Course

Utilizing Humor to Improve Pediatric Care

Course Highlights


  • In this course we will learn about the history of utilizing laughter and humor in healthcare, and the many positive benefits it provides.
  • You’ll also learn the basic humor-based interventions in pediatric care based on developmental stages.
  • You’ll leave this course with a broader understanding of how to utilize humor in pediatric care.

About

Contact Hours Awarded: 1.5

Beth Malley

Course By:
Beth Malley
MSN, RN

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The following course content

Henri de Mondeville, a well-known French medieval surgeon in the 1300s, proposed the use of humor in postoperative therapy; coining the phrase, “Laughter is the best medicine” (10). Do you remember the last time you had a good laugh, one that made your insides jiggle or when you laugh so hard, it brings tears to your eyes? Do you remember how relaxed you felt, and your connection to those around you?  

The use of humor and the effects of laughter on the human body are universal. Incorporating humor into your pediatric care as well as obtaining the desired response can be challenging. Determining the success of humor-based interventions in pediatric care is often dependent on the child’s age, stage of development, and how much patient history you have collected.  

This course will explore humor, laughter, and its health benefits in pediatric care, specifically for hospitalized patients. After this course, the reader will gain an understanding of how the patient’s age and stage of development can support the use of humor to enhance their journey toward recovery.  

“A good laugh heals a lot of hurts.” – Madeleine L’Engle (10).

Introduction   

The history of humor, laughter, and overall health has been a part of human civilization for centuries. There are examples throughout ancient history that showcase how people could recognize that a joyful spirit positively affected their health. For example, Greek physicians prescribed a visit to the hall of comedians as a part of the patient healing process. On top of this, 14th-century physicians would utilize humor during surgery to distract their patients, and in many cultures, serviced clowns/jesters would attempt to inspire laughter during the procedure (10).  

In 1964, William Fry was one of the first people to research and classify laughter as, “Gelotology” (16). The research that has developed since provides scientific evidence that supports the link between the emotions, mind, and body and how it impacts our immune system and overall health ( 1, 19). For example, research showcases the following results when laughter and humor are utilized throughout patient care delivery: 

  • Boosts immunity 
  • Triggers endorphins 
  • Burns calories 
  • Lowers stress hormones 
  • Relaxes muscles 
  • Decreases pain 
  • Prevents heart disease 
  • Improves mood 
  • Eases anxiety and relieves stress 
  • Strengthens resiliency  

    Additionally, it strengthens relationships, enhances teamwork, promotes group bonding, and help reduce potential conflict or tension (1, 7, 8, 16, 19).  

    As a pediatric care provider, it’s essential to recognize the positive difference that humor and laughter can play into the patient’s overall experience and recovery. Developing skills and utilizing available resources potentially make a difference for the patient, their family, and the community (1, 19).  

     

    Current Practice in Pediatric Care

    Child Life departments were developed during the 1920s, and they continue to serve as an integral aspect of pediatric care in hospitals today, especially for inpatients). The professionals who are certified as Child Life Specialists provide theater, music, magic, and art to children (3). According to the Association of Child Life Professionals website, there are over 5,000 members who represent greater than 6,000 organizations worldwide (4). 

     

    Quiz Questions

    Self Quiz

    Ask yourself...

    1. Have you seen the use of humor therapy in any form in your pediatric practice?
    2. Do you use humor in the care of pediatric patients? 
    3. Have you or your patient experienced any of the health benefits mentioned above? 

    Research 

    Psychoneuroimmunology is a field of study that has evolved over the last 50 years and examines the relationship between the mind, body, and immune system (14). 

    While the adult-centered research in this field is robust, the pediatric care research seems limited, as it mainly focuses on the psychological and psychosocial effects of humor and laughter, leaving the physiologic responses much less represented. There is a great deal of opportunity for nurses to continue research in this area for pediatrics. Not only to support the continued use of humor therapy, but also to explore new health outcomes. 

    Recent Pediatric Humor Research Study Examples:

    The Effect of Clown Intervention on Self-Report and Biomarker Measures of Stress and Fatigue in Pediatric Osteosarcoma Inpatients: A Pilot Study (2018) 

    The study suggests that longitudinal measures of psychophysiological aspects could be a possibility and that it should merit additional studies evaluating clown interventions decreasing pediatric osteosarcoma inpatient’s stress, fatigue, and measured cytokine levels (11). 

    Children’s Laughter and Emotion Sharing With Peers and Adults in Preschool (2019) 

    This study reveals that children ages 3-5 can often share emotions through laughter, especially with their peers (5). Peer interactions may be useful when caring for pediatric patients as this can lead to laughter and emotion sharing.  

     

    Clown Intervention on Psychological Stress and Fatigue in Pediatric Patients with Cancer undergoing Chemotherapy (2020)  

    Preliminary evidence showcases a decrease in stress, fatigue, and possible effects on the immune system. They recommend further study (12). 

     

    Effectiveness of Hospital Clowns for Symptom Management in Paediatrics: Systemic Review of Randomized and Non-randomized Controlled Trials (2020) 

    This systematic review suggested the use of clowns during medical procedures, in the preoperative setting, and chronic care can help manage symptoms. Patients admitted to the hospital also had improved psychological well-being after clown interactions (13). 

