Author (Year, country)	Aims of research	Research design	Data collection/analysis	Sample size and sites	Key findings/⁠conclusions	Quality appraisal
1.	Dietz et al. [y@233375]. United States of America (USA).	To compare the effectiveness of three group interventions on trauma symptoms for children where all three groups followed the same treatment protocol and two incorporated animal-assisted interventions.	Quantitative study.	Demographic and abuse-related characteristics were collected from the protective caregiver. Trauma symptoms were assessed using the Trauma Symptom Checklist for Children. A series of one-way ANOVAs (statistical formulas) were conducted to compare the changed scores from pre- to post-test for the three groups.	150 children aged 7 to 17 years in group therapy at a child advocacy centre in the USA.	Therapy dogs can offer unconditional acceptance, which can help children overcome their fears and insecurities. The scores for both the Dogs No Stories and Dogs With Stories groups decreased significantly from pre-test to post-test stages, and the scores for the Dogs With Stories group consistently decreased more than those for the Dogs No Stories group.	Moderate.
2.	McCullough et al. [y@233387]. USA.	To examine the effects of an AAT on the stress, anxiety, and health-related quality of life for children diagnosed with cancer.	Quantitative randomised controlled trial with two groups: (a) standard care plus regular visits from a therapy dog, (b) standard care only. This examined the effects of an AAT on anxiety in children with cancer.	Data were collected at set points over 4 months of the child’s treatment. Measures included the State-Trait Anxiety Inventory™, Pediatric Quality of Life Inventory, Pediatric Inventory for Parents, and child blood pressure and heart rate.	106 children aged 3 to 17 years at 5 paediatric hospitals in the USA.	Children in both groups experienced a significant reduction in state anxiety. Animal-assisted interventions may provide certain benefits for parents and families during the initial stages of paediatric cancer treatment.	High.
3.	Barker et al. [y@233365]. USA.	To investigate the effect of a 10-minute AAT on anxiety and pain in paediatric patients.	Mixed qualitative and quantitative pre- and post-test research reflecting ratings of anxiety with two groups: (a) animal-assisted intervention, (b) jigsaw puzzle work.	A research assistant administered family questionnaires, and pain and anxiety scales immediately before and after the assigned condition.	40 children aged 8 to 17 years. A children’s hospital.	A significant post-condition difference was found between groups regarding anxiety: the AAT group had lower anxiety scores. However, no significant changes between pre–post groups were detected.	Moderate.
4.	Beetz et al. [y@233366]. Germany, Switzerland, and Austria.	To investigate whether children with insecure-avoidant/disorganised attachment can profit more from social support by a dog compared with a human during a stressful task.	Quantitative study measuring salivary cortisol levels.	Data were collected on 2 different days, 1 week apart. On day 1, a questionnaire on the children’s pet ownership and attachment to their own pets and the Separation Anxiety Test were administered. The entire test on day 2 was videotaped and coded for behaviours of the child and their interaction with the social supporter and experimenter.	47 male children identified as having insecure-avoidant or disorganised attachment between the ages of 7 and 11 years. Several schools in Germany and Austria.	Male children with insecure-avoidant or disorganised attachment profit more from the presence of a therapy dog than the presence of a friendly human under social stress. Dogs can be helpful in assisting education since stress interferes with learning and performance.	Moderate.
5.	Hartwig [y@233376]. USA.	To investigate the human–animal resilience therapy (HART) intervention and understand whether the HART intervention significantly reduces anxiety, depression, anger, and disruptive behaviour in both treatment and comparison conditions.	Quantitative research.	The children met with their counsellor/therapy dog team on a weekly basis for 10 individual sessions, and at the final session, the children completed the Beck Youth Inventories-II as a post-test.	29 children aged 10–18 years presenting with emotional issues such as anxiety and grief. Community counselling clinic at a university in Texas.	Paired samples t-test analyses showed statistically significant differences between pre-test and post-test scores for anxiety inventories for both treatment and comparison groups.	High.
