ntertaining Children in a Hospital

PAIN INTERRUPTED, Entertainers In The Hospital:
A Guide to Entertaining Children in the Hospital Setting
By Charles Kraus, with Linda Kraus, MA © 2007

Opening Scene
One day in 1973, an extremely hot August Saturday in Los Angeles, I'd managed to appear at four children's birthday parties -- two clown shows and two magic shows -- 10:30 a.m., 1:30 p.m. 3:30 p.m. and 5:00 p.m. respectively -- in locations spread throughout the length and width of Southern California. By the time I reached home, my thoughts had to do with bathing, eating and resting. More performances were scheduled for the following afternoon, but there had been quite enough show business for now.

My wife, Linda, stood immediately inside the door. As I opened it, I almost slammed into her. She'd been waiting, had missed me by seconds when she'd phoned my last show.

I suspected she'd gotten a call for a performance that evening. In the take 'em when you can get 'em world of clowns and magicians, I'd done as many as seven shows in a single day. I'd also not worked for weeks at a time. Another show, now? Tonight? I was bushed. It didn't matter how much money they'd offered, I was not going.

"The girl is dying," Linda said. "It's not really her birthday, but she doesn't know that. They told her she's having her party. Her tenth birthday party.”

I washed, picked out a new costume and headed for Angelina's final birthday celebration. I went because I knew how to do the show. I had some natural ability, plus a whole lot of experience. Over the years, I'd developed a knack for getting through to kids who were hard to reach. This skill had been honed working with disadvantaged children in ghetto communities. It had taken years to figure out how I could earn laughs from youngsters who found nothing silly, who looked up at me with dull, blank expressions and, if anything, thought that my goofy antics were far too frivolous to fit into their rotten lives. My objective was to find something, anything that made a spark appear in their eyes, a flash, a gleam, or an irrepressible guffaw burst from their bellies. By now I knew how to make that happen. I would do something so unexpected, outrageous and absurd that it created an automatic giggle, or at the very least, that gleeful twinkle in the eye.

If Angelina was about to attend her last party, she was entitled to be in touch with any vivacity and delight that might be left in some obscure corner of her being. If it was there, I could find it. I could help her to feel it.

My drive brought me to a large, older home in the Mid Wilshire area. When the door opened, I saw about 40 guests, lots of balloons, ribbons, and streamers. Party music came from a stereo. The cassette and the decorations were the only festive things in the place. Curtains protected the room from sunshine. Guests sat or stood in silent clusters. The lighting was subdued. The mood reflected resignation and heartbreak.

Several young men guided me to my performing space. They were friends and neighbors of the ill child and had called us hoping an entertainer could help the guests to focus on some positive energy. As soon as I'd set up my equipment, eyes turned to the top of the staircase, where Angelina's father held the slight ten-year-old in his arms. Slowly, he made his way down toward the crowd. The guests offered up a hollow cheer, loud, but remote. From where I stood, it did not seem as if Angelina acknowledged their greeting.

And thus began a show: for a group of kids – some gloomy, some confused, some frightened --, for sad adults and for a fragile young guest of honor, who, it turned out, would die the following afternoon. For several minutes, no one reacted to what I was doing. People simply watched. The funny stuff was not funny. The surefire silly business did no business. I felt upset with myself for even thinking I would be able to cheer up this dispirited group of people.

One of the keys to performing for "sick" children is not to perform to their sickness, to go around it, and reach places in a child that still have the capacity to be tickled. You do some particularly nonsensical, preposterous things, then look into the eyes of the boy or girl, and say with your eyes -- "I know you know how silly that was … what a thing!"

I am not sure which trick, or routine, or movement or combination of movements, cause Angelina to respond. Maybe she looked into my eyes and saw that I needed help from her. She laughed. Not a gigantic rouser, but loud enough to be heard by her anxious guests.

That did it. Angelina's laugh popped the tension right out of that room. She laughed then her guests laughed. Each laugh helped to build the next. We were all in the moment. And the moment had nothing to do with death. We could share NOW, and NOW was funny. We could feel it and we could live it.

Driving home, the thought came to me, that I could be doing shows for lots of sick kids, children who needed some mirth in their treatment plans in addition to medicines. Perhaps, I could perform for kids with a more hopeful prognosis than Angelina. Maybe, instead of being part of the finale, I could be part of the second or third act.
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-The Healing Power of Performance:
Getting well can make a sick person happy. And, getting happy can make a sick person well. Obviously, telling a child a joke or doing a magic trick is not going to cure a serious illness. But, do not discount the “healing” power of a good laugh. Performance improves the health of those in the audience and those doing the performing as well. If I have a bad headache, I mischievously demand that my wife (and manager) book me a show, anywhere, right away. Nothing clears the head like performing. In fact, today most people understand that engaging in certain activities, such as exercising or playing music, causes a release of chemicals into the body that produce happy, calm feelings and a sense of well-being.

When I was a teenage magician, learning my trade back in New York City, I asked my father if I could take magic lessons. He checked around and determined that the lessons offered at Tannens, the downtown magic store, cost more than we could afford. The manager suggested we contact a fellow named Jack Miller. “Professor” Miller had taught at Tannens back in the “old” days. He was in his mid seventies, in poor health, living in semi-retirement on the less fashionable side of Jersey City.

I was a cocky kid. To me, all of Jersey City was undesirable. And people in their seventies were far too over-the-hill for my taste. But my father set up a lesson, and I was obligated to attend. When I did,

“the evidence” seemed to corroborate my suspicions. Jack was old, frail and like most of the elderly I’d encountered, suffered from numerous physical ailments. A dozen or so medicine bottles adorned the telephone table in his drab vestibule. His clothing seemed to hang on his small frame. Even his voice was too small. And the Professor’s hands were so gnarled from arthritis it felt a little scary to shake hands with him.