     

    To the Operating Room! Positive Effects of a Healthcare Clown Intervention on Children Undergoing Surgery (2021) 

    This research study reported that clown intervention influenced positive behaviors and moods of hospitalized children (15).  

     

    Medical Clowns Improve Sleep and Shorten Hospitalization Duration is Hospitalized Children (2024) 

    This study’s findings revealed medical clowns reduced stress and anxiety in hospitalized children as well as increased cooperation. It also reported that clown intervention reduced the pediatric patient’s length of hospital stay. However, larger studies are still needed for further research (17). 

     

    Quiz Questions

    Self Quiz

    Ask yourself...

    1. Do you think the use of humor therapy can impact the immune system?
    2. Think about the impact of humor therapy on treatment response, coping, adapting, recovery time, and the number of inpatient hospital days?         

    Ages and Stages in Pediatric Care

    The utilization of humor is dependent on the cognitive developmental level of the patient and is most often related to age. Recognizing the levels of development and utilizing different interventions provides additional opportunities for humor to be implemented into your pediatric care practice. The chart below lists the approximate age, developmental level and potential issues of the patient, and suggestions for humor-based interventions as well as the intended response (6). 

    Age Humor Response Developmental Issue Intervention
    0-4 Months Smiling Respnds to sights, sounds, movements, and feedings Provide the environment
    4-8 Months Laughter at the physical level with active stimulation Discovering body movements, recognition of human face, and voices “I’m gonna get you…”

    Engage in pysical contact

    8 Months to 1 Year Laughs when in contact with toys Object consistency, distinguish between self & non-self Peek-a-boo, contact play with toys
    1 to 2 Years Expectancy violations incongruent behavior Developing organized schemas of the world Mislabeling, playing with toys in a different way
    2 to 4 Years Fantasy, make-believe, slapstick, silly words and songs, bodily noises, direct participation is important Mastery of motor skills, development of symbols to represent the world, aware of bodily functions Create novel stimulus.

    Play – house, active play, simple songs

    5 to 10 Years Riddles, first simple word incongruences Concerte-operational thinking, can detect transitions and relationships Joke books, cartoons, will repeat over and over
    10 & Over Sophisticated jokes, wit, satire, incongruent social behavior Peer relationships, individual personality, and experiences are important Movie tapes, friendly wit, and sarcasm
    Quiz Questions

    Self Quiz

    Ask yourself...

    1. Do you think most pediatric healthcare providers understand the different cognitive stages/levels and how they influence the child’s perception of humor? 
    2. Would you be comfortable sharing this information with a seemingly unknowing co-worker or student in your pediatric area? 
    3. Using the chart above, think of one additional intervention for each age/stage. 

    Humor Resources in Pediatric Care

    In addition to the various online teaching programs available, Hospital Child Life programs are a great resource! The Association for Applied and Therapeutic Humor (AATH), offers membership, conferences, certification, research sessions, and a humor academy (2).  

    Following, you can also suggest a “Do-It-Yourself” approach to your pediatric patient, which includes (18):  

    • Following a funny meme account on social media 
    • Reading a funny greeting card 
    • Spending time with pets 
    • Listening to a funny podcast 
    • Trying laughter yoga 
    • Hosting a game night 
    • Watching YouTube videos 
    • Spending time with playful people   

       

      Quiz Questions

      Self Quiz

      Ask yourself...

      1. How likely is it that you would reach out to one of these resources to learn more about humor therapy for personal use, or to try with your patients?
      2. Can you think of any pediatric patients that would use the do-it-yourself suggestions from above? 

      Conclusion 

      The use of humor in pediatric care is easy to implement, has no adverse side effects, and depending on your implementation, it is typically low-cost.  Current research supports the health benefits related to the use of humor and the importance of understanding the age and stage of development for the pediatric patient. 

      As health care providers, it is important to remember how the history of humor has led us to ask questions and to investigate further the implications for our health and use in medicine.  

