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Being in a bubble: Comforting children in paediatric hospital care by Animal Assisted Activity
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Barnonkologisk klinisk och translationell forskning)ORCID iD: 0000-0002-7940-4395
2025 (English)Doctoral thesis, comprehensive summary (Other academic)
Description
Abstract [en]

Hospitalisation can be distressing for children, often linked to stress, pain, and anxiety. Complementary therapies show promise in alleviating these effects, especially during medical procedures. Among them, Animal-Assisted Activity (AAA) with dogs has gained increasing recognition in both research and clinical practice for its comforting impact. While integrating dogs into paediatric healthcare offers therapeutic benefits, it also presents challenges such as the risk of pathogen transmission and allergic reactions.

The overall aim of this thesis was to examine the beneficial effects and potential risks, particularly bacterial transmission, of dogs as a complementary therapy in paediatric care. It explores child-dog interactions and how the activity affects the child from the perspectives of children, parents, and healthcare professionals, as well as investigating the risk of bacterial transfer.

Paper I employed a mixed-methods design with a convergent approach, using questionnaires administered before and after the child-dog sessions to explore the experiences of 49 children participating in AAA.

Paper II utilised a cross-sectional design incorporating semi-structured observations to describe the interactions between child and dog across 49 child-dog sessions.

Paper III adopted a quantitative design, supplemented by qualitative data from questionnaires, to examine the attitudes of 61 healthcare professionals (HCPs) towards complementary therapy involving dogs in AAA.

Paper IV applied a mixed-methods design with a convergent approach to investigate 49 parents’ perspectives on how dogs in AAA can comfort their children when admitted to the hospital.

Paper V used a descriptive design to explore whether, and to what extent, aerobic bacteria were exchanged between children and dogs before and after AAA sessions.

The metaphor of “being in a bubble” aptly describes the immersive and focused interaction between the child and the dog during AAA sessions. As children engaged with the dog, guided and supported, external distractions faded, creating a transparent and protective space of connection. Within this space, children reported enhanced well-being and a more positive hospital experience. Parents and HCPs also recognised the potential of AAA to provide physical and emotional comfort. With appropriate hygiene protocols in place, AAA involving dogs can be safely implemented, minimising the risk of clinically significant bacterial transmission.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2025. , p. 78
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 2168
Keywords [en]
Animal Assisted Activity; Animal Assisted Intervention; Children; Comfort; Comfort Theory; Complementary Therapies; Human-Animal Bound; Health Care Professionals; Parents; Paediatric Hospital Care
National Category
Nursing
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-564148ISBN: 978-91-513-2539-2 (print)OAI: oai:DiVA.org:uu-564148DiVA, id: diva2:1986344
Public defence
2025-09-19, H:son Holmlundsalen, Akademiska sjukhuset, ing 100, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2025-09-04 Created: 2025-07-31 Last updated: 2025-09-04
List of papers
1. Children report positive experiences of animal-assisted therapy in paediatric hospital care
Open this publication in new window or tab >>Children report positive experiences of animal-assisted therapy in paediatric hospital care
2020 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 109, no 5, p. 1049-1056Article in journal (Refereed) Published
Abstract [en]

Aim

To evaluate children's experiences of and responses to animal-assisted therapy using a therapy dog as complementary treatment in paediatric hospital care.

Methods

The study was performed using mixed methods, by means of qualitative and quantitative data. Fifty children in a paediatric surgery ward, at a tertiary hospital in Sweden, were included between February 2016 to May 2017. Children answered questions about feelings of well-being and experiences of the hospital stay before and after animal-assisted therapy, and experiences of their interaction with a therapy dog.

Results

The children's well-being increased from moderately good before to very good after animal-assisted therapy, and the children assessed the hospital stay as better after than before. The vast majority of the children (93%) assessed the interaction with the dog as very good. The children described mixed experiences before and mainly positive aspects of joy, satisfaction and pain relief after animal-assisted therapy.

Conclusion

The children's responses before interaction, of both a positive and negative nature, show a focus shift after the interaction with a therapy dog to mainly positive nature regarding self-reported feeling of well-being and experiences of the hospital stay. Using a therapy dog in paediatric hospital care is suitable complementary treatment.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
Keywords
animal-assisted therapy, assessment, children, experience, hospital
National Category
Pediatrics Nursing
Identifiers
urn:nbn:se:uu:diva-397668 (URN)10.1111/apa.15047 (DOI)000494159400001 ()31597211 (PubMedID)2-s2.0-85074593087 (Scopus ID)
Funder
Swedish Childhood Cancer Foundation
Available from: 2019-11-28 Created: 2019-11-28 Last updated: 2025-11-26Bibliographically approved
2. Children's interaction with a dog when having Animal Assisted Activity in paediatric hospital care
Open this publication in new window or tab >>Children's interaction with a dog when having Animal Assisted Activity in paediatric hospital care
Show others...
2023 (English)In: Complementary Therapies in Clinical Practice, ISSN 1744-3881, E-ISSN 1873-6947, Vol. 53, article id 101807Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to investigate the interaction process between child and dog and how it possibly affects children's wellbeing during Animal Assisted Activity.

Children have reported negative feelings such as fear and anxiety when being cared for in hospital and various kinds of complementary treatment can alleviate this. Different complementary treatments, including interaction with a dog, can create positive emotions and the treatment has been reported to have both physiological and psychological beneficial effects. However, there is a lack of studies describing children's interaction with a dog.

