Therapy Dogs Cut Anxiety for Children in the ED

Randomized trial results showed that a brief visit with a therapy dog provided a “modest” reduction in anxiety reported by young patients in the emergency department (ED).

When added to standard child-life therapy, exposure to a certified therapy dog and its handler resulted in children reporting a statistically significant decrease in anxiety 45 minutes later, as measured on the 10-point FACES scale (-2.7 vs -1.5 with standard therapy alone, P=0.02), according to Jeffrey A. Kline, MD, of Wayne State University in Detroit, and colleagues.

Parents and guardians similarly reported a perception of lower anxiety among the children exposed to the intervention (-3.2 vs -1.8, respectively, P=0.008), findings from the single-center study in JAMA Network Open showed.

There was a trend toward lower use of behavior-modifying medications with exposure to the therapy dog, although the difference did not reach statistical significance.

“These findings provide initial evidence for the use of therapy dogs to minimize pain and anxiety without the use of chemical or physical restraint among pediatric ED patients,” the researchers concluded.

Anxiety is common among children visiting the ED, particularly when care involves painful or frightening processes such as blood draws or intravenous access, the authors wrote. Approximately 15% of young patients may need chemical or physical interventions to allow care to continue.

Many young patients in the ED have chronic medical and psychiatric conditions, and anxiety is more common and more severe in patients with these conditions. Anxiety has also been shown to worsen short- and long-term outcomes in patients with chronic conditions like asthma and sickle cell disease.

Currently, pediatric EDs employ certified child-life specialists, who use tools including play therapy or visual or auditory distraction to help mitigate the anxiety. Prior studies have shown that human psychological stress can also be reduced with exposure to animals, so the researchers investigated whether therapy dog exposure added to standard child-life therapy might reduce anxiety in those children with moderate to high anxiety.

For the single-center trial, 80 patients ages 5 to 17 years of age (mean 10.9 years) with moderate to high anxiety were enrolled and randomly assigned to receive either standard child-life therapy or child-life therapy with the addition of a 10-minute session with a therapy dog and handler.

Kline and colleagues examined both child-reported anxiety levels and parent-reported child anxiety levels, which were measured at baseline, and then at 45 and 120 minutes after the intervention. Anxiety was measured using the FACES scale, which uses facial expressions that correspond with levels of anxiety, with 0 (smiling face) indicating no anxiety and 10 (bawling) indicating severe anxiety. Researchers also measured salivary cortisol levels in both children and parents.

At baseline, the mean FACES scores were not different between intervention (5.4 for children and 6.6 for adults) and control groups (5.5 and 6.3).

Among the children, there was no difference in scores between groups at 120 minutes from baseline (P=0.70)

In the control group, 14 participants (35%) received at least one dose of the behavior-modifying drugs ketamine, midazolam, lorazepam, or droperidol versus seven (18%) in the intervention group (P=0.08).

Salivary cortisol decreased in both children and parents between baseline and 45 minutes in both control and intervention groups, but the decline was not different between groups. Parental salivary cortisol levels were “consistently significantly higher than those in children,” the authors wrote.

The study is not generalizable beyond EDs with capacity for therapy dog use and child-life specialists, Kline and co-authors noted, and there was variability in the provision of standard child-life therapy, which may have led to bias or effect modification. Also, the data did not allow for inferences about the magnitude of effect of therapy dogs in EDs that do not have child-life specialists.

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