Context

The first published paper referencing clowns indexed in PubMed dates back to 1969 and their use in dental health education.2 However it was not until 1998, when the film Patch Adams was released portraying the life and philosophy of Dr Hunter Doherty Adams, that the medical world woke up to the therapeutic potential of clowning. Since then there have been numerous publications related to the many positive effects of clowning within the health sector, especially in children’s healthcare settings.

It is important to differentiate between a therapeutic clown or clown doctor and the clowns normally seen in the circus or at children’s parties. Therapeutic clowns aim to relieve stress and anxiety in hospitalised patients, supporting them with the intention of restoring, maintaining and improving mental, physical and emotional well-being. They do this through arts-based programmes, which include comedy, juggling, magic, mime, story-telling and music, choosing the best intervention and improvising for each individual child depending on age, ability, preferences and clinical condition. When children are in an alien hospital environment, particularly in an intensive care unit, they may feel they have little choice or control, and therapeutic …