Jack picked up a prop, a hard rubber ball. He straightened himself, extended his arms, and the ball began doing things a ball couldn’t do. Things no magician I’d ever seen could make it do. The show had begun. When Jack performed, his old gnarled hands became strong and nimble, pulling off tricks that required the dexterity normally associated with twenty-year-olds. As he adjusted his posture, Jack’s whole demeanor became youthful. Suddenly, the man fit the suit. Actually, he became ageless. Entertaining so focused him that there was no room for age or ailment, only for performance art and the joy this brought to him.
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-Entertaining Children
As a clown and magician who has performed thousands of shows at birthday parties, schools, libraries, summer camps, childcare centers, hospitals, hospices, war zone orphanages, ghettos, and disaster areas among other venues, I can attest to the fact that most children, be they sick or well, benefit from being a member of the audience, even an audience of one. Certainly, in the case of a hospitalized youngster, replacing pain, apprehension, boredom or discouragement with a few moments of lighthearted diversion helps a child feel like a child, rather than a patient or a victim. And, of course, there is nothing ... nothing ... more rewarding for an entertainer than noting the sparkle, sustained or fleeting, that sneaks into a kid’s eyes when he or she is hooked by the show.

I’m fortunate because the Starlight Foundation, Costco and other civic minded organizations and individuals, including my wife, Linda, have helped arrange hundreds Charles The Clown/Charles The Magician visits in hospitals throughout the west. When I began, I was a reasonably proficient children’s entertainer. But I had to develop a whole new set of skills for the hospital setting. This guide contains some of my thoughts and observations about hospital shows for children. It looks at the subject from three points of view – that of the entertainer, the audience and the hospital. How to give optimal performances, how to help kids (and their families) get the most out of such visits, and how hospitals can and find and best utilize entertainers.
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-The Many Stages
A hospital “appearance” for Charles the Clown and Charles the Magician, can mean a half hour routine in the recreational therapy room, a complex close-up comedy magic show in the teen lounge, two minute performances in a waiting room, five minutes of clowning at bedside, mini puppet shows in the elevator, storytelling in the cafeteria or a large scale production with parents, children, and staff celebrating Valentine's Day. Any of these visits are sure to be interrupted by kids coming and going, announcements on the public address system, volunteers busy steering IV stands and plugging in monitors, or helping to make the physical setting as comfortable as possible for kids who are downright uncomfortable. Ill children tire easily, get coughing spells, become dizzy, and occasionally throw up during the performance --- sometimes on the performer.

Huntington Memorial Hospital
Pasadena, California

Charles The Clown
18053 – 28th Avenue NE
Seattle, WA 98155

Dear Charles,

Thank you, thank you, thank you for the wonderful show that you recently performed for the children at Huntington Memorial Hospital. It was so exciting to see the children light up with happiness as you entertained with your jokes, tricks and rhymes. Even the young boy who vomited just before your show was smiling and interacting with you during the show! Isn’t that what you are all about … bringing smiles to sick children? I seriously cannot adequately convey my thoughts for your special show …..

With warmth and sincerity,
Doug L., CCL
Child Life Specialist

Clowns, magicians, singers (usually toting guitars), animal handlers, puppeteers, comics, storytellers, people in cowboy costumes, jugglers, folks who like to read to children, harmonica players, teenagers who visit at bedsides bringing a deck of cards or board games, caricature artists, mimes, seniors who teach needlecraft, hobbyists willing (proud) to show off their baseball card collections – these are some of the “entertaining” individuals I’ve encountered during my hospital rounds. I’m sure there are other “acts.” When I was a kid, getting my show business start by performing in the resort hotels of upstate New York, I appeared on the same bill with an eccentric comedian whose entire routine consisted of balancing a broom (horizontally) on his completely bald head while smoking and then eating (true story) lit cigars. I don’t suppose his act would have been appropriate for a hospital setting, though there is a good chance he ended up in the hospital. But, with the exception of old broom-head, just about any variety entertainer can find a productive way to amuse sick kids.

Here’s how …..
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-Advice to the entertainer
Don’t’ expect kids with broken legs to give you a standing ovation.

To: Clown
Fr: Hospital Administrator

If you are used to performing in a defined, organized manner, e.g., “this is the stage, this is the audience, here is the sound, there are the lights, this is the script,” forget it. Try to think of yourself as a well rehearsed improv act. Your routine, all that stuff you’ve practiced and perfected, is the foundation. With each show or mini show, you build yourself an act that meets the needs of your particular audience.

Please note: You are on the schedule for tonight, only we can’t tell you how many kids are going to be available. And I don’t know where you are going to be performing. Might be in a central space called the playroom, but maybe not. Possibly in the hall near the nurses' station or perhaps, you aren't really going to do a "show", instead, you'll have an hour and a half. During that time, please do a few dozen "mini" programs, five minutes, two minutes, some for kids who do not speak or understand English. Do you happen to speak Norwegian? It would help.

By the way, try to remember not to use any props containing the color red when you visit the boy from Nebraska. Your costume is red? Get a different one, please.

The child in room 305 has a video camera following his movements. Don't get between the kid and the camera.

Mention puppy dogs to Sarah - room 211. No, actually, don't mention them, her dog recently died.

And don't say "mother" or 'mom" or anything that will remind the twins, in the next room that they have been crying for their mother.

Rachmon saw you last time you visited. He wants different magic tricks, but the same puppet.