This is an observational study, analysed from field notes with qualitative content analysis using a deductive approach. Children (n = 49) aged 3–18 years of age at a paediatric hospital voluntarily participated in the study.

The results are reported on a six-level scale that describes the child-dog interaction: 1. Passive interaction, 2. One-way non-spoken communication, 3. Facilitating the interaction, 4. Interaction by activity encouragement, 5. Interaction initiated by the child, and 6. Interaction through deepened interplay. All children attained level five. Eighty-nine per cent attained level six and these children interacted fully, having a two-way deepened interplay with the dog. Further, when the interaction proceeded to a deepened interplay this affected the children positively both physically and emotionally.

Structured Animal Assisted Activity with a dog that includes an introduction, an active part and a relaxing part is a suitable model to offer children in paediatric hospital care since the children attained a child-initiated interaction or interaction through deepened interplay.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Child, Animal Assisted Activity, Interaction, Complementary treatment, Hospitalisation, Therapy dog
National Category
Pediatrics
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-516766 (URN)10.1016/j.ctcp.2023.101807 (DOI)001110282600001 ()
Funder
Swedish Childhood Cancer Foundation
Available from: 2023-11-29 Created: 2023-11-29 Last updated: 2025-11-26Bibliographically approved
3. Healthcare professionals' attitudes to Animal Assisted Activity with dogs in paediatric care
Open this publication in new window or tab >>Healthcare professionals' attitudes to Animal Assisted Activity with dogs in paediatric care
Show others...
2025 (English)In: Complementary Therapies in Clinical Practice, ISSN 1744-3881, E-ISSN 1873-6947, Vol. 59, article id 101952Article in journal (Refereed) Published
Abstract [en]

Background

Hospitalization for children often involves stress induced by fear and pain. Complementary therapies, such as Animal Assisted Activities (AAA) with dogs, can alleviate the hospital experience.

Purpose

The first aim of this study was to initiate the development of an instrument that measures healthcare professionals’ attitudes toward complementary therapy, specifically dogs in AAA. The second aim was to elucidate the emerging effects of introducing dogs to children in healthcare settings, as reported by healthcare professionals.

Materials and methods

A questionnaire covering demographics, rating attitudes, and allergy and hygiene risks, followed by open-ended questions, was completed by 61 healthcare professionals (HCPs). Quantitative data were analysed statistically, while qualitative data underwent content analysis.

Results

The Attitude Instrument of Complementary Therapy (AICT) included 7 items and was evaluated using exploratory factor analysis. Healthcare professionals had a median score of 25 (range 18–28), high scores indicating a more positive attitude. However, 36 % of the HCPs perceived a risk of allergies, and this group had a significantly lower median score, 22 versus 26. Open-ended answers were analysed into four categories: “Dogs could positively affect children in hospital”, “Dogs may pose a risk of allergies in children”, “Dogs might be frightening for children” and “Dogs can affect healthcare professionals’ working situation”.

Conclusion

The AICT can serve as a valuable tool for investigating HCPs’ attitudes to dogs in AAA as complementary therapies. Professionals view dogs as beneficial for hospitalized children, but attitudes toward dogs working in paediatric care can be influenced by concerns about risks such as allergies.

Place, publisher, year, edition, pages
Elsevier, 2025
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-565857 (URN)10.1016/j.ctcp.2025.101952 (DOI)001421692600001 ()2-s2.0-85216075962 (Scopus ID)
Available from: 2025-08-27 Created: 2025-08-27 Last updated: 2026-06-05Bibliographically approved
4. Parents’ perspectives on the comfort provided by dogs in animal-assisted activity for hospitalised children: A mixed method study
Open this publication in new window or tab >>Parents’ perspectives on the comfort provided by dogs in animal-assisted activity for hospitalised children: A mixed method study
(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-564146 (URN)
Available from: 2025-07-26 Created: 2025-07-26 Last updated: 2025-07-31
5. Low risk of transmission of pathogenic bacteria between children and the assistance dog during animal-assisted if strict rules are followed
Open this publication in new window or tab >>Low risk of transmission of pathogenic bacteria between children and the assistance dog during animal-assisted if strict rules are followed
2021 (English)In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 115, p. 5-9Article in journal (Refereed) Published
Abstract [en]

This study explored the bacterial transmission between patients and dogs during dog assisted therapy (DAT). Twenty children (55% girls) with a median age of 7 years (range 3-17 years) were included. Two dogs assisted and the conditions were more restricted hygienically with dog 2. Samples from child and dog were collected and cultured before and after each DAT visit. The results showed that dog 1 transmitted bacteria repeatedly to the children. No bacteria were transmitted with dog 2. In conclusion, exchange of bacteria can occur between dog and child during DAT, but it can be reduced by simple infection control measures. (c) 2021 Published by Elsevier Ltd on behalf of The Healthcare Infection Society.

Place, publisher, year, edition, pages
ElsevierElsevier BV, 2021
Keywords
Assistance dog, Dog-assisted therapy, Bacterial transmission, Zoonotic infections, Hygiene routines
National Category
Clinical Science Infectious Medicine
Identifiers
urn:nbn:se:uu:diva-456306 (URN)10.1016/j.jhin.2021.04.025 (DOI)000691276700002 ()33940092 (PubMedID)
Available from: 2021-10-21 Created: 2021-10-21 Last updated: 2025-11-26Bibliographically approved

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