Intended for healthcare professionals

CCBYNC Open access
Research Christmas 2016: Famous Figures

Dispelling the nice or naughty myth: retrospective observational study of Santa Claus

BMJ 2016; 355 doi: (Published 14 December 2016) Cite this as: BMJ 2016;355:i6355
  1. John J Park, Kennedy scholar1,
  2. Ben G T Coumbe, medical student2,
  3. Esther H G Park, medical student3,
  4. George Tse, academic clinical lecturer4,
  5. S V Subramanian, professor of population health and geography5,
  6. Jarvis T Chen, research scientist5
  1. 1Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston 02115, MA, USA
  2. 2University College London Medical School, Royal Free Hospital, London, UK
  3. 3University of Edinburgh Medical School, Edinburgh, UK
  4. 4Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
  5. 5Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston. MA, USA
  1. Correspondence to: J J Park john.park{at}
  • Accepted 22 November 2016


Objective To determine which factors influence whether Santa Claus will visit children in hospital on Christmas Day.

Design Retrospective observational study.

Setting Paediatric wards in England, Northern Ireland, Scotland, and Wales.

Participants 186 members of staff who worked on the paediatric wards (n=186) during Christmas 2015.

Main outcome measures Presence or absence of Santa Claus on the paediatric ward during Christmas 2015. 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).

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. 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). In contrast, there was no correlation with school absenteeism, conviction rates, or distance to the North Pole.

Conclusion 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. Santa Claus is less likely to visit children in hospitals in the most deprived areas. Potential solutions include a review of Santa’s contract or employment of local Santas in poorly represented regions.


  • Contributors: JP conceived the study. JP and GT designed the study. BC, EP, and JP collected the data. JP, SVS, and JTC analysed the data. All authors contributed to the drafting and editing of the manuscript. JP is the guarantor.

  • Funding: This study was not funded or sponsored by industry and follows guidelines on good publication practice.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: A full submission for ethical approval using the integrated research application system was not required since the study did not involve “any modification of investigation, treatment or other aspects of clinical practice,” or involve “potentially physically or mentally invasive procedures on volunteers.” All participants gave informed consent before taking part in the questionnaire study.

  • Data sharing: No additional data available.

  • Transparency: The guarantor (JP) affirms that the manuscript is a honest, accurate, and transparent account of the study bring reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text