Animal-Assisted Interventions in Children’s Hospitals: A Critical Review of the Literature
Animal Assisted Intervetions (AAIs), whereby cats, dogs, and other animals interact with patients and help them with their mental and physical healing through companionship, is becoming more common in hospitals. As the popularity of the therapy grows, researchers are keen to determine what, if any, empirical value the treatment has in helping patients heal. This study looks as the use of AAIs in children’s hospitals, and finds generally positive results, but also notes that much more research needs to be done to draw stronger conclusions.
Animal Assisted Interventions (AAI) is a term that encompasses both Animal Assisted Therapy and Animal Assisted Activities. The idea that AAIs are beneficial for patients’ mental well-being is often thought of as a foregone conclusion to many. It seems that the companionship of a dog or cat, even temporarily, can improve and stabilize mood, and promote a more positive outlook in patients. Though AAIs are increasing in popularity, “the evidence base, and an understanding of the mechanisms behind any effects or lack thereof of the introduction of an animal to work with humans to improve health, is still poorly understood.” The researchers of this study point out that “many existing studies are anecdotal, draw upon weak or flawed research designs, or fail to provide the reader with sufficient methodological information.” In fact, actually constructing studies that have a strong methodology may be a problem in itself: the researchers note that “some authors argue that AAIs cannot be subjected to the randomized controlled trial approach employed to evaluate other health care interventions, and to some extent this is true (e.g., you cannot be blinded to knowing that you are being visited by a dog).” So, there is limited proof as to the extent of the usefulness of AAIs, to see if they do more than just make us “feel better.”
Pediatric hospitals are one place where AAIs are often employed, and are generally seen to have positive effects. In this study, the researchers seek to “review the existing literature on AAIs in children’s hospitals, and make suggestions for ways in which the evidence base might be improved. We also indicate areas for improvement in the reporting of such studies, so as to better inform future practitioners and researchers about potential pitfalls and confounders when designing and implementing their interventions.” The very simple purpose of the literature review is one indication that the AAI field itself is still very new. The authors say that “the implicit assumptions in introducing an animal into health care settings are that animals are desirable and pleasant creatures, […] associated with the reduction of stress.” However, they note that this thought is, in many ways, culturally constructed. Depending on a person’s cultural upbringing, or fears and phobias, being around these animals may not necessarily result in stress reduction. The authors also acknowledge that AAI studies are often carried out on children who have chronic conditions, in places such as oncology wards. This may be because testing the benefits of AAIs for short hospital stays is difficult because “repeated measures, long-term studies, or longitudinal investigations of the effects of animal-assisted interventions cannot be conducted.” Furthermore, the researchers note that there is a tendency in the literature to refer to AAIs as “pet therapy.” This is problematic because in all of the published studies, the animals are previously unknown to the children, and “there is a tendency to slip logically from the health benefits that one might experience from the emotional connection to one’s ‘pet’ to extrapolation that these benefits can be conferred through interaction with any animal.” The researchers say that “there is no research evidence to show that this is the case.”
Overall, the authors note that there is indeed some evidence of the positive impact of AAIs for children in hospital settings. However, the review shows that, when it comes to the more nitty gritty aspects – such as the risks and benefits, knowing which populations benefit the most, and what protocols are most effective – there is not enough proven evidence. Ultimately, the authors of this study want to see progress in the field of AAIs, and they see the best way forward as “more well-designed studies,” as well as “more details of exactly how interventions are conducted.” This is a point that they emphasize strongly: “if future researchers are to learn and build from what has gone before, the need for these details is very apparent.”
There is a perception in the scientific and general communities that hospitalized children benefit from visits by animals. Animal-assisted interventions (AAI), including animal-assisted therapy and animal-assisted activities, usually involving dogs, are thus employed in pediatric hospitals. However, the actual prevalence of AAI in children’s hospitals has been poorly documented in the literature. Furthermore, the evidence base for claims that children in hospital benefit from AAI is limited. There are nine existing research studies in the area, all with methodological challenges that make conclusive statements in either direction about the efficacy of AAI difficult. In this critical review we consider methodological considerations pertinent to evaluations of AAI interventions for hospitalized children. These include: definitions and terminology; cultural attitudes; children’s receptivity to animals, including phobia, type of illness and health status of the child, familiar as opposed to unknown animals, and age of the child; animal welfare; zoonoses and allergies; and hospital staff attitudes toward AAI. We highlight the many difficulties involved in conducting research on AAI in pediatric settings. Given the limited information around AAI for hospitalized children, including the risks and benefits and the limitations of existing studies, future research is required. This should take into account the methodological considerations discussed in this review, so that our knowledge base can be enhanced and if and where appropriate, such interventions be implemented and rigorously evaluated.