Clowns Reduce Perception of Pain when Children with CP Receive Injection, Study Indicates

Having a clown around can help take some of the sting out of the injections that children with cerebral palsy (CP) receive, a study indicates.

The research, “Clown-Care Reduces Pain In Children With Cerebral Palsy Undergoing Recurrent Botulinum Toxin Injections: A Quasi-Randomized Controlled Crossover Study,” was published in the journal PLoS One.

Children with CF often receive repeated injections of Botulinum toxin (BTX) to decrease muscle stiffness and improve muscle function. Although an injection is quick, the needle can cause pain —  and anxiety in both children and their parents.

One way to help children cope is clown care, visits from specially trained clowns.

“Clown care is safe and fun and is a rapidly developing field in medical care,” the researchers wrote. “Accumulating evidence indicates that it aids coping during difficult medical conditions in the hospital setting. The use of medical clowns for needle-related procedures has been shown to alleviate pain in young children and reduce parental anxiety.”

Researchers conducted a clinical trial (NCT01377883) to investigate whether clowns could make BTX injections easier for children with cerebral palsy. Clowns visited 20 of the 45 children during their injections. The other 25 had injections without clowns.

Clowns used several tactics to help children cope. One was to encourage them to think positive with messages such as  “You can do this” or “You are stronger than the needle.” Another was to distract them from the treatment by appealing to their imagination — asking them to imagine they were the captain on a ship, for examples.

Still another tactic was trying to make the children feel empowered. An example was a clown falling to the floor when a child gestured, as if they child had knocked them down. This emphasized the child’s strength and abilities.

Researchers used the Pain Visual-Analogue-Scale to measure perception of pain before and after an injection. The children’s perception of what the pain would be like before an injection was the same whether or not a clown was around, the researchers discovered. When an injection occurred, however, children with clowns around them perceived a lower level of pain than those with no clown entourage.

Another finding was that children who received their first injection when a clown was around had a lower perception of pain on a subsequent injection when a clown wasn’t around. Children who received their first injection without a clown being around had a higher perception of pain in that injection and subsequent ones.

The study “indicates that clown care can alleviate acute pain and creates resilience for future procedures,” researchers wrote. “Although the clown interaction began before the procedure, it did not relieve anticipated pain before the first experience, indicating that clown care is effective when conducted during the needle procedure itself, not before.”

“[This] hopefully will lead to better medical results and reduce the need for general anesthesia in children during medical examinations that require the cooperation of the child,” they added.