Clinical hypnosis in pediatric An adjunctive tool or therapeutic illusion

Authors: Mohammed Al-Beltagi

Abstract

Clinical hypnosis has been proposed as a non-pharmacological intervention in pediatric healthcare, drawing on children’s natural capacity for imagination and focused attention. It has been applied across a broad spectrum of medical and psychological conditions, yet its true clinical value remains a matter of debate. This narrative review synthesizes findings from randomized controlled trials, cohort studies, systematic reviews, and clinical case series on pediatric hypnotherapy. Literature was selected based on relevance, methodological quality, and diversity of application. Evidence suggests that pediatric hypnosis may reduce acute and chronic pain, support management of functional gastrointestinal disorders, alleviate anxiety and habit disorders, improve sleep, and provide symptom relief in chronic diseases such as cancer and cystic fibrosis. Techniques are individualized and developmentally tailored, often using guided imagery, storytelling, and self-hypnosis. Reported benefits include reduced symptom burden, decreased reliance on medications, and improved quality of life. However, the strength of evidence varies considerably across conditions. Limitations include a shortage of large-scale trials, variability in individual responsiveness, limited availability of trained clinicians, and ongoing skepticism from healthcare providers and caregivers. While pediatric hypnosis may show promise as a safe and empowering adjunctive therapy, its clinical efficacy remains to be firmly established across all conditions. Further large-scale, methodologically rigorous research is required to clarify its actual benefits, cost-effectiveness, and role within integrative, evidence-based pediatric care.

Core Tip: Clinical hypnosis has emerged as a developmentally appropriate, non-pharmacological tool with potential applications across pediatric medicine. Evidence suggests benefits in acute and chronic pain, functional gastrointestinal disorders, anxiety, habit disorders, and supportive care in chronic illness. By engaging children’s imagination and suggestibility, hypnotherapy may promote self-regulation, reduce symptom burden, and improve quality of life. However, the evidence base remains uneven—strong in some domains but limited or preliminary in others. Misconceptions, limited training opportunities, and response variability hinder wider use. Further large-scale trials and standardized protocols are required to clarify whether hypnosis is a proven therapeutic tool or primarily a promising adjunct.

INTRODUCTION

Clinical hypnosis is a focused therapeutic technique that harnesses guided attention, vivid imagery, and positive suggestion to induce a state of heightened awareness and responsiveness. In this trance-like state, patients-particularly children-can experience altered perceptions, sensations, thoughts, or behaviors, often leading to significant improvements in symptoms and coping mechanisms[1]. Unlike stage hypnosis, which is purely for entertainment, clinical hypnosis is an evidence-based practice employed by trained healthcare professionals to achieve medical, psychological, and behavioral health goals[2]. Table 1 highlights the difference between clinical and stage hypnosis.

The application of hypnosis in pediatric populations has a rich history, with its roots tracing back over a century to early reports of its use in pain management, surgical preparation, and behavior modification. Hypnosis gained further credibility in the mid-20^th^ century, with growing clinical observations and research highlighting its effectiveness in children[3]. Children, due to their imaginative minds, natural suggestibility, and often reduced psychological resistance, are particularly receptive to hypnotic techniques. Despite these promising attributes, hypnosis largely remained a niche approach until recent years, when the rise of integrative medicine sparked renewed interest in its potential[4].

Modern pediatric care increasingly emphasizes non-invasive, non-pharmacological interventions, driven by concerns about medication overuse, potential side effects, and the overarching need for more holistic patient care. Clinical hypnosis aligns perfectly with this evolving paradigm, offering a safe and adaptable adjunct to conventional treatments across various domains, including procedural pain, anxiety, gastrointestinal (GI) disorders, and behavioral conditions. As healthcare systems continue to prioritize patient-centered approaches and psychological well-being, hypnosis is emerging as a therapeutic tool in the pediatric arsenal[5]. However, despite growing enthusiasm, the clinical evidence remains uneven, and questions persist regarding its true therapeutic efficacy.

