Efficacy of Aromatherapy on Children: A Systematic Review with Meta-Analysis

BACKGROUND. Aromatherapy is one of the most commonly practiced complementary therapies by nurses, identified as central to holistic nursing care and in line with nursing theoretical foundations. Although it is also a widely used intervention in children, studies that have made a quantitative synthesis of its effect on this population are lacking in the literature. OBJECTIVE. To assess the effectiveness of aromatherapy in reducing procedural pain, anxiety, stress-related physiological responses, and in improving sleep duration among pediatric patients undergoing diagnostic or therapeutic procedures. METHODS. Studies were searched from biomedical databases, trial registries, web resources, and refereed journals. The risk of bias of included studies was assessed with RoB 2 and ROBINS-I, and the overall effect size of the intervention was calculated by creating random-effects meta-analyses graphically represented by forest plots. The summary of results was illustrated with a table in accordance with the GRADE method. RESULTS. Thirty-three studies with generally high risk of bias were included (N = 2650, mean age: 1.8 days-12.3 years, males: 33%-75%). Aromatherapy appears to have a positive and large effect on pain [SMD = -1.12 (95% CI: -1.60, -0.65), N = 1794, 27 comparisons, 22 studies], anxiety [SMD = -1.08 (95% CI: -1.52, -0.64), N = 856, 15 comparisons, 9 studies] and sleep duration [SMD = -0.95 (95% CI: -1.94, 0.03), N = 330, 4 studies]; in addition, it also appears effective on physiological signs of stress. The certainty/quality of evidence is very low. CONCLUSIONS. Due to the very low certainty/quality of evidence, at the current state of research it is not possible to make a conclusive assessment of the effect of aromatherapy on pain, anxiety, sleep duration, and stress in children undergoing diagnostic and therapeutic procedures.