If you hold the show in the Playroom, that will mean many children will be coming down from their rooms and actually forming an audience, do your best to get some participation from the children who are not ambulatory. You might have to bring your props to them. Be careful, there are lots of wires and tubes.

And while you are walking to the back of the room so you can reach these youngsters (thereby making it extra difficult for the rest of the kids to see you), avoid getting anywhere near the toddlers because they are afraid of clowns. By the way, Jonathan's mother is also afraid of clowns. Stay away from her. But call her husband up to help with a trick. He's looking forward to that.

Reminder. No balloons. The hospital does not allow any latex balloons.

Also: The volunteer who'll be taking you around is new. You'll have to show her what to do, and where to go.

That’s the pertinent information…for now..

Sincerely yours…
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-Entertaining at the Bedside
You’ll be entertaining kids with various physical and cognitive impairments – chronically ill children, kids who have recently gone through painful medical procedures, kids who are almost ready to leave the hospital and head for home, children who have relatively minor injuries and except for a broken leg might be feeling kind of frisky. There are shy children, enthusiastic children, alert kids, those who have a difficult time comprehending what you’re doing, and those who will anticipate your every move. Many children, certainly the lucky ones, have family members visiting or even staying with them. You’re bound to run into bored siblings teaming with excess energy. You’ll meet tired parents who may or may not be in the mood to deal with an “entertainer.”

One of your many tasks is to be objective about the potential benefits and the potential disturbance your presence can make in a room. I say “in a room,” rather than “to a child,” because you have to think about your impact on everybody who is going to be in the “audience,” doctors, nurses, staff, family members. If there is more one bed in the room, then double or triple the prospective size of the crowd. The youngster in bed A may have been waiting for you all day, but the child in bed B might be too sick to have a disruptive visitor in the room. It’s his room, too!

Prioritize. Find out if any of the kids on the list have medical needs that will take them away from their rooms during part of your touring schedule. If so, consider visiting these kids first. During evening visits, think about entertaining the youngest children before you get to the older ones. Obviously, nurses, doctors and recreation specialists will be involved in deciding which children you visit. But one moment a child is “ready” for you and the next he or she might not be feeling well enough for company. And remember, the patients may have siblings and friends visiting so the room could be crowded with a mixed-age group of children.

Ascertain the following information before entertaining a room -- “Is there anything special I need to know about this child?” Some of the answers might be:

  • In pain.
  • Agitated
  • Clown fear or fear of costumed characters, e.g. Easter bunny (NOTE: Most little ones between 18 and 36 months are fearful of a person in a costume)
  • Frightened of strangers in general
  • Hearing impaired
  • Low vision
  • Developmentally delayed
  • Differently abled
  • Language barrier
  • Unable to move
  • Feeling especially sad or homesick
  • Wants parent to be there
  • Requires all people who enter the room to wear mask and gown



-Room protocol
Have the volunteer or staff person who is escorting you, enter the room and ask if you should come in. Assuming the answer is “yes”, enter and re-introduce yourself. Tell everybody why you are there. Meet everyone --- parents, kids, doctors, nurses ... and teddy bears.

Wash your hands at the sink, or if the hospital has a hand sanitizer dispenser at the door, make it a point to clean your hands before entering; don’t touch the kids; keep a little distance.

The length of individual visits depends on the way you balance individual patient interest and needs, number of rooms you’ll be visiting, and total amount of time you’ll be in the hospital. When making room visits, remember that these children were not able to come down to the playroom to see your program because they are too sick. Respect this. Just because siblings and parents are having fun watching you does not mean you need to stick around impressing them with your skills. The idea is to provide diversion for the patient. If a child begins to tire or lose interest, conclude quickly.
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-Special environments
* You can enter the room, but must stay back, behind a protective clear plastic wall.
* The patient is hooked to lots of tubes and monitors -- keep this child still. No asking him to lift up his hand, no reaching out to select a card ... even down play too much laughing.
* Occasionally, you’ll find yourself in a room where the child is literally on television. He or she is being monitored, perhaps taped, for evaluation. Do not get yourself between the child and the camera (mounted on the wall or on a tripod). The doctors don’t want your picture!
Please consider your presence through the eyes of the children

Quick lesson in kid-thought:

  • WOW!


-Parent involvement
Parents would like their kids to be well, to be home, not in a hospital. They don’t want their children to be sad and hurting. “Make my child laugh. Make him feel happy!” So, Mr. /Ms. Entertainer, you’re the professional. The hospital has allowed you to visit. You must know what you’re doing.

The fact of the matter is, parents don’t necessarily know any more about “hosting” the entertainer who has just walked into the room, than their child does. If their child doesn’t feel up to a visit, is it rude to send the singer away? If the kid is afraid of a clown, but the parent keeps telling the clown it’s okay, and telling the kid “it’s okay, don’t be afraid, you’re okay”. Is it okay? Nope. The decision to stay or go is entirely yours. Use tact, and use your head. You didn’t come to the hospital to walk around upsetting kids.
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-Chain of command
A hospital entertainer answers to several “bosses”. The organization that sent him, such as The Starlight Foundation, the hospital administrator, the recreation therapist, the doctors, nurses and related staff, the parents and the kids. Being supervised by so many folks can create a certain amount of confusion. The list of rooms given to you by the recreation therapist says Room 401, but the sign on the door says Do Not Enter. The nurse says you can go in, but the parent seated at bedside motions for you to stay away. She’s trying to get her daughter to eat, only things aren’t going well. Under the circumstances, you’ve decided to skip this room -- except that just as you’re getting ready to head down the corridor, the child in the next bed cries out – “I want to see the clown!” Who is in charge? What do you do?
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-Basic guidelines:

