Clowns in the United States do not have a sterling reputation. Their mere mention is likely to conjure up images of horror film fiends or social pariahs—manic, makeup-wearing, troubled individuals who shouldn’t be allowed near children. Because they are seen as outcasts, clowns are frequently dismissed as dangerous exploiters of innocent imagination.
Ironically, it is the ability of hospital clowns to stride the line between reality and fantasy that bestows on them a special role in pediatrics. For over three decades, medical clowning has been shown to have significant beneficial effects on the stress levels of children in pediatric care.
The hospital setting is the antithesis of a nurturing environment. Sterile and cold, it hardly inspires imagination and playfulness. Large, intimidating equipment fills small rooms, ominously beeping and squeaking. The setting is controlled by professionals who poke and prod patients or check written charts. These professionals rarely have time to fully explain the procedures to the children who are undergoing them. Children kept in the dark have high anxiety that interferes with the procedures and may cause psychological trauma.
By promoting play and treating children with compassion and dignity, clowns quell unease and encourage strength and self-esteem. Studies, including one published in the European Journal of Pediatrics and another published by the American Academy of Pediatrics, have shown that hospital clowns lower the anxiety of children while making them feel confident and less fearful during their stay.
Hospital clowns are vastly different from the typical clown at a child’s birthday party. Though their job is to make light of a distressing situation, hospital clowns are trained to be aware and respectful of hospital protocol. Hospital clowns know how to stay with the children and entertain them while not interfering with the doctors and nurses.
Even their appearance is carefully thought out. Clowns need to be able to stand out in a crowd but also be relevant to the environment. Stark white makeup may be effective at a circus, but it is not the norm when working one on one with a sick child. Instead, many hospital clowns choose to mimic doctors, donning white coats and carrying oversized bags stuffed with basic medical supplies and clown props. A big red nose or silly hat adds a touch of absurdity and prevents the clown from being viewed as an authority figure.
Hospital clowns thus do not have to adhere to the same social rules as those in charge. They are unique characters gifted with empathy, impish jokers who turn the absurdities and tragedies of real life into comedy, but most notably they add a spark of color to an otherwise bleak environment.
When a child who has been the victim of sexual or physical abuse enters a hospital, there can be shame and guilt associated with the visit. The child goes through medical examinations that often cause him or her to relive the trauma. But in such a situation hospital clowns can mitigate retraumatization.
At Baruch Padeh Medical Center in Israel, doctors found that hospital clowns were able to create an atmosphere that calmed young victims. The simple establishment of trust between a child and a clown ensured cooperation from the child during the examination and even eliminated the need for anesthesia, reducing recovery time and costs. Numerous other studies confirm the finding that clowns lower procedural anxiety.
Clowns are not always the first people we think of when we need comfort, but they deserve a closer look, as there is ample evidence that they are antidotes to anxiety. Proven to lower stress, increase self-esteem, and even reduce health care costs, clowns maintain joy in an environment that can be disconcerting or unpleasant. Clowning is a job that we can no longer dismiss as trivial or disreputable. Hospital clowns are more than goofy adults in costume; they are the protectors and preservers of comfort and resilience.