PEDIATRIC NURSING/March-April 2015/Vol. 41/No. 2 65

T he human-animal bond con-tinues to be a topic of explo-ration in research, philoso-phy, and psychology. Animal-

facilitated therapy (AFT) is consideredto be a subset of complementary andalternative medicine (CAM) because itcomplements treatment and affectsthe way a patient experiences symp-toms (Urbanski & Lazenby, 2012).The American Veterinary MedicalAssociation (AVMA) (2012) estimatesthat 69.9 million U.S. householdsown a pet dog, and 74.4 million owna pet cat. Veterinary researchers havefound that benefits to pet ownershipinclude an increase in social interac-tions and attention, improvement inmood, and extended life expectancy(Beetz, Uvnas-Moberg, Julius, &Kotrschal, 2012; O’Haire, 2010).

Clear distinctions exist betweentherapy and service animals. Serviceanimals are trained, often with specif-ic purpose, to aide with specific dis-abilities, such as visual or mobilityimpairments, and are owned by theperson for whom they provide serv-ice. Service animals are also legallydefined and recognized by federal law(Rossetti & King, 2010). For example,under the Americans with DisabilitiesAct (ADA), businesses are required toallow people with disabilities to bringtheir service animal onto premiseswhere customers are allowed, such as

Continuing Nursing Education

Animal-facilitated therapy (AFT), more specifically known as animal-assisted ther-apy (AAT) or “pet therapy,” has had an increased presence in the literature with asurge of recent research methodologies exploring this complementary alternativemedicine (CAM) intervention. However, limited studies have been conducted in thepediatric population, with many articles anecdotal in nature. A literature reviewincluded primary data sources PubMed, PsychINFO, Medline, and CINAHL, andyielded positive and beneficial outcomes to be gained through AAT in the pediatricpopulation. Primary outcome variables of decreased anxiety and pain are the mostcommonly reported results. Further research studies are indicated to include theeffects of AFT with children with different diseases and diagnoses. Exploration ofother psychosocial and physical variables, such as self-esteem, would be useful.Interdisciplinary strategies are needed to develop interventions to help reducepatient symptoms and treatment-associated stress, as well as to facilitate healingand wellness beyond traditional medical treatment plans. Complementary thera-pies are of continued interest to the health care community, especially for pediatricnurses. Effective use of animals to facilitate conversation, lead discussion, or breakcommunication barriers has been demonstrated through both research and anec-dotal reports.

The Role and Impact of Animals withPediatric Patients

Anna Tielsch Goddard and Mary Jo Gilmer

Objectives and instructions for completing the evaluation and statements of disclosure can be found on page 70.

Anna Tielsch Goddard, MSN, BS, RN,CPNP-PC, is a Pediatric Nurse Practitioner,Children’s Medical Center Dallas at Legacy,Dallas, Texas. She is a PhD doctoral studentat Vanderbilt University School of Nursing.

Mary Jo Gilmer, PhD, MBA, RN-BC, FAAN,is a Professor of Nursing, VanderbiltUniversity School of Nursing, and the Directorof the Pediatric Palliative Care ResearchTeam and a Professor of Pediatrics, MonroeCarell, Jr., Children’s Hospital at Vanderbilt,Nashville, TN.

restaurants, hotels, retail stores, taxi-cabs, and sports facilities (U.S. De -partment of Justice, 2008).

Companion animals, a subset ofservice animals, have received in -creased attention for their value indetecting underlying disease in theirowners, including cancer, seizures,and hypoglycemia (Wells, 2012). Asopposed to the federal recognition ofservice dogs, therapy animals are notdefined or regulated by the federalgovernment. Therapy animals are usu-ally not owned by the clients or res -ponsible for their well-being, and arebrought to the pet therapy session bythe owner, who is called the “handler”in these sessions. Therapy animals arealso not subjected to the extensiveand somewhat rigorous training span-ning between 1 to even 2 years thatservice animals endure (Rossetti &King, 2010). However, both handlersand therapy animals are required tocomplete prerequisite courses offeredthrough Pet Partners licensed pro-grams. Therapy animals must also passa series of tests by a certified pet ther-apy agency to be a licensed therapyanimal (Pet Partners, 2012a).