  • If a child doesn’t want to see you, stay away.
  • If a parent doesn’t want you to enter the room, go away.
  • If you are not sure if it is appropriate to enter a room, ask the nurse.
  • Don’t ask the volunteer to answer these questions. These are questions that need to be addressed by staff or parents. Certainly, if one child wants you to visit, and the youngster in the next bed doesn’t want you to enter the room, negotiations are in order. These take place between the parents, sometimes with staff assistance.
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-Depth of material
Have a lot of material. Chances are you’ll end up using all of it, plus two or three things you’d forgotten you knew until you found a sudden need to retrieve them from the rear storage compartment in your head. The fluctuating and diverse group of kids who will populate your audiences, combined with the special qualities of your show means, for example, that a singer’s repertoire has to include songs for kids of varying backgrounds and ages. Happy songs, birthday songs, familiar songs from different cultures, story songs, songs about feeling sick, feeling scared, feeling angry, feeling better. The point is to try and gear your presentation to the here and now experience of the young patient or to some familiar event, place or person. Your presence should help the boy or girl feel comfortable as well as give comfort. By the way, excellent and developmentally appropriate songs for children can be found in recordings by Peter Alsop, Marcia Berman, Patty Zeitlin, Animal Crackers, Dan Crow or the Mister Rogers series – all available by a good internet search.
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-Story Telling / Magic
Likewise, storytellers might be called upon to tell stories about a child’s favorite kind of animal, about being away from home, about being brave. Be prepared with short, medium and long versions of your material, mirroring short, medium and long attention spans.

Tell a story, and each time the main character is to be named, cue the sick child and get him to say the character’s name. When working with older kids, ask where they go to school, the names of their best friends, if they have any pets -- and incorporate these “facts” into your stories. “Hey, my best friend is named Ramona! ... Let me tell you about this big adventure she had last summer…”
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-Magic tricks
Magicians may meet kids who want to show off their own card tricks, or need the entertainer to work up real close -- too close to hide the secret string. Maybe, the rope or coin trick has stimulated a conversation, and as a youngster’s two (or three or four) parents are present, you decide to make this a “family” trick. Prepare a range of participation material.
It is best to ask a child if he would like to help -- help hold something, help say the magic word, help wave the wand. The question always offers a clear and friendly choice so that if someone is not interested, he or she doesn’t end up feeling embarrassed. “You can watch, or would you like to help by saying the magic word?” If the child wants to help, but has physical or cognitive limitations, the assistance might come in the form of getting him to push the invisible button on the top of the box, touching his own nose, or sticking out his tongue (sticking out a tongue is a real favorite among seven-year-old boys). Some kids help by smiling, real big, at the appropriate moment, others by making a funny face. Lots of kids, healthy or unwell, will want to examine the trick box or other magical prop.
Songs, stories, tricks, jokes -- whatever your specialty --should not only be developmentally appropriate, but should be planned so as to enable your young patient to: DO SOMETHING.
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-Clowning Around
Hospital clowns are prepared to be funny or quietly engaging -- both attitudes tempered with warmth and sincerity. Often, a child appreciates a little of each of these approaches. He or she may start out laughing, and then grow tired after only a few minutes. In this case you do not want your show to “build”, to get bigger and bigger reactions. You want to calm it down until a quiet, sincere, friendly finish is achieved.

No balloons, please -- at least that is the rule in most hospitals. Yes, kids will ask about balloon animals, and yes, some parents will encourage this. Play by the rules.
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Children typically need a few moments to warm to strangers. The stranger the stranger, the longer it might take to establish rapport. However, it rarely takes children more than a moment to warm to a friendly puppet. A puppet can do most of the visiting for you, talking to the child, responding to what the youngster says. A puppet can do some of the magic tricks or tell a few stories. It can ask the right question or make the right responses to your act, modeling appropriate responses to your jokes.

If you plan to present a story where several puppets interact with each other, be ready to deviate from the script as you monitor the reaction of your audience.
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-No English
How many languages do you speak? French, Vietnamese, sign? The correct answer is - not enough, at least not to communicate with the variety of patients frequenting big city hospitals.

There are several ways to handle the language/communication barriers you'll be encountering. More than likely, you'll end up blustering your way through such interactions - lots of pointing, miming, the substitution of simple single English words for the complex sentences you'd normally be using ... What a chance to be your most creative self.

Try to find out in advance if your route will include any communication challenging situations. The recreation therapist may very well know about potential language difficulties. And, he or she might be able to provide assistance. After all, the nurses and doctors have to speak with their patients. How do they accomplish this? Are they dependent on a child's parents or relatives? Can a staff person serve as an interpreter? If you have enough notice, you might be able to bring along your own interpreter or at least brush up on the high school Spanish that you haven't used in a dozen years.

Even if you cannot "learn" a new language in two days, you might be able to memorize just enough words or phrases to get you through the appearance. Even a handful of familiar words thrown into your routine can help a youngster feel more comfortable.

Consider holding up photographs SHOWING what you are trying to state with language. Do your best to make your intentions so obvious that language does not become an obstacle. Or, if patter is an important part of the trick or bit you are performing, have an alternative bit or an alternative presentation ready.
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-Shy Youngsters
Shy children don’t so much “watch” a show as “overhear it”. Perform for the other kids, for parents, or even for your puppet, from time to time checking to see if Mr. Shy Guy is sneaking a peek or two at your shenanigans. Work as if the child is simply part of a bigger audience, composed of parents, siblings, volunteers, nurses, doctors, and other patients in neighboring beds. Don’t “aim” the show directly at the child, just include him. Try to determine if he or she is becoming more engaged. As that occurs, focus in his or her direction.

