Clown therapy: not only a pediatric matter

Clown therapy: not only a pediatric matter

Alessandro Boscarelli

Pediatric Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, RM 00161, Italy

Correspondence to: Alessandro Boscarelli, MD. Pediatric Surgery Unit, Sapienza University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy. Email:

Submitted Feb 03, 2017. Accepted for publication Feb 08, 2017.

doi: 10.21037/tp.2017.03.03

Clown therapy is currently an important aspect of the hospital care setting in pediatric units worldwide, since the notorious Patch Adams first introduced this practice in hospital not too long ago. As he recently reiterated, love and humour are key features of this context of the medical setting (1).

Particularly, clown doctors help surgical and oncological patients to deal and forget the stress and anxiety of surgical procedures or specific debilitating therapies. Lots of studies have been published over the years regarding the effects of clown therapy on pediatric patients. In detail, only in the last few years, Meiri et al. studied the role of clown therapy in reducing the stress and anxiety during intra-venous cannulation or venipuncture in children aged 2–10 years compared with local application of an anesthetic cream (EMLA®, AstraZeneca, London, UK). They concluded that medical clowns help to reduce stress and anxiety, even if medical clowning does not reduce the pain in these children (2). Similarly, Felluga et al. found that clown therapy is useful in reducing children’s anxiety during painful procedures also in an emergency department (3). Furthermore, two recent meta-analysis of the literature confirmed the important role of clown therapy in reducing stress and anxiety both in children and their parents before surgery or invasive investigations (4,5). Meanwhile, literature is scant of studies and evidences about clown therapy and its effects on adult patients. Notably, Dionigi and Canestrari found that clown doctors could be a good expedient to reduce stress and anxiety in non-children patients (6). Despite this, further studies are needed to deepen and confirm the role of medical clowning in adults.

In conclusion, as already promulgated by Patch Adams, clown therapy should be encouraged also in adult patients undergoing specific invasive procedures and its effects on these patients should be studied more in deep. Additionally, this could help all of us to not forget that we are not only surgeons or doctors and, moreover, that they are not only patients.


The author would like to thank Cinzia Santarelli M.D. for her support in reviewing the literature about this topic in adult patients.


Conflicts of Interest: The author has no conflicts of interest to declare.


  1. Adams P. Humour and love: the origination of clown therapy. Postgrad Med J 2002;78:447-8. [Crossref] [PubMed]
  2. Meiri N, Ankri A, Hamad-Saied M, et al. The effect of medical clowning on reducing pain, crying, and anxiety in children aged 2-10 years old undergoing venous blood drawing--a randomized controlled study. Eur J Pediatr 2016;175:373-9. [Crossref] [PubMed]
  3. Felluga M, Rabach I, Minute M, et al. A quasi randomized-controlled trial to evaluate the effectiveness of clowntherapy on children's anxiety and pain levels in emergency department. Eur J Pediatr 2016;175:645-50. [Crossref] [PubMed]
  4. Zhang Y, Yang Y, Lau WY, et al. The effectiveness of pre-operative clown intervention on psychological distress: A systematic review and meta-analysis. J Paediatr Child Health 2017;53:237-45. [Crossref] [PubMed]
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  6. Dionigi A, Canestrari C. Clowning in Health Care Settings: The Point of View of Adults. Eur J Psychol 2016;12:473-88. [Crossref] [PubMed]
Cite this article as: Boscarelli A. Clown therapy: not only a pediatric matter. Transl Pediatr 2017;6(2):111-112. doi: 10.21037/tp.2017.03.03