Abstract: Objective: To systematically evaluate the effectiveness of clown care on children and their caregivers. Methods: We searched related databases to collect randomized controlled trials on the effects of clown care on children and their caregivers from the establishment of these databases to October 2021. Two researchers conducted quality evaluation and data extraction. Meta-analysis was performed using RevMan 5.4 software. Results: A total of 14 articles involving 2160 children were included. Meta-analysis results showed that compared with routine care, clown care could reduce children's pain [SMD=-0.70, 95% CI (-1.24, -0.17), P=0.01], anxiety [MD=-13.50, 95% CI (-20.05, -6.95), P<0.0001], hospital stay [MD=-0.86, 95% CI (-1.06, -0.66), P<0.0001], crying time [MD=-1.41, 95% CI (-1.79, -1.03), P<0.00001], caregivers' state of anxiety [MD=-3.60, 95% CI (-5.78, -1.43), P=0.001] and caregivers' trait anxiety [MD=-3.70, 95%CI (-6.68, -0.72), P=0.02]. Conclusion: Clown care can not only reduce children's pain and anxiety, but also shorten their hospital stay and crying time, and relieve the anxiety of their caregivers. Limited by the quality and quantity of included studies, the above conclusion still needed more high-quality studies to verify in the future.

Key words: clown care; children; anxiety; pain; Meta-analysis