It is rather complicated to “rehearse” the part where the child leans over the edge of the bed to get closer to the storyteller and suddenly throws up all over the visitor’s Scandinavian Folk outfit. At the very least, be prepared for the inevitable. The “inevitable” can mean an upset stomach, sudden fear of strangers, or even the unexpected onset of so much enthusiasm that a child starts to cry every time you try to leave the room.

Though you cannot “rehearse” these possible scenarios, it is important to think about them, to imagine as many “awkward moments” as you can. Also, ask the recreation therapist or other hospital staff to describe potential problem situations. These may be stories about circumstances unique to the particular hospital -- having to do with the physical plant, way things are laid out, structured or scheduled. The clown who is writing this guide once spent an incredible 20 minutes “stuck” in the back stairwell at UCLA Medical Center because an aide had suggested a “short cut”. The fact that none of the doors could be opened from inside this route was not mentioned, and the clown in question finally resorted to pounding on the doors with his giant shoes, thus gaining the attention of a nurse who freed him, but not without lecturing about too much clowning around.

Have a contingency plan. Have several of them. Perhaps you’ll never need to use them, but if a need arises, you’ll be able to alter your response or problem solve on the spot.
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-General Preparation
Call ahead so you can determine who the audience is going to be, then give some final thought to the kinds of material you’ll perform.

Are there volunteers? Will the recreation therapists be on site? To whom do you report? What does the hospital expect of you on this particular visit? What special information might you need to know -- has a popular child been discharged, has someone taken an unexpected and serious turn for the worse (and do the kids know about this; they often do). Have the patients just been visited by a movie star, football team, radio personality? Has another clown made a recent appearance (and if so, how did it turn out. If he frightened half the audience and bored the other half, you might want to know).

If your appearance is going to coincide with a holiday -- Valentines Day, Easter, Christmas Ramadan, Hanukah, Las Posadas, Kwanzaa ... does the hospital have any advice. Do they want the holiday mentioned at all?

  • Who is having a birthday?
  • Who is from out of town, out of state, out of the country?
  • Are there going to be unusual language problems?
  • And, what exactly is the hospital population today? All three year-olds? All teens? All over the place?

You are the entertainer, and one of your responsibilities is to help the staff get the most out of your visit. Offer your thoughts and ideas. If it turns out that on the day you are secluded to perform, the only hospitalized children are 3 year olds and 12 year olds, let the staff know you think it best to do two shows, one for each age group, and that the three year olds need to see the early show. Tell the recreation therapist if you have a great activity the kids can do after seeing your performance. Let the therapist know if you have photocopied lyrics, or a handout describing games related to your visit.
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-Time Frames
Factors that can influence a child’s attention span are age, level of maturity, state of physical and/or emotional health, physical setting, and what is being watched. Television screens mesmerize kids of all ages for hours on end. Homework doesn’t have this effect. When it comes to “live entertainment, be it in a hospital or on the Broadway stage, the vaudeville rule still holds -- leave ‘em begging for more!

Most entertainers have “insurance” material, sure fire routines, to fall back on if the planned program does not work out. An actual show for young children rarely runs longer than half an hour. Be ready to “all back to your best twenty minutes, your best fifteen, or just your insurance.

Size up an audience before beginning the concert. Work the room, meeting kids and parents, explaining that in a little while, you’ll be performing a show. Talk about what you are going to do, where the audience is going to sit, why the kids are going to have a good time. So as not to stimulate worry, let children know you’ll only call on them if they raise their hands and offer to assist. Help people to feel safe, and to feel excited about what they are about to see. This is more than warming up the audience. Warming up an audience means getting the laughter and spirit going so people are ready to receive your show. Go one step farther; reassure your audience that they are going to be okay, and that they’re going to have a good time.

Children who are feeling very poorly or younger children may have difficulty sitting through a full program. Lots of other kids could benefit from the complete show, so if you suspect the need for an intermission, hold one. Inform volunteers and staff you might be performing Part A and Part B. That way, they are ready to help a portion of the audience back to the rooms or on to other activities. Keep the “break” short. You don’t want to lose the attention of the kids who are waiting for the second half of your program.
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-The Concert Show
Visitors such as friends, siblings, parents, and relatives, who have come by to say hello to patients, make excellent members of the audience. These folks are generally enthusiastic, and almost automatically go out of their way to spread their enthusiasm to the hospitalized children. Ask a doctor about the most contagious thing he/she can think of and the answer will likely be chicken pox or influenza. Ask an entertainer what’s contagious and the answer will be laughter.

The composition of a recreation room audience is generally quite diverse. Your mixed-age audience will be composed of youngsters from different socioeconomic, ethnic and religious backgrounds recovering from a range of ailments. Some kids won’t understand English. Others are hearing or vision impaired. Some youngsters can walk to the performance, often assisted or encouraged by volunteers or parents, while other children are wheeled to the show. A few kids are coerced into attending (hopefully because the “nurse or volunteer” knows that once the program begins, the child will enjoy and benefit from watching). High tech monitoring devices, plugged into power sources, might accompany some of your audience members.

Shows should not run longer than a half an hour; often this is too long. Use bright, colorful props. If you suspect the need, bring along a speaker system, but don’t use one if you don’t have to. Better to communicate directly rather than via yet another electronic contraption. Carry a few “indestructible” props the kids can examine. Make sure your props are clean and that your costume looks spotless. Your personal hygiene is especially important in this setting. And be certain to allow enough time, after the performance, to spend a few minutes talking with the kids and parents who have been watching you.
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-Getting Around
The physical layout of a hospital -- corridors, tunnels, banks of elevators, north, south, east, west wings, closed doors that tell you to stay out, signs that say authorized personnel only, detours, stairwells, shortcuts, and so much new construction that you have to update and revise everything you remember about traversing the place last time you were in town -- These are all good reasons to depend on a seasoned volunteer to get you around.

