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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). 

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). 

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). 

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   

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.  

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