IMPACT OF HOSPITAL CLOWN INTERVENTIONS ON PSYCHOLOGICAL WELL-BEING AND THE HUMANIZED PEDIATRIC CARE: A SYSTEMATIC REVIEW

Introduction

Previous studies have reported effects of hospital clown interventions among hospitalized children. However, the available evidence remains fragmented, indicating the need to synthesize existing findings. The objective of this study was to analyze the scientific evidence on the impact of hospital clown interventions on the psychological well-being of hospitalized children and their implications for humanized pediatric care.

Methods

This systematic review was conducted according to the PRISMA guidelines. Searches were performed in PubMed and BVS (Virtual Library in Health) using Boolean operators (AND/OR), including studies published from 2010 to 2026 in English and Portuguese. The main inclusion criteria were studies evaluating hospital clown interventions in hospitalized children and psychological outcomes, while the exclusion criteria were studies not related to the target population or intervention, as well as secondary studies and opinion articles.

Results

Across the included studies, hospital clown interventions were associated with reduced anxiety, fear, duration of crying (1.3 ± 2.0 min) vs. control (3.8 ± 5.4 min, p=0.01), and distress, as well as improved cooperation, coping ability, emotional well-being and satisfaction during hospitalization and medical procedures. Additional benefits included improved sleep and shorter hospitalization (104 ± 42h vs. 128 ± 42h, p < 0.05). However, effects were not uniform: fear of clowns was reported in 1.2% of hospitalized children, and pain reduction varied according to age and clinical context. The qualitative evidence highlighted the importance of child autonomy and trust suggesting that hospital clown interventions may contribute to the humanization of pediatric care.

Conclusions

Hospital clown interventions appear to improve the psychological well-being of hospitalized children. These findings suggest that hospital clowning may contribute to the humanization of pediatric care through child-centered, individualized, and emotionally supportive interactions. However, there exists the need for further high-quality research.