If you are performing a show and then touring the rooms, make arrangements to store show related paraphernalia with the Recreation Therapist once you have completed the “formal” program. Take a single, reasonably sized, prop bag with you on your rounds. Request that the volunteer return you to Recreation Therapy at the conclusion of your tour. And make sure the office will still be open when you come back to retrieve your equipment.

Is there a map or diagram of the hospital? Get a copy. If none exists, make your own, especially if you are going to visit on a regular basis. Learn as much as you can about the layout. Some elevators can get you there faster than other elevators. Find out.
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-Parking and Signing In
The first space is the parking space, and it may be miles away. In Los Angeles, at Harbor UCLA Medical Center, which services mostly modest income families in the southwest section of the city, the parking lots are endless. They cover acres, and if you end up parking at the outskirts, you had better be able to easily wheel your equipment into the building, and be protected from the rain, if you are experiencing inclement weather. And don’t forget that there is going to be a long line of people waiting to enter the facility. Each visitor has to pass through a metal detector run by the security force. The first time I encountered this, I had a sharp scissors in my showcase. It gets used during the cut and restored rope trick.

“Yes, officer, the big shoes, the wig, the scissors, why it’s obvious, isn’t it, I’m part of a gang … of clowns, come to the hospital to bore sick children with dull old comedy routines. I threaten to come back and do the show again if they don’t get better and go home.”

At Children’s Hospital & Medical Center, in Seattle, visitors are asked to park in either a lot or structure at the top of a hill. The hospital is comprised of several connected buildings at different levels along the slope. You enter on either the 5th or 6th floor. The recreational play area where the show takes place is on the second floor at the opposite end of several extremely long corridors. You take the “Balloon” elevator to the 3rd floor, hike another corridor, then get on the “Whale” elevator for your final decent … but not your final corridor. It can take 15 minutes from the time you arrive until you reach your second floor destination. And, of course, once you’ve concluded your appearance, you have to retrace your steps.

Many hospitals insist that everyone enter through the main lobby. This is true of the Lucile Packard Children’s Hospital in Palo Alto, where the receptionist checks you in, gives you a visitor’s tag and directs you the appropriate location. Each hospital is unique, some exceptionally formal and regulated, others more relaxed.
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Being in the hospital is a very private and personal experience, not one that people want strangers, even clowns or magicians, to document. Entertainers who would love to get a photograph of themselves sitting among all the kids who have watched the show, are advised to leave their cameras at home. It is inappropriate for you to take pictures of the children. On the other hand, the hospital may ask the entertainer to pose for pictures with the kids so patients can receive a photo of the experience.

Often parents ask an entertainer if it is okay to take his or her picture. Unless the hospital has a policy that prohibits this, sitting for the picture can be an enjoyable experience for the child and the performer. Unfortunately, it can also turn out to be a very uncomfortable experience for some youngsters. This can occur when well-meaning parents attempt to force or cajole kids into posing with the entertainer. If you get the feeling that taking the picture is going to be more trouble and pain than it is worth, look at your watch and say, “oh ... I didn’t realize it was so late. I’ll try to get back here when I have time, but right now, I have to stay on schedule or I won’t be able to visit the rest of the kids.”
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-Assisting Physicians
You are never going to be asked to assist a doctor by handing her the scalpel, but you may end up serving as a pleasant distraction while she changes a dressing. If you happen to arrive in the room just as the doctor is trying to administer a shot, or perform an uncomfortable procedure, you might be asked to “do something” to refocus the child’s attention.

Just your presence may be enough to divert the patient’s focus. Stay back. Don’t try to become part of the procedure. But even standing in the doorway, you can give out a comic comment. Drop a prop, then talk to yourself in a silly way about the problems you are having retrieving it. Start to sing, but substitute funny lyrics for the correct ones, then stop yourself and comment about the strangeness of the words. Or, start itching. “Oh my, I think I’m getting very ticklish, my back is, no ... my stomach is ... no, actually, my right ear ... which is my right?? Oh, this right ear! Not that right ear, because that right ear is really my left one!” Being at your comic best isn’t all that important. The idea is to cause the child to look your way just long enough for the doctor to finish the exam.
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No reflecting, not ‘til you get home.

Do your job. Don’t pause, don’t hesitate, don’t take a breath, because if you do, you’re going to look around and find you’re looking at some mighty sick children. The job is to bring positive energy into this place, not to let the place fill you with despair. This experience is not about you!

