Anyone who has read Stephen King's It would probably never choose to decorate a children's ward with clowns.
And it probably comes as no surprise to horror fans that a University of Sheffield study of 250 children for a report on hospital design suggests the children find clown motifs "frightening and unknowable".
King's It has sparked a slew of schlocky movies over the past 20 years, known as the killer clown or evil clown genre.
Examples include Clownhouse from 1990 where three boys at home alone are menaced by escaped mental patients who have taken on the identities of clowns they have killed; Mr Jingles from 2006, where a killer clown takes its revenge; and 2004's In Fear of Clowns, in which an artist with coulrophobia is stalked by a clown resembling one of her paintings.
S.I.C.K., Killjoy and the Camp Blood Trilogy are other low-budget examples of the genre. But perhaps the highlight is 2001's Killer Klowns from Outer Space, with the tagline "In Space No One Can Eat Ice Cream".
British horror writer Ramsey Campbell says the recurring theme in popular culture of the scary clown goes back at least as far as silent move star Lon Chaney Sr, who identified the spooky potential when he reportedly said: "There is nothing laughable about a clown in the moonlight."
"It is the fear of the mask, the fact that it doesn't change and is relentlessly comical," says Campbell, who has explored dark clown themes in his story The Other Side and in his latest novel The Grin of the Dark.
The place of the scary clown in mainstream popular culture can be seen in The Simpsons with Bart's intonation of "can't sleep, clown will eat me". And the real-life serial killer John Wayne Gacy, who often dressed as a clown for neighbourhood parties, provides an unpleasant undertone to the motif.
Search for fear of clowns on the internet and the results include plenty of sites referring to "coulrophobia".
But he believes children's fear may be less to do with clowns per se and more to do with being unsettled by something as unusual-seeming as a clown.
"People are typically frightened by things which are wrong in some way, wrong in a disturbingly unfamiliar way," Prof Salkovskis says.
"It is almost certainly not a reaction to clowns, but we are sensitive to things which are extraordinary, particularly sensitive when we are young. My three-year-old was terrified by Peter Rabbit at a B&Q. Peter Rabbit is six inches high, not seven feet high."
And obviously it doesn't take a great leap of the imagination to suppose that children in hospitals, away from home, in an unfamiliar environment and worried about their health or elements of the treatment, may be more nervous than usual.
"Being away from home or away from a carer makes children more susceptible to fears," Prof Salkovskis says.
Below is a selection of your comments.
I'm almost 30 and have a fear of clowns, no idea why... But I'm much more scared of "living statues" *shudder*. Unfortunately, I work on the South Bank where they seem to have the biggest population outside of Covent Garden (which is almost a "no go" zone for me in summer) I have no idea why I'm so scared of them but even the sight of one makes me hyper-ventilate and break out in a cold sweat.
Sharon, London, UK
I don't think it is clowns per se. Most small children are scared of Father Christmas. This is because it is an image that is unrecognisable to them. This is not to say we should ban Father Christmas, just that we should be aware of why children feel the way they do. Personally I love clowns as does my five year old, but both of us would be pretty freaked by the images in your news story. There are clowns and there are clowns and we do not know how the study in question was carried out and what images were shown to the children surveyed.
Anna, Maidstone, Kent
This is no surprise whatsoever. As I child I did not like clowns and didn't find them funny either, and I've never met anyone who did. In fact, I'm at a loss to explain the clown phenomenon or why anyone would ever have thought that children would like them.
Rob, Reading, UK
I'm 24 and have a hatred of clowns that it shared by most of my friends. We have discussed it before as it does seem very strange and we all agreed that our generation has been scarred by Tim Curry's Pennywise in IT. Best proof of the trauma this has caused was when we visited the Horror nights at universal studios and found the worst experience of the night was the 3d clown night - forget Freddy or Jason that was terrifying. One particular friend who is a massive horror fan was almost in tears and suffered a mild asthma attack after what I can only describe as one of the most horrible experiences of my life... And this fear isn't just among the girls...
Clair, N Ireland
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