History of Animal-AssistedTherapy

Dr. Boris Levinson is often credit-ed as a pioneer in use of animal-assist-ed therapy (AAT) (Rossetti & King,2010). A practicing child psychologistin the 1960s, he theorized that hispatients were less anxious and had lessresistance to therapy when his dog,Jingles, was involved in the sessions(Levinson, 1965). Levinson noticed thatone of his child patients, who had pre-viously refused to speak during ses-sions, would interact and speak toJingles prior to his sessions. Levinsonconjectured that Jingles allowed himto build a sense of rapport with hispatients and felt Jingles was an “exten-sion” in therapeutic milieus (Fine,2006; Levinson, 1969). Jingles was atransitional object to facilitate the re -lationship between Levinson and hispediatric patient (Levinson, 1969).Levinson then began to bring Jinglesto sessions with other pediatric pa -tients and later coined the term “pettherapy” in 1964.

Succeeding Dr. Levinson’s workwas Dr. Samuel Corson who used dogs

66 PEDIATRIC NURSING/March-April 2015/Vol. 41/No. 2

to implement his biophysical researchwith in-patient psychiatric patients.Dr. Corson continued this workthrough his career and was labeledthe “father of pet-assisted therapy”after his death in 1998 (Thomas,1998). Dr. Corson was a professor ofpsychiatry and biophysics at OhioState University who originallyfocused his research on the effects ofstress on dogs. Corson recalled a caseof an adolescent with selectivemutism who was unresponsive totreatment who opened up and beganspeaking when a dog was brought tohis room (Corson, Corson, Gwynne,& Arnold, 1977). Corson then beganfocusing his work on pet-assistedtherapy and the effects pets had inpsychotherapy with patients. Hestarted to publish manuscripts report-ing the positive social interactionsand influences on the patients andthe staff when dogs were brought tothe psychiatric inpatient and milieuswith the psychiatry profession(Corson et al., 1975, 1977). This re -search has been credited as a catalystfor interest into the use of animals,particularly dogs, in therapy withpeople (Thomas, 1998).

Other therapists have labeled ani-mals as having a “social lubricant”effect with patients; humans with ani-mals are sometimes seen as moreapproachable and provide a topic forconversation (Fine, 2006; Nimer &Lundahl, 2007; Rossetti & King,2010). For example, patients who aremore withdrawn may engage in in -creased communication with newacquaintances in the presence of adog (Rossetti & King, 2010).

Florence Nightingale also usedwhat she called “animal-companiontherapy” for her patients who weresick and disabled (Snyder &Lindquist, 2010). Nightingale des -cribed the benefits of an animal-com-panion as a source of therapy to herpatients. She used pets with woundedsoldiers in the early 19th century andfound that pets were companions inthe healing process (Chu, Liu, Sun, &Lin, 2009). Sigmund Freud has beencredited with recognizing the role ofanimals in therapy and stated that hisdog had a “special sense.” Freudbelieved the calming presence of hiscanine was especially useful with chil-dren and would bring his ChowChow, “Jo-Fi,” to therapy sessions(Fine, 2006).

Pet Partners, formerly known asthe Delta Society, is the international

claims of study results. For instance,Sobo, Eng, and Kassity-Krich (2006)re ported positive benefits after“canine visitation therapy” as an AATintervention. However, on review ofspecific intervention method ology,the therapeutic visit consisted ofspending time with the child, sleep-ing with the child, allowing the childto pet her, and performing tricks forthe child (Sobo et al., 2006). This spe-cific intervention actually describesAATs that, although are therapeutic tothe patient, are not classified underPet Partner’s classification of animal-assisted “therapy.” Although the vari-ety of animal interactions may differin actual definition, benefits havebeen found among all substituteterms for these animal-facilitatedinteractions in both adult and pedi-atric patients.

