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.


Contact Hours Awarded: 1.5

Beth Malley

Course By:
Beth Malley

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The following course content

Henri de Mondeville, a French medieval surgeon in the 1300s, proposed the use of humor in postoperative therapy; coining the phrase, “Laughter is the best medicine (12). 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).


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 (1).  

“A cheerful heart is a good medicine, but a crushed spirit dries up the bones” The Book of Proverbs 17:22 (1).


In 1964, William Fry was the first to research and classify laughter as, Gelotology (8). 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, 11). 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, defuses conflict, and attracts us to others (7, 8).  

“Laughter is the shortest distance between two people.” – Victor Borge (10).


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 can truly make a difference for the patient, their family, and the community (8).  

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 (4). The professionals in the Child Life programs provide theater, music, magic, and art to children (5). Some examples of current programs in pediatric care include:  

  • The Laughter League Team at Boston Children’s Hospital 
  • Humor Cart in Chicago 
  • The Big Apple Circus Clown Care provides services to the Nicklaus Children’s Hospital in Florida (2, 3)
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? 


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 (1, 6). 

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:

Therapeutic clowns in pediatrics: a systematic review and meta-analysis of randomized controlled trials (2016)

This data was collected from 19 eligible studies and determines a statistically significant decrease in the stress and anxiety from the hospitalized child, as well as a reduction in the observed anxiety from the parents or guardians of the patient (15). 


Effects of a Humor Therapy Program on Stress Levels in Pediatric Inpatients (2017)

This randomized pediatric study examined the salivary cortisol levels of the pediatric patients, various assessments of stress, and a comparison of both a humor intervention group and a non-intervention group. The results from the assessments as well as additional blood work showed beneficial effects on stress and cortisol levels (9).  


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 (20). 


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 (19). 

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 (13). 

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 (17). Additionally, the World Laughter Tours offer different programs and resources to enhance your humor-based interventions in your pediatric care practice (18). 

Following, you can also suggest a “Do-It-Yourself” approach to your pediatric patient, which includes (14):  

  • Following a funny meme account on social media 
  • Creating a Pinterest board 
  • 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? 


The use of humor in pediatric care is easy to implement, has no adverse side effects, and depending on your implementation, it is typically lowcost.  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.  

“The art of medicine consists of amusing the patient while nature cures the disease.” – Voltaire (10)

