The Effect of Medical Clown on the Pain and Anxiety Perception During LRH Analog Treatment or GH Provocation Test
The Effect of Medical Clown on the Pain and Anxiety Perception During LRH Analog Treatment or GH Provocation Test
The investigators would like to examine the contribution of medical clowns in routine medical
 procedures in the endocrine clinic. This will be the first time that will objective evaluate
 the effect of medical clown on stress hormone such as adrenaline cortisol and prolactin, and
 also evaluate the effect of mental stress on growth hormone secretion in children.

 The aim of the current study is testing the pain and anxiety of the patient and the
 accompanying parent and medical staff in the presence or absence of medical clown at the
 time:

 1. LRH analog (decapeptyl) intramuscular injections for precocious puberty.

 2. Growth hormone tests.

 Secondary end point will be:

 1. Changes in stress hormones: cortisol , prolactin and adrenalin during growth hormone
 tests in the presence of a clown.

 2. Does the presence of a medical clown and the mental stress affect the secretion of
 growth hormone?

 3. Are there differences in growth hormone secretion and stress hormones between the
 various tests for growth hormone secretion (glucagon, clonidine or arginine) in the
 presence of a clown?

 4. Are there differences in response to stress and the secretion of growth hormone in
 children with obesity?
80 children from the endocrine clinic who are referred for treatment with LRH analog or
 directed to growth hormone tests, will take part in the study:

 1.40 children who are referred to decapeptyl treatment will receive the injection once with a
 medical clown, and the next time with out the clown and vise verse. The pain and anxiety
 perception of the child and caregivers will be compare between the two scenarios. The
 children will be randomly assigned to begin treatment in the presence of a clown and the next
 injection without medical clown and the second group starts the injections without medical
 clown and the next shot in the presence of a clown.

 2.40 children from endocrine clinic who are referred for growth hormone tests because of
 short stature will have the test with or without medical clown in a random selection.

 Procedure

 1. Children who receive decapeptyl injections once a month. Before getting the shot will be
 offered to participate in the study. After signing the consent form and parent consent
 they randomized to get the treatment in the presence of a clown or without health.

 2. The kids and their parents who referred to growth hormone test will be offered to
 participate in the study and after signing the consent will be invited for the test.
 According to accepted protocol, the children arrived after overnight fast, an
 intravenous line is inserted and blood is taken for measurement of human growth hormone
 levels, IGF1, thyroid function test, prolactin, cortisol, and adrenaline and then a
 stimulates substance (glucagon, clonidine or arginine) is given. Afterward blood tests
 for human growth hormone and cortisol levels, are taken every 30-60 minutes for
 approximately 3-4 hours after administration of the provocative substance. During the
 test regular vital signs are monitored according to Protocol.

 In both procedures, anxiety of the child and his parent will be evaluated by questionnaires.
 State-Trait (STAI) Inventory questionnaires for the parent and STAIC questionnaires for the
 kids. In addition, the kid, his parent and the medical staff will evaluate for pain by Visual
 Analog Score (VAS).

 Inclusion criteria:

 -  Children older than 4 years.

 -  referred by the endocrine clinic to a decapeptyl treatment or growth hormone test.

 The criteria included:

 • The consent of a parent and the child to participate in a study

 Questionnaires Anxious parent questionnaire (STAI). Anxiety questionnaire (STAIC)

 Pain assessment scale:

 Pain assessment by the child, the parents and the staff (VAS).
Inclusion Criteria:

 -  Children older than 4 years. referred by the endocrine clinic to a decapeptyl
 treatment or growth hormone test.

 Exclusion Criteria:

 -  none