P2B344: Medical Clowns Improve Sleep and Shorten Hospitalization Duration in Hospitalized Children

Background: There is significant evidence in the literature showing medical clowns reduce stress and anxiety in children during hospitalization, yet their effect on children's sleep remains unclear. The importance of sleep for recovery and overall health has been established, and sleep disturbances are common among hospitalized children.

Methods: The study is an observational matching (case-control) interventional study which took place at the department of pediatrics in Carmel Medical Center. 42 hospitalized children ages 2-17 were included in two equal groups of intervention or control. Children in the control group were recruited based on a method of matching the chief complaint plus medical diagnosis and age of the children in the intervention group, in a 1:1 matching. The children's sleep parameters were objectively evaluated for two consecutive nights using an Actigraph device and subjectively by parent’s questionnaire. Additional factors such as hospital length of stay and demographics were monitored as well. The study group had an encounter with a medical clown (15-30min) prior to bedtime on either the first or the second night, and the control group was not exposed to a medical clown at al. We then compared the data from both groups using unpaired t-tests.

Results: Hospitalized children exposed to a medical clown prior to bed time (n=21), and children not exposed to a medical clown (n=21) were comparable in age and clinical characteristics. The study group had a significantly delayed wake up time compared to control group (06:59±46min vs 07:26±42min, p< 0.05) (mean difference of 27min). Night's duration (from bedtime to wakeup) was significantly longer in the study versus control group (570±76 vs 500±66.1min, p< 0.05), a total mean increase of 70 minutes, and sleep efficiency was significantly increased (92.3±4.6% vs 87.9±8.7%, p< 0.05). Within the clown group, when comparing nights with and without exposure to a medical clown, total sleep time was prolonged by a mean of 54 minutes on the night of the intervention (518±74min vs 464±59min, p< 0.01), and the total wake time during the night was reduced (52± 27min vs 77±61, P< 0.05), mean difference of 25min), mainly by reduction of wake period after sleep onset (WASO) (42±25min vs 66±58, p< 0.05), mean difference of 24min). Regarding general medical outcomes, hospital stay was significantly shorter on the clown group vs control (104±42h vs 128±42h, p< 0.05), a mean reduction of 23h – nearly an entire day.

Conclusion: An encounter with a medical clown prior to bedtime in hospitalized children positively effects sleep parameters, which may be of great importance for healing in general. The clown intervention was also shown to shorten the hospital stay. Larger scale studies are warranted to establish these findings.