Fortunately, the kids often help keep you going. Some of the sickest youngsters I’ve seen have smiled some of the biggest smiles. Later, after you’ve gone home, a few faces might find their way into your dreams. Hopefully, the strongest recollections will be the smiles.
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-Other Locations
Where else might you perform your highly specialized "nurture-the-young" "bed-side" routine? Orphanages, hospices, out-patient centers, camps, schools and recreational programs for the specially-abled, and in private homes where a child is confined or recovering from an illness.
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-Advice To The Hospital
(This section is for hospital staff and administrators, but if I were a serious entertainer, hoping to do shows for sick children, I’d read it thoroughly so I had some understanding about the needs and expectations of administrators, doctors and nurses when they are dealing with entertainers.)
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-How to Select Entertainers
A person is not a children’s entertainer simply because he or she “loves” kids and happens to own a clown costume or an acoustic guitar. And a hospital is not a training ground where beginners can practice their acts then move along to the main stage at Disneyland. Performing for children is an acquired skill. Unfortunately, there is more enthusiasm than integrity in the variety entertainment industry. Some entertainers have a moronic assumption that goes something like this: I’m not quite good enough to entertain adults, so I’ll call myself a kid’s entertainer. And there might be a part two: I’m not quite good enough to entertain healthy kids, so I think I’ll entertain sick ones!
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-Finding Great Acts
There are several ways to track down great acts for hospital shows; over time, you’ll most likely end up using all of them. You’ll be looking for entertainers who possess many qualities -- manner, talent, professional appearance, reasonable price, availability, reliability, and appropriateness. If you can get one who happens to have a degree in early childhood education, so much the better. If not, at least try to find somebody who is familiar with some basic child development concepts. Look for people who relate well with kids. This is not the same as “perform well in front of children.” Hospital appearances have much more interaction between “audiences” and entertainers than do shows given in traditional theater settings. Hospital programs are essentially performer-patient dialogues.

Children’s Entertainer Wanted
Experienced, knowledgeable variety performers capable of providing bedside and small group shows for sick children in the hospital setting.

If you happen to live in a city that supports entertainment trade publications such as Variety, Back Stage, or the Hollywood Reporter, run a classified ad. Trade publications for magicians, clowns and puppeteers -- small, national magazines such as Genii Magazine (4200 Wisconsin Ave. NW,Suite 106-384, Washington, DC 20016), and Magic Magazine (6220 Stevenson Way, Las Vegas, NV 89120) -- accept classified ads, or may even run a short item indicating your need for entertainers.

Theatrical agents can help you locate acts. Be certain the arrangement is clear so the agent doesn’t end up trying to get a fee for each show the act does at your hospital. The Yellow Pages lists entertainers under the following categories: Entertainers, Clowns, and Magicians.

Many entertainers belong to associations or unions that will be eager to help you put their members to work. Search the by city and type of talent. Example: “Seattle Magicians”. One excellent resource is Peppers & Pollywogs.
Some of the organizations:

  • The International Brotherhood of Magicians [address of national to be provided]
  • Society of American Magicians [address to be provided].
  • Shriner Clowns, Clown Alleys, Clowns of America [more].
  • The Children’s Music Network [address to be provided]
  • Storytellers: [more]
  • Storytellers Guild?
One of the best ways to acquire acts that will meet your needs is to ask for recommendations from other hospitals, from school principals, parks and recreation leaders, scout leaders, and children’s librarians. All of these people hire children’s entertainers. Also, ask your own staff for feedback about the entertainers who have already visited your hospital.
Once the word is out that you are looking for acts, you’ll probably start to receive unsolicited promotional material from local variety entertainers. Even if you are satisfied with your current performer roster, maintain the file for future reference.
Interview and audition potential acts.
Many state or local governments require entertainers (and others) who plan to work with kids register and/or be given background checks. Recommendations are great, but a background check is still a good idea, even if your state does not require one.
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-Questions to Ask

  • How much experience does the act have working in front of and with children?
  • Has the act had previous hospital performance experience?
  • Do members have any special skills such as the ability to sign, or to speak a foreign language?
  • Do the entertainers have any “messages” that they intend to pass along to the kids -- religious, philosophical, political, spiritual?
  • Why do the entertainers want to appear in a hospital?
When interviewing the act, explain in great detail the various types of performance spaces and assignments you’ll want covered. Ask for lots of feedback about how an act might use such settings.
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Try to see a “live performance” rather than having the entertainer describe or run through the show in your office or in an empty auditorium. Many acts have CD’s or DVD’s so you can see a sample of their performance at its finest. If an act auditions at your hospital, limit the trial to a short routine and a sample bedside visit.

Among the things you’ll want to consider -- the costumes, the number of people in an act (1 to 3 is fine; more than that and it starts to get crowded), the condition and kinds of props used, and especially the type of material you are witnessing. Are you watching a show that can withstand lots of interruptions? Can it be presented in a flexible manner that will work well in hospital situations?

Potentially Great Hospital Entertainers
There are lots of wonderful children’s entertainers who have never set foot into a hospital. Try to provide short, structured opportunities for such individuals to perform for selected hospital audiences. You will be developing quality hospital entertainers, and benefiting all involved, your facility, the entertainers, the kids and the community. Perhaps a holiday party can feature entertainment by a seasoned pro and a potential pro. Or, a “new” act can shadow the pro on his or her regular rounds.

Unfortunately the variety entertainment field is a land mine of egos and paranoia. Acts that have worked hard to learn their trade are generally reluctant to pass along “secrets” to potential rivals. Therefore, it may not be possible to develop apprenticeships with established acts. But it’s worth a try. Some entertainers are willing to share their knowledge. If you plan to ask your current roster of entertainers to train an up and coming act, be sensitive and realistic about the response. By all means, ask the act if it is ok to have another performer tag along.
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-How to Schedule
Appearances are often scheduled weeks or even months in advance. And though this is generally necessary, it is almost impossible for a hospital to know that far ahead what the census will be on a particular show day. That is why children’s entertainers need flexible acts – an audience might be comprised of three patients or forty-three. Often, a visit is successful in part because the act arrived at the “right” time on the “right” day, and performed for the “right” audience.