References + Disclaimer

  1. Savage, Brandon M., Department of Physiology, Heidi L. Lujan, Raghavendar R. Thipparthi, Stephen E. DiCarlo, American Association for the Advancement of Science., Banas JA, Berk L, Berk LS, Berk RA, Berlyne DE, Booth-Butterfield M, Bryant J, Burton R, Butler B, Check J, Clarke CC, Claus CJ, Cousins N, DiCarlo SE, Dillon KM, Emmons SL, Fry W, Fry W Jr, Fry WF, Fry WF Jr, Frymier AB, Garner RL, Gorham J, Gray D., Hattie J, Hayashi K, Kaplan RM, Kher N, Kleisiaris CF, La Fave L, Lujan HL, Martin R, Martin RA, McGhee PE, Michael J, Miller M, Mobbs D, Modell HI, Petty R, Pollio HR, Provine RR, Sauter DA, Schwartz BG, Stambor Z, Teslow JL, Wanzer MB, Watkins A, Wells K, Zillmann D, Ziv A, Address for Reprint Requests and Other Correspondence: S. E. DiCarlo, Luís Henrique Montrezor, Patricia A. Halpin and Chaya Gopalan, Lais Tono Cardozo, Douglas Curran-Everett, and Anne-Claire Dorsemans. “Humor, Laughter, Learning, and Health! A Brief Review.” Advances in Physiology Education. American Physiology Society, 05 July 2017. Web. 02 Apr. 2021. 
  2. Keilman, John. “Hospital’s ‘Humor Cart’ Helps Sick Kids.” The Seattle Times. The Seattle Times Company, 09 Dec. 2010. Web. 02 Apr. 2021. 
  3. Children’s Hospital, Staff Nicklaus. “Big Apple Circus Clown Care® Celebrates 15 Years of Bringing Smiles to Hospitalized Children at Nicklaus Children’s Hospital.” Big Apple Circus Clown Care® Celebrates 15 Years of Bringing Smiles to Hospitalized Children at Nick | Nicklaus Children’s Hospital. Nicklaus Children’s Hospital, 04 Nov. 2015. Web. 02 Apr. 2021. 
  4. “.” Gale Encyclopedia of Psychology. . 1 Apr. 2021 Ed. Ken R. Wells., 02 Apr. 2021. Web. 02 Apr. 2021. 
  5. ACLP, Staff. “History of the Association of Child Life Professional.” Web. 02 Apr. 2021. 
  6. Blog, Staff Laughter. “Laughter Therapy History: Who, What, When.” Laughter Online University. 16 Mar. 2020. Web. 02 Apr. 2021. 
  7. Robinson, Lawrence. “Laughter Is the Best Medicine.” Oct. 2020. Web. 02 Apr. 2021. 
  8. T, Calheiros-Cruz, Fernández-Requejo C, Parrado-Alonso MJ, Lago-López P, Ruibal-Azevedo J, Villar-Fernández B, Álvarez-Martínez MC, Paz-Otero V, Fernández-Carrera MC, Martínez-Rodríguez MJ, Cameselle-Cortizo L, and Cameselle-Teijeiro JF. “The Need for Laughter Therapy in Pediatrics.” Medical and Clinical Archives 2.3 (2018). Web. 
  9. Sánchez, Julio C., Luis F. Echeverri, Manuel J. Londoño, Sergio A. Ochoa, Andrés F. Quiroz, César R. Romero, and Joaquín O. Ruiz. “Effects of a Humor Therapy Program on Stress Levels in Pediatric Inpatients.” American Academy of Pediatrics. American Academy of Pediatrics, 01 Jan. 2017. Web. 02 Apr. 2021. 
  10. Juma, Norbert, and Lead Editor & Master Quote Curator on a Mission to Inspire. “70 Laughter Quotes Proving Why It’s the Best Medicine.” Everyday Power. Everyday Power, 02 Apr. 2021. Web. 02 Apr. 2021. 
  11. Louie, Dexter, Karolina Brook, and Elizabeth Frates. “The Laughter Prescription.” American Journal of Lifestyle Medicine 10.4 (2016): 262-67. Print. 
  12. Khajuria, Kavita, MD. “Laughter Is the Best Medicine.” Psychiatric Times. Psychiatric Times, 17 Aug. 2018. Web. 02 Apr. 2021. 
  13. Puder, Christine. “The Healthful Effects of Laughter.” The Healthful Effects of Laughter. Journal of Child Youth Care, Aug. 2003. Web. 02 Apr. 2021. 
  14. “10+ Scientifically Proven Ways Laughter Can Relieve Stress.” University of St. Augustine for Health Sciences. Mayo Clinic, 12 Aug. 2020. Web. 02 Apr. 2021. 
  15. Sridharan, Kannan, and Gowri Sivaramakrishnan. “Therapeutic Clowns in Pediatrics: A Systematic Review and Meta-analysis of Randomized Controlled Trials.” European Journal of Pediatrics. U.S. National Library of Medicine, 08 Sept. 2016. Web. 02 Apr. 2021. 
  16. Luis C. Lopes-Júnior, Gabriela Pereira-da-Silva. “The Effect of Clown Intervention on Self-Report and Biomarker Measures of Stress and Fatigue in Pediatric Osteosarcoma Inpatients: A Pilot Study – Luis C. Lopes-Júnior, Gabriela Pereira-da-Silva, Denise S. C. Silveira, Luciana C. Veronez, Jéssica C. Santos, Jonas B. Alonso, Regina A. G. Lima, 2018.” SAGE Journals. 17 Sept. 2018. Web. 02 Apr. 2021. 
  17. Admininstration, Staff. “Home.” The Association for Applied and Therapeutic Humor. AATH, na. Web. 02 Apr. 2021. 
  18. World Laughter Tour Organiztion, Staff. “Training World Laughter Tour.” World Laughter Tour. 02 Mar. 2021. Web. 02 Apr. 2021. 
  19. Junio, Lopes. “Clown Intervention on Psychological Stress and Fatigue in Pediatric Patients With Cancer Undergoing Chemotherapy.” Cancer Nursing. U.S. National Library of Medicine, 08 July 2020. Web. 02 Apr. 2021. 
  20. Lopes-Júnior, Luis C., Gabriela Pereira-da-Silva, Denise S. Silveira, Luciana C. Veronez, Jéssica C. Santos, Jonas B. Alonso, and Regina A. Lima. “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 (2018): 928-40. Print. 

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