      References + Disclaimer

      1. Akimbekov, N. S., & Razzaque, M. S. (2021). Laughter therapy: A humor-induced hormonal intervention to reduce stress and anxiety. Current research in physiology, 4, 135–138. https://doi.org/10.1016/j.crphys.2021.04.002 
      2. The Association for Applied and Therapeutic Humor. (2023). Become a Certified Humor Professional. The Association for Applied and Therapeutic Humor. Retrieved from https://www.aath.org/ 
      3. Association of Child Life Professionals. (2023). History of the ACLP.  Association of Child Life Professionals. Retrieved from https://www.childlife.org/about-aclp-legacy/history-of-aclp 
      4. Association of Child Life Professionals. (2023). Who We Are. Association of Child Life Professionals. Retrieved from https://www.childlife.org/about-aclp 
      5. Cekaite, A., & Andrén, M. (2019). Children’s Laughter and Emotion Sharing With Peers and Adults in Preschool. Frontiers in psychology, 10, 852. https://doi.org/10.3389/fpsyg.2019.00852 
      6. Centers for Disease Control and Prevention. (2023, June 6). CDC’s Developmental Milestones. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/ncbddd/actearly/milestones/index.html 
      7. Du, P. (2022). Shared Laughter as Relational Strategy at Intercultural Conflictual Workplace Interactions. Journal of Pragmatics. 188, 39-55. https://doi.org/10.1016/j.pragma.2021.11.016 
      8. Ejlertsson, L., Heijbel, B., Andersson, I. H., Troein, M., & Brorsson, A. (2021). Strengthened workplace relationships facilitate recovery at work – qualitative experiences of an intervention among employees in primary health care. BMC family practice, 22(1), 49. https://doi.org/10.1186/s12875-021-01388-x 
      9. Juma, N. (2023, November 7). 227 Funny Laughter Quotes On Why It’s The Best Medicine. Everyday Power. Retrieved from https://everydaypower.com/laughter-quotes/ 
      10. Lamour, C. Charisma and Surgery in the Middles Ages: The Example of Henri de Mondeville, Surgeon of Philip IV the Fair. Religions2023, 14, 699. https://doi.org/10.3390/rel14060699  
      11. Lopes-Júnior, L. C., Pereira-da-Silva, G., Silveira, D. S. C., Veronez, L. C., Santos, J. C., Alonso, J. B., & Lima, R. A. G. (2018). The Effect of Clown Intervention on Self-Report and Biomarker Measures of Stress and Fatigue in Pediatric Osteosarcoma Inpatients: A Pilot Study. Integrative cancer therapies, 17(3), 928–940. https://doi.org/10.1177/1534735418781725 
      12. Lopes-Junior, L. C., Silveira, D. S. C., Olson, K., Bomfim, E. O., Veronez, L. C., Santos, J. C., Alonso, J. B., Nascimento, L. C., Pereira-da-Silva, G., & Lima, R. A. G. (2020). Clown Intervention on Psychological Stress and Fatigue in Pediatric Patients With Cancer Undergoing Chemotherapy. Cancer nursing, 43(4), 290–299. https://doi.org/10.1097/NCC.0000000000000690 
      13. Lopes-Júnior, L. C., Bomfim, E., Olson, K., Neves, E. T., Silveira, D. S. C., Nunes, M. D. R., Nascimento, L. C., Pereira-da-Silva, G., & Lima, R. A. G. (2020). Effectiveness of hospital clowns for symptom management in paediatrics: systematic review of randomised and non-randomised controlled trials. BMJ (Clinical research ed.), 371, m4290. https://doi.org/10.1136/bmj.m4290 
      14. Magan, D., & Yadav, R. K. (2022). Psychoneuroimmunology of Meditation. Annals of neurosciences, 29(2-3), 170–176. https://doi.org/10.1177/09727531221109117 
      15. Markova, G., Houdek, L., & Kocabova, Z. (2021). To the Operating Room! Positive Effects of a Healthcare Clown Intervention on Children Undergoing Surgery. Frontiers in public health, 9, 653884. https://doi.org/10.3389/fpubh.2021.653884 
      16. Savage, B. M., Lujan, H. L., Thipparthi, R. R., & DiCarlo, S. E. (2017). Humor, laughter, learning, and health! A brief review. Advances in physiology education, 41(3), 341–347. https://doi.org/10.1152/advan.00030.2017 
      17. Shimshi-Barash, M., Orlin, I., Jacob, T. et al. Medical clowns improve sleep and shorten hospitalization duration in hospitalized children. Sci Rep14, 2357 (2024). https://doi.org/10.1038/s41598-024-52943-2 
      18. Sparks, D. (2019, June 26). Mayo Mindfulness: Laughter for Stress Relief in No Joke. MayoClinic. Retrieved from https://newsnetwork.mayoclinic.org/discussion/mayo-mindfulness-stress-relief-with-laughter-is-no-joke/ 
      19. van der Wal, C. N., & Kok, R. N. (2019). Laughter-inducing therapies: Systematic review and meta-analysis. Social science & medicine (1982), 232, 473–488. https://doi.org/10.1016/j.socscimed.2019.02.018 
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      Use of Course Content. The courses provided by NCC are based on industry knowledge and input from professional nurses, experts, practitioners, and other individuals and institutions. The information presented in this course is intended solely for the use of healthcare professionals taking this course, for credit, from NCC. The information is designed to assist healthcare professionals, including nurses, in addressing issues associated with healthcare. The information provided in this course is general in nature and is not designed to address any specific situation. This publication in no way absolves facilities of their responsibility for the appropriate orientation of healthcare professionals. Hospitals or other organizations using this publication as a part of their own orientation processes should review the contents of this publication to ensure accuracy and compliance before using this publication. Knowledge, procedures or insight gained from the Student in the course of taking classes provided by NCC may be used at the Student’s discretion during their course of work or otherwise in a professional capacity. The Student understands and agrees that NCC shall not be held liable for any acts, errors, advice or omissions provided by the Student based on knowledge or advice acquired by NCC. The Student is solely responsible for his/her own actions, even if information and/or education was acquired from a NCC course pertaining to that action or actions. By clicking “complete” you are agreeing to these terms of use.

       

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