E ight-year-old Ke Xinqiao claps so hard when the man with the red plastic nose twists a balloon into the shape of a dog that the boy's mother worries that he will accidentally pull out his intravenous needle.

Xinqiao and a dozen other pint-size patients at the Beijing Women and Children's Hospital laugh and shout as the clown waves his magic wand and turns black-and-white drawings in a coloring book to color.

Dangling his legs off the bed and crunching on a rice cracker, Xinqiao hardly notices as his mother pats the IV needle into place. His attention is focused on clown Liu Yongjun, who, along with his brother Liu Jinjun, has been brightening up the drab wards of two Beijing children's hospitals since 2003.

With their goofy blue-and-white balloon trousers and magic wands, the Liu brothers are China's first hospital clowns, pioneering the therapeutic benefits of a dose of laughter.

"This type of performance is taking our clowning to a new level," Liu Yongjun says. "It's not about slapstick. We're here to make the kids laugh, to make them forget. It's all about happiness."

The Liu brothers come from a family of acrobats, magicians and jugglers and have been clowning since they were 11. Now in their 50s, they make their living performing at birthday parties, fairs and luxury hotels in the Chines

They started entertaining sick children when they signed up with the Beijing-based charity Magic Hospital in 2003.

Ke Xinqiao is a big fan. When the Lius visited, he had been hospitalized for two weeks and had another 20 days of treatment for a disease his mother would only describe as neurological.

"He has been so listless," she says, wiping droplets of saliva from his mouth. "But when he saw the clowns, he was so excited. It was as if he was a normal child again."

Hospital clowns are familiar figures in the West, where doctors and nurses sometimes don frizzy wigs and crack jokes to jolly small patients along the road to recovery. Some children's hospitals have humor carts, stocked with games, comic books and costumes.

But in China, public hospitals are bleak places where strict visiting hours mean children might see their parents just once a week.

It was the lack of support or activities for hospitalized children that inspired Claudia Vogg, a German woman who was working in China, to set up Magic Hospital.

"All I could see was adults providing for them what adults think they need - food, clothes, medicine and school work. But I thought, `They're children, so why not try and bring in a bit of fun?'," she says from her home in Paris.

Vogg has returned to Europe and is setting up a version there of the same program to conduct theater workshops for children in hospitals and prisons.

The doctors and nurses at the 750-bed Women and Children's Hospital, one of the world's biggest hospitals for youngsters, agreed to the program in 2003 after just two meetings, Vogg says.

"I was so surprised, but the doctors all sat there nodding their heads when I explained the concept of xiao ye shi yao or `laughter is also medicine,"' she says. "I was also surprised because it was a laowai (foreigner) proposing it."

Besides the Liu brothers, the Magic Hospital team includes teachers of art and English. Except for the clowns, who earn 250 yuan (HK$242) each for their two-hour biweekly stint at the hospital, everyone else is a volunteer.

The money comes from private donations and fundraising events, though a few corporations have donated. In the early days, Vogg paid the clowns out of her own pocket.

Magic Hospital also takes clowns to orphanages, schools for the children of migrant workers and homes for street children.

"It's about ensuring that children enjoy their right to be a child: to have fun and play," says Magda The, a Dutch woman who is one of the group's 13 volunteer workers.

In China, "doctors and nurses know how to administer medicine and treat a patient on medical terms. But a bedside manner has never been a part of the curriculum for medical training," says The, a former liaison officer for the medical charity Doctors without Borders and a mother of two.

"For the kids, just seeing these guys in costumes and with their painted faces, it's different from the endless parade of white coats. They know they are going to have some fun," she says. "It's also a bit of a respite for parents and the nursing staff."

Beijing Women and Children's is one of the capital's more progressive hospitals, and allows one parent to sleep in a child's room on a cot. But there are few distractions from the hospital tedium, and many of the children are lethargic with drugs, pain or boredom.

"I would really like to have music in all the children's wards, as well as cartoon books and DVDs," says head nurse Chen Jianjun, also an associate professor of nursing at Peking University.

But, as in many Chinese hospitals, the overworked staff has few resources to do more than look after patients' basic needs.

The clowns did their first stint at the Women and Children's hospital in May 2005, and Chen said it was a resounding success.

"Normally, the children just sit around waiting for injections or medicine," she says. "It was the first time I'd heard laughter like that in the ward. It's really wonderful."

But Magic Hospital's The admits that magic tricks and balloons only scratch the surface of helping to rehabilitate children who may have spent months hooked up to medical equipment, away from home and with little knowledge of what is happening to them.

"We're pioneers in this area in China. It's still very new and there are no training courses for therapeutic clowning as there are in Europe or the United States," she says.

"In Holland, you go to school for two years to learn this type of clowning. We don't have that luxury here."

Liu Yongjun, the younger Liu brother, trained in San Francisco with burger giant McDonald's, but he says clowning to sell hamburgers and clowning for children in hospitals require very different skills.

"Sometimes the children are a little bit scared," he says. "They might start crying. You have to know who to focus on and who to leave alone."

ASSOCIATED PRESS