Animal-Facilitated Therapy Animal-facilitated therapy (AFT),

also referred to as “pet therapy,” is the overarching term that refers toboth animal-assisted activities (AAA)and animal-assisted therapy (AAT)(Urbanski & Lazenby, 2012). AAA andAAT are sometimes used interchange-ably in the literature, but significantdifferences exist. Table 1 provides acomparison summary of AAA andAAT. AAA refers to activities that in -volve pets visiting the patient orclient, often use the same activity,and do not use specific treatmentgoals. Detailed notes on the AAA visitare often unnecessary, and the visitcontent is spontaneous (Pet Partners,2012b). In contrast, AAT can be a sig-nificant part of treatment for peoplewith a physical, social, emotional, orcognitive diagnosis through the useof an animal (Rossetti & King, 2010).AAT requires stated goals for each ses-sion, and the treatment is often indi-vidualized to the patient. Progressnotes in the patient’s chart should berecorded after each session, and visitsare usually scheduled with a pre-determined length of time based onthe patient’s needs (Pet Partners,2012a). Pet Partners provides exam-ples of AAT on its website. For in -stance, a therapist may have a childmanipulate buckles, clasps on leashes,or collars in order to improve thepatient’s fine motor skills. Addi -tionally, a therapist may have a childopen a container of treats and feedsmall pieces of food to the cat in orderto work on the child’s ability to

non-profit professional organizationfor volunteers interested in AAT. Theorganization provides professionalresources, training programs, and re -search for volunteers interested inanimal based therapeutic services (PetPartners, 2012a). Pet Partners hastrained over 10,000 handler/animalteams in both their companion ani-mal and therapy animal programs.The organization is funded throughindividual, foundation, and corpora-tion financial support (Pet Partners,2012a).

Method of Review This literature review provides a

synthesis of the current state of thescience of animal therapy in pediatricpatients. A comprehensive databasesearch was conducted in October andNovember 2012 to accessible li brarydatabases, including PubMed, Psych -INFO, Medline, and CINAHL. Themain search terms used were animal-assisted therapy, animal-assisted activi-ties, animal therapy, pet therapy, andcanine therapy. The literature searchwas specifically focused on the use ofanimals as therapeutic agents withinpediatrics identified with search ter-minology of pediatrics, youth, child,children, and adolescents. In Pub -Med, medical subject headings(MeSH) terms were used with Booleanoperators. Secondary searching ofjournal manuscripts not found in theprimary search was also reviewed foradditional references. Expert recom-mendations were sought throughemail inquiry to Pet Partners and theAVMA. Limitations to the literaturesearch were the various uses of anddefinitions for the terms “animal-assisted therapy” or “pet therapy.”Only studies available in English wereexplored. Results were not restrictedto date. Identified databased manu-scripts were critically analyzed forquality research design and method-ology.

Terminology related to the typesand titles of pet therapy differs amongthe literature reviewed. Therapeuticanimal interactions have been inter-changeably referred to as “animal-facilitated therapy,” “pet therapy,”“animal-assisted activities,” “animal-assisted therapy,” and “animal-assist-ed interactions.” Upon reviewing sci-entific studies and results using theseinterventions, distinguishing amongterminologies may be necessary toproperly evaluate the researchers’

The Role and Impact of Animals with Pediatric Patients

PEDIATRIC NURSING/March-April 2015/Vol. 41/No. 2 67

sequence events. The more generalanimal-assisted activities may includevolunteers taking their dog or cat to anursing home to visit or bringing ananimal to a children’s facility to“play” with the patients. AAT visitsare performed by volunteer servicesand are a cost-saving intervention tothe hospital (Marcus, 2012).

