Dogs are said to be man’s best friend, and the majority of children like dogs independent of their health status. Since the 1960s, American paediatric oncology departments have used therapy dogs with good results. In Sweden, however, it has been very difficult to bring dogs into emergency hospitals due to unclear hygiene reasons and concerns about allergic reactions.

Many children find hospital visits unpleasant and frightening, often becoming anxious and worried, especially when they have to go repeatedly or stay for long periods. Most children’s hospitals therefore use clowns, play therapy or video games to make hospital visits or stays less stressful for the children. In a recent study, we demonstrated that when given the choice, sick children preferred Hospital Dog over other options such as video games, mobile phones or TV.1 We have also observed on several occasions that with the help of Hospital Dog, sedation with restraint can be avoided (see quote below). It is important to note that sedating an anxious child who is extremely fearful of hospitals constitutes a high-risk situation. Such children are often so distressed that they must be physically restrained, which is not only deeply unpleasant for the staff involved but also raises serious ethical and legal concerns under Swedish health and medical care law and the Convention on the Rights of the Child.

In addition to being invaluable to patients, caregivers, relatives and staff, Hospital Dog also clearly offers economic benefits, which is very important in today’s cost-conscious healthcare system. A Hospital Dog visit costs approximately EUR 450 (GBP 390; USD 530; SKR 5000). In contrast, the estimated cost of a visit, based on invoice data in the hospital system where restraint and anaesthesia are required for examination, is approximately EUR 5400–6300 (GBP 4700–5500; USD 6300–7300; SKR 60 000–70 000).

Over a period of 10 years, research has been conducted in which we have, figuratively speaking, put the dog through a rigorous testing process similar to that used in the development of medicines (online supplemental figure 1).

At the Academic Children’s Hospital in Uppsala, Sweden’s only two Certified Hospital Dogs currently work in everyday clinical practice: Luna (granddaughter of Sweden’s first Hospital Dog Livia) and Liona (figure 1). During the spring of 2025, Luna and Liona also worked on a pilot project, which will hopefully become permanent from the fall of 2025, at Gävle Hospital and Hudiksvall Hospital. Five of Luna’s puppies are apprentices to Hospital Dog and will hopefully be certified as Hospital Dog in the near future—four apprentices are in Sweden and one in Norway.

The Hospital Dogs, the labradoodles, Luna (to the right) and Liona. Photographer: Helen Wolgers.

A Certified Hospital Dog is well-groomed, trained (including, among other things, not licking) and cared for in accordance with guidelines developed by our research team. It does not secrete any measurable amounts of allergens and adheres to the hygiene regulations applicable in hospitals.2–4 The Hospital Dog is always accompanied by a qualified Hospital Dog Instructor who is also a healthcare professional. A Hospital Dog meets one patient at a time, where the patient’s medical records are carefully checked after consent to ensure that there are no contraindications to meeting a Hospital Dog, for example, carriages or infections with multiresistant bacteria.

A Sjukhushund/Hospital Dog is officially certified and quality-assured by Sjukhushund i Sverige AB. It is a registered trademark in the EU, UK, USA, Australia, New Zealand and Norway and represents a specific methodology and definition (online supplemental figure 2). Some people confuse Hospital Dog with social service dogs, such as therapy or care dogs, or with animal-assisted activities. However, it is important to clarify that there are significant differences between them in terms of education, training, care, supervision, quality assurance and professional standards.

Below, with permission, we reproduce two different quotes—one from a mother and one from a paediatric nurse—that show how invaluable Hospital Dog is for patients, caregivers/relatives and staff.

The first meeting with Luna was so important and memorable. We wouldn't have been able to get our child out of bed after the major operation if it hadn't been for this first of many fantastic meetings. The hospital dogs are such joy spreaders. It’s so cool to see them walking around the hospital. They can get a child who might otherwise refuse to move to do so anyway, unconsciously. Forget the pain and all the hard work for a while. Getting to play, laugh, and cuddle with these fluffy, lovely dogs in the hospital—there’s not much that beats that.

Wow! The patient has been sedated twice and heavily sedated three times over a four year period. The reason for this is an extreme fear of hospitals… The patient has never wanted to come here, has been unable to influence their care, or communicate with staff except to say that it wanted to go home. The child is well known in the department because the visits are so long, conflict-ridden, and anxious……. With the help of a hospital dog, we were able to perform a complete heart examination with ultrasound and ECG. The patient came into the reception area on their own with the hospital dog Liona and lay on the bed next to the hospital dog. The child communicated with us, the staff, and was able to participate. The patient listened to what we said and we understood that the child understood. The patient was involved in their care for the first time in four years, which is how long I have known the child. After the ultrasound, the patient was instructed on a dummy how to position the ECG electrodes. We then connected them to the child, who had the hospital dog by their side the whole time. The patient was able to lie down and chat while we took the ECG. The child then removed the electrodes itself. After years of anxious visits for the patient, who had to be restrained, we now met a happy and calm child who was even happy on the way out. What a fantastic meeting and visit, thanks to the hospital dog!

Hospital Dog means a lot to the patients and is cost-effective.

Hospital Dog works according to scientifically developed guidelines.

We have not had any incidents in over 10 years of working with Hospital Dog.

Hospital Dog has been shown to be both effective and safe. A Hospital Dog reduces fear, anxiety and perceived pain in unselected hospitalised children. The multiple physiological responses observed suggest centrally mediated effects, although the full mechanism is still being explored.

A Hospital Dog is selected for its traits, often from puppyhood, and undergoes approximately 2 years of intensive training and testing before certification. The definition of a Hospital Dog is shown online in supplemental figure 2.

A Hospital Dog is always accompanied by a well-educated, trained dog instructor and represents a developed dog therapeutic approach, integrated medicine, in which the dog is quality-assured.

More than 9 out of 10 hospitalised children report improved well-being after meeting a Hospital Dog. Yet, the Hospital Dog is clearly underutilised. The time for change is now, but ‘Change will not come if we wait for some other person or some other time’ (Barack Obama).

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