxiety in children: A randomized, prospective study. doi
  11. (2014). Clown intervention to reduce preoperative anxiety in children and parents: A randomized controlled trial. doi
  12. (2009). Clowns for the prevention of preoperative anxiety in children: a randomized controlled trial. doi
  13. (2008). Development of a brief behavioral intervention for children's anxiety at anesthesia induction. Childrens Health Care, doi
  14. Distraction with a hand-held video game reduces pediatric preoperative anxiety. doi
  15. (2011). Do Clown visits improve psychological and sense of physical well-being of hospitalized pediatric patients? A Randomized-controlled trial. doi
  16. (2007). Effects of age and emotionality on the effectiveness of midazolam administered preoperatively to children. doi
  17. (2007). Effects of preoperative therapeutic play on outcomes of school-age children undergoing day surgery. doi
  18. (2010). Effects of therapeutic suggestion in children undergoing general anesthesia: Arandomized controlled trial. doi
  19. (2014). Functional health status in children and adolescents after Fontan: comparison of generic and disease-specific assessments. doi
  20. (2010). Functional health status in children following surgery for congenital heart disease: a population-based cohort study. doi
  21. (2004). General anesthesia, surgery and hospitalization in children and their effects upon cognitive, academic, emotional and sociobehavioral development: A review. Paediatric Anaesthesia, doi
  22. (2006). Giving toys to children reduces their anxiety about receiving premedication for surgery. Anesthesia and Analgesia, doi
  23. (2004). Interactive music therapy as a treatment for preoperative anxiety in children: A randomized controlled trial. doi
  24. (1983). Manual for the StateTrait Anxiety Inventory.
  25. (2015). Melatonin versus midazolam premedication in children undergoing surgery: A pilot study. Journalof Paediatricsand Child Health. Advance online publication. doi
  26. (2003). Paediatric day surgery: Impact on Hong Kong Chinese children and their parents. doi
  27. (2014). Parental anxiety and stress before pediatric anesthesia: A pilot study on the effectiveness of preoperative clown intervention. doi
  28. (1998). Parental anxiety before elective surgery in children: A British perspective. doi
  29. (2010). Parental presence, clowns or sedative premedication to treat preoperative anxiety in children: What could be the most promising option? Pediatric Anesthesia, doi
  30. (2014). Perioperative anxiety and postoperative pain in children and adolescents undergoing elective surgical procedures: a quantitative systematic review. doi
  31. (2013). Preinduction techniques to relieve anxiety in children undergoing general anaesthesia. Continuing Education in Anaesthesia, doi
  32. (2004). Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. doi
  33. (2011). Preoperative anxiety in adolescents undergoing surgery: a pilot study. doi
  34. (2016). Preoperative anxiety in children: Predictors and outcomes. doi
  35. (2006). Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. doi
  36. (2014). Preoperative distraction in children: hand-held videogames vs clown therapy. doi
  37. (1990). Preoperative parental anxiety predicts behavioural and emotional responses to induction of anaesthesia in children. doi
  38. (1986). Preparing children for medical examinations: the importance of previous medical experience. doi
  39. (2014). Providing preoperative information for children undergoing surgery: a randomized study testing different types of educational material to reduce children's preoperative worries. doi
  40. (1999). Psychological reaction by children of various ages to hospital care and invasive procedures. doi
  41. (1986). Stress management-training for parents and their children undergoing cardiac-catheterization. doi
  42. (2000). The child surgery worries questionnaire adolescent form. doi
  43. (2010). The effect of “hospital clowns” on psychological distress and maladaptive behaviours in children undergoing minor surgery.
  44. (1981). The effect of music and desensitization on preoperative anxiety in children. doi
  45. (2010). The effects of clown intervention on worries and emotional responses in children undergoing surgery. doi
  46. (1995). The effects of music assisted relaxation on preoperative anxiety. doi
  47. (1997). The Yale Preoperative Anxiety Scale: How does it compare with a "gold standard"? doi
  48. (2016). Treating perioperative anxiety and pain in children: A tailored and innovative approach. doi
  49. (2015). Using an educational multimedia application to prepare children for outpatient surgeries. doi
  50. (2015). Video distraction and parental presence for the management of preoperative anxiety and postoperative behavioral disturbance in children: A randomized controlled trial. doi
  51. (2014). Wacky Wednesday: Use of distraction through humor to reduce preoperative anxiety in children and their parents. doi
  52. (2015). Web-based tailored intervention for preparation of parents and children for outpatient surgery (WebTIPS): formative evaluation and randomized controlled trial. Anesthesia and Analgesia, doi

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.