AAT Goals A variety of goals may be incor-

porated into AAT and focus on physi-cal, mental, educational, or motiva-tional objectives. Physical goals mayinclude improving fine motor skills,wheelchair skills, or balancing whilestanding. Mental health goals mayrange from increasing verbal interac-tions among group members, increas-ing attention skills, developing recre-ation skills, increasing self-esteem, toreducing anxiety and loneliness in achild. Educational goals are oftenbased on increasing vocabulary orimproving knowledge of concepts(e.g., color, size). Finally, examples ofmotivational goals refer to improvinga child’s willingness to be involved ingroup activities, improving interac-tions with others, or simply exercise(Pet Partners, 2012b). See Table 2 forexamples of potential AAT interven-tional goals.

sensitive to loud noises (e.g., alarms,IVs, children screaming or speakingloudly). The dog must not startlearound the sudden and sometimeserratic movements of children in therooms or hallways. The dog must beof good physical health, current on allvaccinations, and have yearly veteri-nary health checks (Marcus, 2012; PetPartners, 2012a). Certifying agencies,such as Pet Partners, provide insur-ance for dogs if they have passed andabided by the certification program(Marcus, 2012). See Figure 1 for exam-

AAT DogsThe most common AAT animal is

the dog. AAT dogs have rigorousrequirements that are often set forthby the Pet Partners. The dogs mustundergo initial temperament tests,obedience class training for basiccommands, and then additional AATtraining for appropriate behavior in afacility (Pet Partners, 2012a; Rossetti& King, 2010). The dogs must be ableto ride on elevators; be calm aroundwheelchairs, walkers, or other ambu-lation-assistance devices; and not be

Table 1.Differences between Types of Animal-Facilitated Therapies (AFT): Animal-Assisted Activity (AAA)

and Animal-Assisted Therapy (AAT)

Animal-Assisted Activity (AAA) Animal-Assisted Therapy (AAT)

Definition • Activities that involve pets visiting people• Often “meet and greet” in nature

• Integrated part of treatment plan• Often for people who have physical, social,

emotional, or cognitive needs

Goals No specific treatment goal Specific treatment goal for each session

Activity Same activity with many patients Individual treatment activity for each patient

Charting Unnecessary Required

Visits Spontaneous Scheduled

Length of time SpontaneousDiffers as desired

Pre-determined to best fit the patient’s needs

Example • Dog performs tricks in patient’s room• Child holds/pets visiting cat in a long-term care

facility

• Goal = sequencing of events: have the childopen a container of treats, break treats intopieces, feed to cat

• Goal = increase ambulation skills with a physicaltherapist; child walks the dog short distancearound facility

Source: Adapted from Pet Partners, 2012.

Table 2.Animal-Assisted Therapy Goals

Type of Goal Examples

Physical goals Improving fine motor skillsImproving wheelchair skillsBalancing while standing

Mental goals Increasing verbal interactions between group membersIncreasing attention skillsDeveloping recreation skillsIncreasing self-esteemReducing anxiety or loneliness

Educational goals Increasing vocabularyImproving knowledge of concepts (e.g., color, size)

Motivational goals Improving child’s willingness to be involved in group activitiesImproving interactions with othersExercise

68 PEDIATRIC NURSING/March-April 2015/Vol. 41/No. 2

ple of therapy dogs that are certifiedthrough Pet Partners and practice inthe Dallas-Fort Worth metroplex atthe local area Children’s hospitals.

Studies show that the presence ofAAT dogs does not increase zoonoticinfections. One study on the effects ofAAT in an elderly population in along-term care facility (N = 1,690)reported no zoonotic infections whenthe AAT dogs visited over a five-yearperiod (Banks & Banks, 2002). Anoth -er pilot study performed at a chil-dren’s hospital to look at the potentialoccurrence of infection with AATshowed no difference in the rates ofhospital infections over one year ofweekly dog visits. There were also noknown occurrences of microorganismor contagious illness transmission bythe dogs (Caprilli & Messeri, 2006).

