P2.D075: Randomized Trial of Therapy Dogs as an Adjunct to Child Life Therapy to Reduce Child and Parental Anxiety in a Pediatric Emergency Department

Background: Prior randomized trials have suggested that adjunctive use of therapy dogs in emergency care can reduce perceived anxiety among adult patients. No trial has tested therapy dogs in emergency care of children. The hypothesis of this work was that the adjunctive use of therapy dogs to standard child-life therapy would reduce child and parental anxiety in a pediatric emergency department.

Methods: This was a registered (NCT03784573), single-center randomized controlled trial performed in a pediatric emergency department, and approved by the Institutional Review Board (1811186507). Children ( < 18 years) and parents were approached for assent/informed consent based upon physician suspicion of moderate-to-high child anxiety. Child and parental stress were measured using the 0-10 FACES scale, together with salivary cortisol concentrations. All children received exposure to standard child-life therapy and were randomized to receive either nothing additional (control), or exposure to a therapy dog-handler for under 10 min (intervention). Measurements were made at baseline (T0), +45 min (T1) and +120 min (T2). Sample size of 80 was predicated on an 80% power to detect a >2.5 change in the primary outcome, which was the change in FACES from T0 to T1.

Results: 80 patients were enrolled with n=40 in each arm. At T0, mean FACES scores did not differ between arms for either the child patients (mean 5.4±2.8) nor their parents (6.4±2.4). Compared with T0, at T1, child anxiety reduced in both groups with a mean decrease of -1.5±3.4 in controls vs. -2.7±2.5 in the intervention arm, (P=0.017, Mann Whitney U). Similarly, parental anxiety decreased -1.8±2.7 in controls vs. -3.2±2.3 in the intervention arm (P=0.008). Twenty-three percent of children in the control arm had a >2.5 decrease in FACES score compared with 46% in the intervention arm (P=0.04, Fisher’s exact). By T2, FACES scores from children decreased to 3.6±3.4 in controls, vs. 3.0±2.7 after intervention (P=0.7). After child-life (±Dog) exposure, 55% of controls were administered ketamine, midazolam or intravenous narcotics, vs. 35% in the intervention group (P=0.13, Fisher’s). Salivary cortisol did decrease in both children and their parents from T0 to T1 in both groups (Child Dog T0-T1 mean change 0.046, SD 0.193; No Dog T0-T1 mean change 0.031, SD 0.103; Parent Dog T0-T1 mean change 0.186, SD 0.354; No Dog T0-T1 mean change 0.226, SD 0.472). but the decrease was similar between groups. A salient finding was that parental salivary cortisol was consistently higher than their children.

Conclusion: Adjunctive use of therapy dogs to standard child-life therapy afforded modest but significantly greater reduction in both child-reported and parental-reported anxiety in the pediatric emergency department.