New study to examine effect of therapy dogs during pediatric ER visits

Monkey Business / stock.adobe.com

Virtually all children experience some degree of psychological stress as patients in an emergency room (ER), and a new study funded by the Human Animal Bond Research Institute (HABRI) and Pet Partners is set to determine whether bringing therapy dogs to visit these children will alleviate their anxiety.

“Scientific research to validate the efficacy of therapy dogs in ER has the potential not only to provide more children with much needed comfort and emotional support, but also to help serve as a complementary intervention to improve medical outcomes,” says C. Annie Peters, president and CEO of Pet Partners.

The long-term goal of the study is to improve how physicians acquire and process information at the bedside to make good clinical decisions while building empathy with pediatric patients.

“The inclusion of therapy dog visits in addition to a child-life specialist could provide a low-cost, low-risk method to help reduce child and parent anxiety in the emergency department,” says principal study investigator, Jeffrey A. Kline, MD, vice chair of research in emergency medicine and professor of physiology at Indiana University School of Medicine. Kline will complete this project alongside co-investigator Alan Beck, ScD, director of the Center for the Human-Animal Bond and professor of animal ecology at Purdue University College of Veterinary Medicine.

According to Kline, one of the unique and paradigm-changing aspects of this work is that dogs bring the dimensions of affection and unconditional caring to children and families during times of perceived emergency. “This objective is important because anxiety, stress, and ‘threat perceptions’ are major negative modifiers of the emergency department experience in children and adults,” he says.

Study protocol

The investigators will evaluate the child’s perception of fear, the parents’ perception of their child’s anxiety, and salivary cortisol levels in the children. The hypothesis is that adding a therapy dog will improve the patient’s overall well-being when added to the standard care, which is the provision of a child-life specialist who helps the child and family cope with the challenges of hospitalization, illness, and disability.

The study is a registered, 2-arm, block randomized trial with 1-to-1 matching of patients receiving therapy dogs as an adjunct to a child life specialist, compared with children who receive child life specialists alone.

The children will receive a 15-minute canine visit, with the research team periodically collecting saliva samples during that time to test cortisol levels. The study will also test whether therapy dogs afford greater anxiety reduction in children with psychiatric complaints, autism spectrum disorder, or brain injury versus children with none of those conditions.

All study participants will be recruited from Riley Hospital for Children at Indiana University Health. Child participants will range in age from 5 to 17 years and have “moderate or greater anxiety” as reported by the parent or guardian. The children’s parents will also be tested for their anxiety levels before, during, and after the study to determine whether the therapy dogs can also reduce anxiety in this population.

Children who are not selected for a canine therapy visit will be given the opportunity to have that visit after study measurements have been obtained.

Expected response

“From our pilot data, there’s no doubt when the dog comes into the room the whole mood improves and the burden of fear, stress, and threat perception decreases,” Kline says. “The benefit is shared by everyone in the room, including the parents. I wouldn’t be doing this study if I didn’t have good reason to believe that we will find significant reductions in anxiety compared with the control group that gets no therapy dog.”

Kline notes that the higher the patient’s anxiety, the larger the effect of the dog. “Scientifically, that is called regression to the norm. Even with placebos, the further you are from normal, the more likely you are to have a big change, even with a placebo effect,” he says.

“These dogs take people with 10 out of 10 paralyzing anxiety and take them down reliably to a 3,” Kline says. “The dogs are real medicine. We do not give the children drugs, use restraints, or need to take their cognition away, like we must do for terribly upset people.”

In addition to the children’s response, Kline is keen to witness the effect dogs will have on the parents’ anxiety level. “The mantra in pediatric emergency medicine is that the kids are easier to care for than the parents are,” says Kline. “I hypothesize that the dogs will bring everyone’s anxiety level down, not just the children.”

Pandemic delay

In recent months, due to the coronavirus disease 2019 (COVID-19) pandemic, hospitals have had virtual therapy dog visits. During virtual visits, of course, the child cannot touch the dog and true interaction between patients and dogs is impossible. Although virtual visits might be somewhat helpful, Kline suspects they will not be as effective in relieving anxiety as in-person visits.

“We’ve done some cognitive interviews with adults and asked them how important it was to touch the dog versus just looking at the dog. A significant minority—about 30% of people—say just seeing the dog’s face makes them feel better. But most people indicate that touching is extremely important to them,” Kline says.

Unfortunately, COVID-19 has hijacked the study for now, but Kline is optimistic with the vaccination effort underway that the study will commence later in 2021. “I am very appreciative of the HABRI Foundation, their patience and understanding,” he says. “They’ve been exceptionally good to work with due to the delay caused by the pandemic.”