Benefits of Canine Therapy Much of the research on AFT has

been done in the adult populationwith studies in pediatrics consistingmainly of anecdotal evidence, consis-tent with the research trend of usingadult participants as research subjects.In these adult studies, therapy reduc -ed pain, anxiety, depression, andfatigue in both inpatient and outpa-tient populations (Marcus, 2012).Studies done in nursing care facilities

dogs in a chronic pain facility (Marcuset al., 2012). Rigorous methodology,such as the use of a single therapy dogand handler for all 295 therapy dogvisits, was used to control for con-founding variables. Pain severity wassignificantly reduced in 23% of pa -tients. Among patients with a pre-AAT pain score greater than 5 (withnumeric pain ratings of 5 or highercorrelating with substantial pain-related interference and disability),clinically meaningful pain reliefoccurred in 26.2% of patients withthe visiting therapy dog. Amongpatients with primary mood disorders(to include depression and anxiety),significant improvements in anxietywere found after the AAT interven-tion (p = 0.001) (Marcus et al., 2012).Investigators also included qualitativethemes verbalized by the therapy dogparticipants, with overarching themesreported as time with the dog reducesdiscomfort; time with the dog is relax-ing; the dog provides a positive dis-traction from symptoms; patientcomments on overall positive impres-sion of the dog. Patient commentsincluded “this dog is like a sanctuaryto me” and “this dog helps me to for-get my misery and pain” (Marcus etal., 2012, p. 53).

Canine Therapy With Children

In experimental studies within thepediatric population, physiological,psychological, and emotional benefitshave been supported. For example, apilot study on canine visitations withchildren in pain showed overarchingthemes that were often based on reduc-ing anxiety (Sobo et al., 2006). Thesethemes included providing distractionfrom the pain and/or situation, bring-ing pleasure and happiness, entertain-ment, reminding the child of home,enjoyment of snuggling and contactwith the dog, providing company,calming, and pain easement (see Figure2) (Sobo et al., 2006).

In a quasi-experimental study in3- to 17-year-old hospitalized childrenwho had AAT with a dog, a significantdecrease in pain reports was foundamong subjects (Braun, Stangler,Narveson, & Pettingell, 2009). Groupselection to the AAT interventiongroup (N = 18) was determined by eli-gibility requirements (including abili-ty to use FACES pain scale, 3 to 17years age range, not fearful or allergicto dogs, not in isolation) along with

have shown a decrease in lonelinessand anhedonia (Banks & Banks, 2002;Chu et al., 2009; Nathans-Barel,Feldman, Berger, Modai, & Silver,2005). In one study of adult patientsreceiving chemotherapy, 86% ofpatients opted to have their chemo -therapy performed in a room with atherapy dog when given the option(Davis, 1988). Further, a statisticallysignificant decrease in depressionscores in the patients receiving dogtherapy (p = 0.01), and patients expe-rienced increased arterial oxygen sat-uration (p = 0.004) (Davis, 1988).

Therapy dogs have even beenshown to reduce anxiety scores inpatients waiting for appointments(Ruchman, Ruchman, Jaeger, Durand,& Kelly, 2011). Investigators found a33% reduction in anxiety scores afterspending 15 minutes with a therapydog prior to a scheduled MRI (p <0.001) (Ruchman et al., 2011). Otheradult literature reports that AATenhances socialization, activities ofdaily living, and general well-being inadults with mental health diagnoses,such as dementia and schizophrenia(Barak, Savorai, Mavashev, & Beni,2001; Rossetti & King, 2010).

A larger study conducted in anoutpatient tertiary care pain manage-ment clinic was designed to explorepotential benefits in using therapy

The Role and Impact of Animals with Pediatric Patients

Figure 1.

Source: Photograph © Paws Across Texas, Inc. (PAT). Used with permission. Theauthor allows reprint permission and copyright release.

Note: Paws Across Texas, Inc. (PAT) is a nonprofit community service organizationestablished in 1986 providing animal-assisted therapy with certified PAT therapy dogsin multiple diverse populations throughout the Dallas and Fort Worth metropolis inTexas.

PEDIATRIC NURSING/March-April 2015/Vol. 41/No. 2 69

the dog being present when child washospitalized. Designation to the con-trol group (N = 39) was mainly dictat-ed by a child’s fear or allergy to dogs.AAT sessions were 15 to 20 minuteseach. The AAT intervention group re -ported significant decrease in painlevel compared to the control group(p = 0.006).

