Medical clowns boost sleep quality and reduce hospital stay for children, study finds

Background 

Sleep is crucial for recovery, yet hospital environments often disrupt it, particularly affecting pediatric patients. Hospitalized children experience late bedtimes, frequent awakenings, and reduced sleep time, intensifying their anxiety and discomfort.

Medical clowns, a non-pharmacologic intervention, have demonstrated potential in reducing stress and anxiety, enhancing overall well-being and cooperation in pediatric care, yet further research is essential to conclusively establish their effectiveness in improving sleep quality and overall recovery outcomes in hospitalized children.

About the study

This single-center, prospective observational study, conducted at The Lady Davis Carmel Medical Center in Israel from July 2019 to January 2022, involved pediatric patients aged 2-18 years, predicted to stay for at least two nights. Patients were recruited based on admission order and matched 1:1 for age and clinical condition with controls. Exclusions included children under 2 or over 18, those with sleep disorders, on sleep-altering medication, chronic conditions, a fear of clowns, or expected one-day hospitalizations. Participants were excluded if discharged or transferred within one night or if they removed the Actigraph sleep-monitoring device prematurely.

Study results 

In the present study, 57 children were initially recruited, but 15 were dropped for not completing the required two-night protocol, leaving 42 participants divided into a clown group (n = 21) and a control group (n = 21). Children were matched by age and clinical characteristics, averaging around 10.8 years, with a nearly equal gender distribution. Medical conditions varied, including acute appendicitis and abdominal pain, among others.

The sleep habits of both groups were initially similar. However, the study revealed significant differences in sleep patterns post-intervention. The clown group, exposed to a medical clown intervention before bedtime, showed a delayed wake-up time by approximately 27 minutes compared to the control group. This group also experienced longer time in bed and total sleep time as assessed by both objective measures and parental estimates.

Beyond sleep parameters, the study also observed general characteristics of the children's hospital stay. A remarkable outcome was that the length of hospitalization was significantly shorter in the clown group compared to the control group, with an average reduction of nearly a full day. 

Symptoms Of Sleep

Conclusions

The study found significant improvements in sleep parameters for the clown group, including later wake-up times, reduced wakefulness during the night, and increased sleep efficiency. This improvement was particularly notable when comparing nights with and without the clown intervention within the same group. Moreover, the study discovered a substantial reduction in hospital stay duration for children who interacted with the clowns. These findings suggest that medical clowns not only improve sleep quality but also potentially expedite overall recovery.