The floor nurses need to assess the needs of the population and determine who would most benefit from attending a show in the playroom, who should be entertained at bedside, who gets a “wave” and brief hello from the clown as he walks down the hall, and who gets a room visit where children in a multi-bed setting watch a uniquely crafted show … presented just for the kids and parents in C248. The nurse’s assessment should be given to the entertainer as soon as the act arrives, so time frame, energy and strategy can be shaped.
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Some hospitals are lucky enough to have a hardy supply of well trained volunteers to work and play with the kids, hold babies and read stories. Often, these individuals are responsible for gathering the kids who are assembling to watch the recreation room show. Volunteers assigned to specific children are encouraged to sit with their charges during the performance. Other staff members need to be strategically placed throughout the crowd, where they model and lead reaction to the show. If the children are supposed to sing, the volunteers sing. If the children are supposed to laugh, the volunteers laugh. By example, volunteers and recreation specialists help their young friends turn into an audience. Remember, few children have experienced a “live” show. We live in a virtual world where most “entertainment” is viewed on the screen. Younger kids may, at first, be intimidated by a “live” performance. Should they “react,” or is this like when the teacher is talking to a class filled with kids and the “audience” is supposed to pay attention but remain quiet?
Volunteers also help parents and siblings of hospitalized kids with seating arrangements and crowd control: big kids behind little kids and children who have to leave before the show ends toward the back of the room, so they can exit with as minimal disruption to the rest of the group.

Some recreation room visitors are not at all interested in watching the show. They require help playing quietly in another area. A few kids start out thinking they want to watch, but end up feeling too uncomfortable as the program progresses. Volunteers will help guide them to a more desirable setting.

Volunteers Who Tour With The Act
Entertainers do not walk into hospital rooms unannounced. On occasions when an act is handed a list of rooms and told to “do his (unguided) best”, or when a busy nurse, rightly concerned with more pressing medical matters, points in a general direction, indicating that the performer should seek an audience somewhere off in that wing -- things are likely to go wrong.

Even if a child knows a clown is supposed to visit, it is still startling when a person whose face is covered with white make-up, who is wearing size 79 shoes and a bright orange wig enters the room without a warning. Each child’s preconception or expectation of a “clown” is going to be unique, and the character that enters may not be what is expected.
Entertainers need introductions, and this task falls to the volunteer who is escorting the act from room to room. Volunteers can prepare the audience, even an audience of one, for what’s coming. The brief moment when a volunteer precedes an act into a hospital room is an opportunity for the escort to assess the pluses and minuses of a room visit. A child who agreed to have this visit when asked about it in the morning, may have changed his or her mind by the afternoon. A youngster who was enthusiastic about having Susie the Clown stop may not know that he is afraid of clowns until zero hour, when the clown stops by to say hello.

Most hospital entertainers are able to overcome these obstacles. If given a reasonable chance to perform, they often win over a tentative child. But why put a child, or an entertainer, into such a situation. Have a volunteer precede the act into the room and offer the patient the choice:

“We have Charles The Clown visiting today. He’s out in the hall, with his dog puppet and some silly magic tricks. Would you like him to come in?”

Assuming you are asked to visit, it can be helpful to have the volunteer stand by, ready to provide appropriate “audience” reactions. This encourages bedridden kids to respond in a similar fashion, it also helps with the timing and pace of a show, and makes the entire experience feel more special.
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-Medical Considerations - Entertainment Limitations
“OK kids, raise your hand if you want to help ...” Getting patients to participate is one of a hospital entertainer’s goals, but the level of participation has to reflect both the medical and developmental limits of the audience. If certain children should not be raising their hands, or if no one is going to be available to “be a volunteer from the audience,” if while visiting the rooms, the act needs to wear a surgical mask or gloves, make this known. An entertainer can perform an entire routine while standing behind a clear plastic shield, or in the doorway. But it sure is helpful be told about limitations and restrictions, rather than guessing the parameters of a situation.
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-How the Staff Can Prepare the Kids
The fun begins before the act arrives.

Show children photographs of the performers. Kids might wish to talk or draw about the forthcoming appearance. Some may want to make “decorations”, either for the stage area, or their rooms (a “greeting” for when the entertainer stops by during a bedside visit).

Many acts have performance CD’s or DVD’s of their shows. If you can, obtain copies. Select and play segments the children will find enjoyable --- a “sneak prevue” of the entertainer who will be visiting later.

The objective is to raise reasonable and positive expectations. Enthusiasm, shared between the staff and patients is a bond. Watching a show “together” is not only fun, it is a unifying experience.
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-Pre/Post Activities
In addition to decorations, what about some hand-made tickets? Or, more to the point, kid-made tickets. Each child can make a ticket for another child, or for himself. If a youngster is feeling up to it, he or she might become the ticket taker.

Older kids can be pressed into service designing flyers for duplication and distribution within the hospital community. If an audio cassette recorder is available, the teens can create and record a “commercial” which a volunteer will play at the bedside of each interested child.

Arrange for a for a post-show “interview” time during which children can ask questions. These can be formulated in advance --have kids write down questions (for boys and girls unable or too uncomfortable to write, perhaps questions can be dictated to volunteers). After the performance any children who would like to interview the entertainer will have a ready made “script.” New questions may be stimulated as the children watch the performance.
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-After the entertainer leaves the building
There is still plenty of mileage to be gotten from the recently concluded event. Thank you notes are appropriate. Often children like to draw pictures of the show they’ve just seen. They may wish to keep their art projects, or to send them to the entertainer. Collect the materials for mailing to a very appreciative magician or storyteller. Make sure that children sign the notes and pictures using only their first names.

One (of the many) reasons acts must stick to developmentally appropriate routines, is that children often imitate what they’ve seen and enjoyed. Therefore, magicians cannot perform “escape” tricks or hocus pocus involving knives or other potentially dangerous props, certainly, no tricks that use fire. In the days following the performance, if there are dramatic play props available, some patients will enjoy engaging in pretend play as a clown, magician, singer, storyteller, et al.
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