An earlier study focusing on chil-dren hospitalized on a pediatriconcology unit found 89% of the chil-dren who received canine therapyhad increased independence andappetite, as well as decreased fear andpain from treatment and procedures(Gagnon et al., 2004). A descriptivepilot study in hospitalized post-opera-tive 5- to 18-year-olds showed a sig-nificant decrease in physical pain andemotional distress as measured on a 1to 10 scale with happy and sad faceson a ruler strip (p = 0.01) (Sobo et al.,2006). The AAT intervention in thisstudy involved a therapy dog spend-ing time with the child postoperative-ly. Activities included watching televi-

in adults (Parish-Plass, 2008). No ex -perimental studies have been pub-lished to further explore these clinicalexemplars in this population.

A case study of a 12-year-old boywith autism reported increased partic-ipation in the presence of a therapydog (Silva, Correia, Lima, Magalhaes,& de Sousa, 2011). The autistic childwas exposed to two treatment condi-tions: a 1:1 structured activity with atherapist and certified therapy dog,and a 1:1 structured activity with thesame therapist without the dog. Onvideotaped review, researchers andthe therapist noted improvement wasfound when the child was with thetherapy dog. These positive behaviorsincluded smiling, increased positivephysical contact, and less frequentand shorter durations of negativebehaviors, such as aggression or out-bursts (Silva et al., 2011).

An additional benefit reportedfrom one study was improved staffmoods on an inpatient unit. A pedi-atric oncology study using AFT on aninpatient floor also collected self-ad -ministered questionnaires from hos-pital staff. These results not onlyshowed a change in the mood for thepatients, but found reported improve-ments in hospital morale and motiva-tion of the registered nurses on thefloor (Gagnon et al., 2004).

Additional Benefits To Patients

Although many research studiesand prior literature show the impor-tance of AAT with therapeutic goalsand a more regimented visit, animal-assisted activities (AAA) also benefitpatients. A randomized control trialconducted in a large psychiatric insti-tution with participants diagnosedwith schizophrenia showed signifi-cant improvements (p = 0.005) in self-esteem, self-determination, positivepsychiatric symptoms, and emotionalsymptoms after an 8-week animal-assisted activity intervention (Chu etal., 2009). Investigators noticed thatthe touching and accompaniment ofdogs had positive effects on thepatients’ health (Chu et al., 2009).Therefore, the therapeutic benefit ofanimals on the human patient shouldnot be disregarded if the interactionwas not formally presented in theAAT format.

Studies conclude that individualsreport improvement in social interac-tions with dogs. In individuals with

sion with the child, being petted bythe child, and doing tricks on com-mand for the child. Researchersreferred to this AAT intervention as“canine visitation therapy.” Limi -tations to the study include a smallconvenience sample size (N = 25).This research involved post-interven-tion interviews and the investigatorsalso analyzed the qualitative dataobtained. Emerging themes reportedby researchers included 1) the animalproviding a distraction, pleasure, orentertainment; 2) the animal remind-ing the child of home; 3) snuggling;4) providing company; and 5) easingpain (Sobo et al., 2006).

Anecdotal evidence from childpsychologists show that AAT is espe-cially useful in helping children whohave been abused or neglected withsubsequent insecure attachments(Parish-Plass, 2008). Clinical exam-ples show that using AAT with thesechildren helps foster trust and in -creases communication in childrenwho otherwise have a strong distrust

Figure 2.Animal-Assisted Activities with Handler at National Pediatric Hospital

Source: Photograph courtesy of Children’s Medical Center of Dallas, Texas. Usedwith permission. The author allows reprint permission and copyright release.

disabilities, service dogs not only helptheir owner, but also normalize inter-actions with other people (Guest,Collis, & McNicholas, 2006; Wells,2009). An earlier study on self-esteemin adolescents showed that teenagersranked a companion animal, or pet,below parents but above other socialacquaintances when listing whatmade them feel satisfaction or goodabout themselves (Juhasz, 1985).

