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Merja Väisänen This text was developed in close consultation with Susanna Suurla Over the past three decades, hospital clowning has been globally established as a significant support activity in children’s healthcare. Hospital clowns, those ‘peculiar red noses’ interrupt the everyday routines and hierarchies of the hospital environment by creating an atmosphere of merriment through their interactions. Humour and laughter increase children’s psychological and physical well-being by reducing fear, stress, anxiety and other effects of hospitalization. The clowns therefore offer sick children a chance to disengage from their illness. Hospital clowns are easily recognizable due to their appearance and their arrival at a hospital does not go unnoticed. In this chapter, I examine how the clown’s appearance influences the social situations between children, parents and healthcare personnel and how integral the clown’s costume is to her/his personality and expression.