7 Data were unavailable for Kent, Surrey, Sussex, Thames Valley, Wessex, Northern Ireland, and Scotland. Secondly, we obtained data from the Ministry of Justice on the conviction rate for crimes by young people per 1000 of the 10-17 year old population. School absenteeism was defined by the total number of authorised and unauthorised absences, counted in sessions where each session is equivalent to half a day. Firstly, rates of absenteeism from primary school as a proxy for child behaviour were obtained from national government databases in 2015, available online for each respective country (England, 3 Scotland, 4 Northern Ireland, 5 and Wales 6) and regions within England. We considered two sources of data as potential indicators of naughtiness. We used the website FreeMapTools ( to record the distance (km) between the hospital (closest city or town to the hospital) and North Pole, as the reindeer flies. We evaluated the relative importance of children’s behaviour, distance to the North Pole, and contextual socioeconomic deprivation on the likelihood of a visit from Santa Claus. 2 We chose to study paediatric hospital wards because sick children are the most deserving of a visit from Santa Claus at Christmas. 1 The Christmas classic goes on: “he sees when you’re sleeping, he knows when you’re awake, he knows if you’ve been bad or good, so be good for goodness sake!” Yet no empirical evidence exists to support the assertion that Santa Claus rewards children based on good behaviour or to establish whether this is the only factor determining the likelihood of a visit from him. This belief finds textual support in the popular holiday song “Santa Claus is coming to Town,” written by Fred Coots and Haven Gillespie and published in 1934. It has long been thought that Santa Claus visits children depending on whether they have been naughty or nice in the past year (fig 1 1). Santa Claus (also known as Saint Nicholas, St Nick, Father Christmas, Kris Kringle, Santy, or simply Santa) is a popular Christmas figure celebrated for travelling around the world to give children presents on Christmas Day (25 December). Potential solutions include a review of Santa’s contract or employment of local Santas in poorly represented regions. Santa Claus is less likely to visit children in hospitals in the most deprived areas. In contrast, there was no correlation with school absenteeism, conviction rates, or distance to the North Pole.Ĭonclusion The results of this study dispel the traditional belief that Santa Claus rewards children based on how nice or naughty they have been in the previous year. The odds of him not visiting, however, were significantly higher for paediatric wards in areas of higher socioeconomic deprivation in England (odds ratio 1.31 (95% confidence interval 1.04 to 1.71) in England, 1.23 (1.00 to 1.54) in the UK). Results Santa Claus visited most of the paediatric wards in all four countries: 89% in England, 100% in Northern Ireland, 93% in Scotland, and 92% in Wales. This was correlated with rates of absenteeism from primary school, conviction rates in young people (aged 10-17 years), distance from hospital to North Pole (closest city or town to the hospital in kilometres, as the reindeer flies), and contextual socioeconomic deprivation (index of multiple deprivation). Main outcome measures Presence or absence of Santa Claus on the paediatric ward during Christmas 2015. Participants 186 members of staff who worked on the paediatric wards (n=186) during Christmas 2015. Setting Paediatric wards in England, Northern Ireland, Scotland, and Wales. Objective To determine which factors influence whether Santa Claus will visit children in hospital on Christmas Day.ĭesign Retrospective observational study.
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