Contraindications to AFTIn some cases, the child may not

be interested in dogs or might even beallergic to certain animals (Rossetti &King, 2010). Some children may haveconditions that are agitated in thepresence of certain animals, such asasthma or a pet-dander allergy(Morrison, 2007). Some children orfamilies may actually be fearful ofdogs or other animals. Therefore,individual assessment of the patientand possible contraindication tousing an animal to facilitate therapyor treatment should be considered.Most facilities have policies not allow-ing AAT visits with patients who arecolonized with methicillin-resistantStaphyloccocus aureus or Clostridiumdifficile (Marcus, 2012).

Clinical NursingImplications

The nursing profession is oftennoted for seeking out additional inter-ventions to help patients reducesymptoms and treatment-associatedstress as well as facilitate healing andwellness beyond traditional medicaltreatment plans. Complementarytherapies are of continued interest tothe nursing community. Most studiescompleted in the pediatric populationreport both physical and psychologi-cal benefits or emotional benefits tothe patients. Research studies showsystematic benefits of animal-facilitat-ed therapies to reduce pain, decreasepsychological distress, and decreaseanxiety (Braun et al., 2009; Gagnon etal., 2004; Sobo et al., 2006). The use ofan animal to facilitate conversation,lead discussion, or break communica-tion barriers has been demonstratedthrough both research and anecdotalreports (Chu et al., 2009; Gagnon etal., 2004; Parish-Plass, 2008; Silva etal., 2011; Sobo et al., 2006).

Optimal pain management inpatients, especially in pediatrics, is ofcontinued interest to the health care

provider. Exploration of interventionsfor pain relief remains a primary goalfor pediatric nurses and researchers.Nurse researchers have explored com-plementary therapies to potentiallyprovide evidence of pain reductionthrough areas of CAM, including AFT.Although further research is neededthat involves the role of AFT in chil-dren, decreased pain reports anddecreased anxiety related to pain bothseem to be surfacing as outcomesfrom canine-assisted therapies andactivities.

Some facilities and hospitals havepolicies on pet visits that AAT pro-grams must follow. For example,requiring hand sanitizer use by thepatient and the handler before andafter visits, placing a clean towel orfresh linen on the bed before the visit,or discouraging feeding treats to thedog during visits (Fine, 2006; Marcus,2012). Some facilities that allow ani-mal service or therapy visits requireparents to sign a canine consent formfor the dog to visit while the child ishospitalized (Sobo et al., 2006).Nurses should be familiar with infec-tion control policies as it relates toanimal visits at their facilities.

Areas for AdditionalResearch

Although there has been a recentsurge in literature related to AFT andbenefits to pet companionship overthe last 10 years, further study of AAT,especially in teens and youth, is indi-cated. For example, several pilot stud-ies explored AAT in children withcancer. Studies exploring the useful-ness and comparison of similar out-comes, such as decrease in stress oranxiety, would be useful in pediatricparticipants with different diseasestates and diagnoses. Additional out-comes, such as self-esteem, activitiesof daily living, or the overall impactof AFT visits, could also be explored indifferent pediatric populations. Furth -er, most experimental and researchdesigns have focused aims on the useof canines in AFT with children.Explorations of AFT with the use ofcats, rabbits, or even birds as a thera-peutic milieu for children have yet tobe explored heavily in research.

There is also a lack of scientificdata defining a specific protocol forthese animal-facilitated interventionprocedures. Delivery of animal inter-ventions may differ from study tostudy, and specific details of the ther-

The Role and Impact of Animals with Pediatric PatientsInstructions For

Continuing Nursing EducationContact Hours

The Role and Impact ofAnimals with Pediatric

Patients

Deadline for Submission: April 30, 2017

PED 1502

To Obtain CNE Contact Hours1. For those wishing to obtain CNE contact

hours, you must read the article and com-plete the evaluation through PediatricNursing’s Web site at www.pediatricnursing.net/ce

2. Evaluations must be completed onlineby the above deadline. Upon completionof the evaluation, your CNE certificatefor 1.4 contact hour(s) will be mailed toyou.

