Virtually all children experience some degree of psychological stress as patients in the emergency department (ED), and about 15% suffer such stress that they require an intervention to allow care processes to continue. Anxiety is more prevalent and severe in children with psychiatric problems, spectrum disorders and cognitive impairment from prior brain injury. Moreover, parental perception of their child’s fear can amplify the stress response, negatively affecting the child’s recall of the entire ED visit, which in turn can contribute to long-term threat perception and future avoidance of emergency care. Therefore, an urgent and critical need exists for a low cost, low risk method to reduce child and parental anxiety in the ED.
The primary hypothesis is that pediatric patients with moderate to high anxiety will have significantly reduced stress and anxiety after interacting with a therapy dog, compared with a child life specialist. The secondary hypothesis states that the magnitude of reduction in anxiety will be significantly greater in children with known psychiatric problems, autism spectrum diagnoses, or cognitive impairment.
This will be an NCT-registered, two-arm, block randomized trial with 1:1 matching of patients receiving therapy dogs-handlers, compared with children who receive child-life specialists. Parents can identify patients as having moderate or greater anxiety as soon as practicable in their visit, triggering approach for enrollment. Based upon assignment by randomized four-hour blocks, participants would either receive anxiety reduction by at 15 min visit from child life specialists, or by a 15 min visit from a therapy dog-handler pair. Children and parents will provide saliva for cortisol measurements before and 40-45 min after the intervention to assess physiological stress response.
Children and parents in the therapy dog group will report 20% greater decrease in anxiety compared with children and parents exposed to the child life specialists. Children or adolescents with psychiatric complaints, autism-spectrum disorder or brain injury will have a greater reduction in
anxiety with exposure to therapy dogs-handlers than those without these conditions.