6.	Branson et al. [y@233368]. USA.	To assess the effectiveness of animal-assisted activities (AAA) on stress responses (anxiety) in hospitalised children.	A quantitative, two-arm, randomised controlled design.	The AAA intervention consisted of a one-time 10-minute AAA with a dog and handler who interacted with the child, while the control group was given a new plush stuffed dog for the same 10-minute time frame; no structured activity was given for either group. The State Trait Anxiety Inventory for Children (STAI-C) was used as well as the 10-item Positive and Negative Affect Schedule for Children, the Pet Attitude Scale, the Human–Animal Interactional Scale, and salivary cortisol testing.	53 children were recruited from a medical-surgical unit in an urban teaching hospital in the USA.	Positive affect and decreases in negative affect were larger in the intervention condition (AAA); however, pre- and post-intervention differences between the intervention and control groups were not significant. Pre- and post-intervention differences between the conditions in salivary cortisol and C-reactive protein (CRP) were not statistically significant. Baseline levels of anxiety, cortisol, and CRP had a significant correlation to the corresponding post-intervention measures.	High.
7.	Crossman et al. [y@233373]. USA.	To evaluate the effects of brief, unstructured interactions with unfamiliar dogs on children’s anxiety, affect, and physiological arousal following exposure to a stressful task.	A quantitative controlled study.	The children completed the Trier Social Stress Test for Children, which was followed by interaction with a dog, or a tactile stimulation control condition, or a waiting control condition. The Positive and Negative Affect Schedule for Children, Short Form, and the STAI-C were completed at baseline and post-test stages. Salivary cortisol was assessed at 5 time points.	78 children aged 10–13 years from the local community surrounding a university in the USA.	Brief, unstructured interactions with dogs boosted children’s positive emotions and reduced anxiety. No effect was detected on physiological arousal. Additional research is needed to establish whether the benefits of interactions with animals exceed the effects of other common strategies for alleviating stress.	High.
8.	Vidal et al. [y@233395]. Spain.	To evaluate the efficacy of dog-assisted therapy (DAT) combined with pharmacological treatment in children with foetal alcohol spectrum disorder (FASD).	A quantitative, randomised, rater-blinded controlled study.	Pre-test and post-test measures were completed a week before and after the 12-week intervention. The Child Behaviour Checklist, Social Skills Improvement System–Parent Form, and Clinical Global Impression Scale for Severity were completed by the parents.	33 children with FASD between the ages of 6 and 18 years. University hospital in Barcelona, Spain.	No significant differences were obtained in internalising symptoms (anxiety and depression). DAT is a promising adjunctive treatment for children with FASD.	High.
9.	Lindström Nilsson et al. [y@233385]. Sweden.	To evaluate children’s responses to AAT using a therapy dog as complementary treatment in hospital care.	Mixed methods.	Children answered fixed and free response questions about their feelings of wellbeing, experiences of the hospital stay before and after AAT, and experiences of interactions with a therapy dog.	50 children aged 3 to 18 years on a surgery ward in a tertiary hospital in Sweden participated and answered questions about feelings of wellbeing before and after AAT. Statistical Package for the Social Sciences (SPSS) was used for the statistical analyses of the quantitative data.	The children mentioned negative thoughts such as fear about procedures and sadness over their illness. DAT plays an essential role in decreasing fear or anxiety for children. The children reported feeling more relaxed and not thinking so much about their pain when they had received AAT.	High.
10.	Stefanini et al. [y@233394]. Italy.	To compare the effects of AAT with a standard treatment protocol in children and adolescents admitted to a psychiatric hospital for acute mental disorders.	A pre–post-experimental design with a randomised controlled trial.	The AAT intervention structured sessions lasted for 3 months, and the 45-minute weekly sessions were videotaped. The instruments used included the Children’s Global Assessment Scale. Video evaluation of AAT was coded by two independent investigators.	34 children aged 11 to 17 years (placed in either the AAT or control group) with a mood disorder, schizophrenia, eating disorder or anxiety disorder. Meyer Paediatric Hospital (University of Florence in Italy).	Results indicated a statistically significant improvement in global functioning in children and verified that AAT can have significant positive effects on therapeutic progress and the recovery process.	High.