Fees – Subscriber: Free Regular: $20

GoalThe purpose of this activity is to enable thelearner to understand the use of animal-facility therapy (AFT) in pediatric patients.

Objectives1. Define animal-facilitated therapy (AFT),

including its alternative terms animal-assisted therapy (AAT) and animal-assisted activities (AAA).

2. Discuss the possible benefits of usingAFT.

3. Explain possible limitations to usingAFT.

Statement of Disclosure: The author(s) re port - ed no actual or potential conflict of interest inrelation to this continuing nursing education act -ivity.

The Pediatric Nursing Editorial Board membersreported no actual or potential conflict of interestin relation to this continuing nursing educationactivity.

This independent study activity is providedby Anthony J. Jannetti, Inc. (AJJ).

Anthony J. Jannetti, Inc. is accredited as aprovider of continuing nursing education by theAmerican Nurses Credentialing Center's Com -mission on Accreditation.

Anthony J. Jannetti, Inc. is a providerapproved by the California Board of RegisteredNursing, Provider Number, CEP 5387.

Licenses in the state of California mustretain this certificate for four years after the CNEactivity is completed.

This article was reviewed and formatted forcontact hour credit by Rosemarie Marmion,MSN, RN-BC, NE-BC, Anthony J. Jannetti, Inc.,Education Director; and Judy A. Rollins, PhD,RN, Pediatric Nursing Editor.

70 PEDIATRIC NURSING/March-April 2015/Vol. 41/No. 2

PEDIATRIC NURSING/March-April 2015/Vol. 41/No. 2 71

apeutic procedure are often notreported. When evaluating outcomedata from experimental studies,analysis of the animal interactionbetween the animal and child shouldbe recognized.

A widespread belief exists thatthe child-animal interaction is benefi-cial to children’s development onboth a social-emotional and cognitivelevel (Melson, 2003). However, thereis a lack of rigorous and peer-reviewedpublished studies showing this con-nection. The human-animal bond con -tinues to be explored across multipledisciplines, such as veterinary medi cineand clinical psychology with a varietyof variables under in vesti gation.

Finally, due to lack of financialsupport for most experimental studiesevaluating AAA or AAT, many studiesare done with small conveniencesamples. Further, no longitudinalstudies have been completed withAAT in pediatrics. Many studies thathave been done with animals havebeen conducted in the adult or geri-atric population. Therefore, a broadand general need for experimentalstudies examining the influences,role, and different psychosocial vari-ables that AFT interventions can con-tribute to the pediatric population arewarranted. In conclusion, rigorousintervention studies that examine therole and impact of animals with chil-dren are needed as we strive to allevi-ate children’s symptoms and treat-ment-associated stress.

ReferencesAmerican Veterinary Medical Association

(AVMA). (2012). U.S. pet ownershipand demographics sourcebook.Schaumburg, IL: Author.

Banks, M.R., & Banks, W.A. (2002). Theeffects of animal-assisted therapy onloneliness in an elderly population inlong-term care facilities. The Journals ofGerontology, Series A, Biological Scien -ces and Medical Sciences, 57(7),M428-432.

Barak, Y., Savorai, O., Mavashev, S., & Beni,A. (2001). Animal-assisted therapy forelderly schizophrenic patients: A one-year controlled trial. The AmericanJournal of Geriatric Psychology, 9(4),439-442.

Beetz, A., Uvnas-Moberg, K., Julius, H., &Kotrschal, K. (2012). Psychosocial andpsychophysiological effects of human-animal interactions: The possible role ofoxytocin. Frontiers in Psychology, 3,234.

Braun, C., Stangler, T., Narveson, J., &Pettingell, S. (2009). Animal-assisted

trolled pilot study. Psychotherapy andPsychosomatics, 74(1), 31-35.

Nimer, J., & Lundahl, B. (2007). Animalassisted therapy: A meta analysis.Anthrozoos, 20, 225-238.

O’Haire, M. (2010). Companion animals andhuman health: Benefits, challenges,and the road ahead. Journal ofVeterinary Behavior: Clinical Appli -cations and Research, 5(226-234).

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