The 28th Bobble Wrap

Cite this article as:
Leo, G. The 28th Bobble Wrap, Don't Forget the Bubbles, 2019. Available at:

With millions upon millions of journal articles being published every year it is impossible to keep up. Today, being the 1st of April, the Don’t Forget The Bubbles Team thought it best to celebrate laughter and humour in children and our hospitals. The formal Bubble Wrap for April will be released next week.

Article 1: A Humorous Cookie

Question: Why did the cookie go to the hospital?
Answer: He was feeling really crumbie!

What’s it about?

This joke about why a cookie went to the hospital is a pun on feeling “crummy” and the fact that biscuits can have crumbs and be crumbly.

Why does it matter?

It suggests that cookies have feelings too and need to be taken care of.

The bottom line

Cookies are a delicious and well known treat for children so this joke might possibly make your next patient smile.


Article 2: Jokes between siblings

Paine AL, Howe N, Karajian G, Hay DF, DeHart G. ‘H, I, J, K, L, M, N, O, PEE! Get it? Pee!’: Siblings’ shared humour in childhood. British Journal of Developmental Psychology 2019. 10.1111/bjdp.12277.

What’s it about?

This study was designed to investigate the use of humour and type of humour patterns between older and younger siblings during free play. The study included children who were 7 years old with their younger or older siblings. Eighty six families participated and the sibling pairs were randomly assigned either a village set or train set to play with. The interactions between the siblings were recorded for 15 minutes and interactions were coded including responses. Examples of humour types were performing incongruities, word play, sound play (e.g. exaggerated voices), taboo (e.g. fart jokes), banter and clowning with responses being none, positive/neutral, negative, seeking clarification, imitating or extending humour.

The study found that an average of 9% of the siblings’ play time was spent engaged in humour. Just over three quarters of the time both children produced humour. Responses to the humour occurred 59% of the time and when they did respond, 28% included humour. More humorous interactions were observed with the village set than the play set. Male-male pairs had significantly more frequent humour production than female-female. Younger sibling pairs used more sound play which is supportive of the changing types of humour with children’s age.

Why does it matter?

Humour has an important social and emotional role in helping with interpersonal relationships and expressing positive emotions. Understanding and appreciating different way humour can be engaged in can help parents and healthcare workers foster and encourage humorous play with children.
The village set led to more production of humour so it may be that having a variety of open ended toys for children will be more helpful for building skills in play and humour compared to more rigid sets.

Clinically-relevant bottom line?

Remember the importance of humour to childhood play and that there are many ways that we can engage with humour with children and each other.

To quote directly from a humour instance in the study…
Older Sibling: (Singing) A-B-C-D-E-F-G (Sound play)
Younger Sibling : (Joins in singing) E-F…(with emphasis) R! (Sound play + Word play, extension response)
Older Siblings: H-I-J-K-L-M-N-O… (With emphasis) PEE! Get it? Pee! (Sound play, word play, taboo, extension response)
Younger sibling: Pee-pee! (Taboo, Extension response)
OS: Pee-pee! (Taboo, Imitation response)


Article 3: Jimmy and kids talk Health Care


Article 4: Clowning around in the ED for procedural pain and anxiety

Felluga M et al. A quasi randomised-controlled trial to evaluate the effectiveness of clown therapy on children’s anxiety and pain levels in the emergency department. Eur J Paediatr. 2016 May;175(5):645-50

What’s it about?

This study looked at the presence of clown doctors during painful procedures in the ED for children between 4 and 11years of age undergoing painful procedures. These procedrues included venous blood sampling, intravenous cannulation, burn or wound dressings, immobilisation of injured limbs and wound suturing. There was no premedication. The control group of children received traditional distraction techniques (soap bubbles, video games/TV and books).  The intervention group had interaction with two clowns in the waiting room for 20 minutes as well as in the ED during the medical examination and procedure.

Primary outcome was procedural pain with the secondary outcome being influence on children’s anxiety. A numerical pain rating scale was used for children 8-11yo and the Wong-Backer scale for those 4-8 years old. Anxiety scoring was via the CAPS-Anxiety scale which is a self-reported measure for both anxiety and pain. Staff and clown opinions were also taken.

The study found that there was no significant difference in pain levels but that anxiety levels were significantly lower for the children having clown therapy. The ED staff self reported that the clowns were helpful for children and parents and particularly useful in the waiting room but the majority of staff (90%) were not in favour of the clowns being present in the medical room.

Why does it matter?

Procedures can be distressing for children attending the ED department. The presence of clowns in the hospital is often recognised as a way to distract children and help with anxiety and pain. This small study helps to quantify the effect of clowns in the emergency department in helping relieve anxiety but no significant finding was made for pain.

Clinically Relevant Bottom Line:

Clown doctors can be helpful in reducing anxiety of children undergoing painful procedures. Although medical staff are positive towards their engagement in waiting rooms, they found it distracting or a possible disadvantage for them in the medical/procedural room.


Article 5: When I grow up, I want to be…

Source: AstroCat16 “My old school asked kids in preschool what they wanted to be when they grew up…”


What’s it about?

This infographic illustrates different dreams that a group of pre-school aged children had about who or what they want to be when they grow up. There were 16 children involved in the project who documented their aspirations using chalk and a whiteboard following which they were photographed.

Why does it matter?

Given that we are looking after paediatric patients, to understand them better it is helpful to know more about their desires for the future. Just like knowing about their favourite toys and their siblings, some of these dream roles may be topics for conversation and could help build your rapport with patients and their parents.

The bottom line

This article showcases how children have a diverse range of aspirations and great depth of imagination. In particular, we would like to acknowledge the great detail-oriented mind of the little boy who wants to be a sprinkled red-frosted donut.


If we have missed out on something useful or you think other articles are absolutely worth sharing, please add them in the comments! That’s it for this week. Many thanks to all of our reviewers who have taken the time to scour the literature so you don’t have to.

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Grace is a Registrar at Sydney Children's Hospital. She loves innovative medical education and paediatrics. She is on the organising committee for the DFTB18 and SMACC conference. Grace is a former internal director of the AMSJ. She enjoys board games, cooking and graphic design.

Author: Grace Leo Grace is a Registrar at Sydney Children's Hospital. She loves innovative medical education and paediatrics. She is on the organising committee for the DFTB18 and SMACC conference. Grace is a former internal director of the AMSJ. She enjoys board games, cooking and graphic design.

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