The relevance of hypnosis in child health is more pronounced now than ever. Children grappling with chronic illness, challenging medical procedures, or significant psychological distress require management strategies that are both effective and empowering[6]. Hypnosis not only offers symptom relief but also equips children with crucial self-regulation skills, fostering resilience and emotional control. Given these unique advantages, a thorough re-examination and consolidation of existing evidence are essential to better inform and advance clinical practice[7].

This comprehensive review aims to critically evaluate the role of clinical hypnosis in pediatric healthcare. It examines the underlying neurocognitive mechanisms, surveys its diverse clinical applications across a wide range of pediatric conditions, and highlights both its potential advantages and its current limitations compared to conventional treatments. By synthesizing the available evidence and identifying gaps in knowledge, training, and accessibility, this review seeks to inform pediatricians, child psychologists, and allied health professionals about the promise-and the uncertainties-of hypnotherapy. Ultimately, it emphasizes the need for cautious, evidence-based integration of hypnosis into pediatric care while outlining priorities for future research and clinical practice.

LITERATURE REVIEW

We conducted this review through a narrative synthesis of the existing literature on pediatric clinical hypnosis, using a comprehensive search of electronic databases, including PubMed, Scopus, Web of Science, and Google Scholar, for studies published in English up to August 2025. Search terms combined keywords such as “pediatric hypnosis”, “clinical hypnotherapy”, “children”, “adolescents”, “pain management”, “functional disorders”, “anxiety”, and “non-pharmacological therapy”. Both randomized controlled trials (RCTs), cohort studies, systematic reviews, and relevant case series were considered. Reference lists of key papers were also manually screened to identify additional studies. Studies focusing exclusively on adult populations were not included except where a brief reference was necessary to contextualize pediatric findings. Because this is a narrative review, no formal quality assessment tool was applied; instead, emphasis was placed on peer-reviewed studies with clear methodology, adequate sample sizes, and clinical relevance. This approach ensured a broad yet clinically focused synthesis, while acknowledging that methodological diversity may limit direct comparisons between studies.

MECHANISM OF HYPNOSIS

Clinical hypnosis is a unique and dynamic state of focused attention and increased suggestibility, accompanied by reduced peripheral awareness and a heightened responsiveness to therapeutic guidance. Figure 1 shows the core components of clinical hypnosis. Crucially, this is not a state of unconsciousness or sleep, but a distinct neurocognitive condition that involves both biological and psychological modulation. Advances in functional neuroimaging have significantly clarified the neural mechanisms underlying hypnosis, revealing consistent changes in brain activity, connectivity, and neurochemical signaling[8].

At the core of the hypnotic state lies a functional reorganization of brain networks. The anterior cingulate cortex (ACC)-a region essential for attention control, emotional regulation, and conflict monitoring-is consistently activated during hypnosis. In contrast, there is a reduction in the activity or functional connectivity of the dorsolateral prefrontal cortex, which typically governs executive control and critical evaluation. This decoupling helps explain why individuals under hypnosis become less constrained by rational filtering and more open to therapeutic suggestion[9]. Additionally, hypnosis is associated with a downregulation of the default mode network, which is responsible for self-referential thought and mind-wandering, fostering a deep immersion in the therapeutic experience. These shifts align closely with patients’ subjective reports of narrowed focus, heightened absorption, and diminished internal distraction-especially beneficial in children with shorter attention spans[10].

Hypnosis also exerts multi-level effects on pain processing. At the cortical level, it alters the sensory-discriminative aspects of pain via the primary and secondary somatosensory cortices, the thalamus, and the posterior insula. The emotional-motivational dimension of pain is modulated through the anterior insula and dorsal ACC, while cognitive appraisal and re-framing of pain occur in the prefrontal cortex[11]. Hypnosis can also influence pain transmission at the spinal level by activating descending inhibitory pathways and reducing the R-III reflex-a spinal marker of nociception[12]. Moreover, it affects the autonomic nervous system by decreasing sympathetic tone and modulating the hypothalamic-pituitary-adrenal axis, promoting physiological relaxation. At the peripheral level, hypnosis may attenuate pain signals by reducing the activity of A-delta and C fibers, which carry nociceptive input to the spinal cord[13]. Figure 2 illustrates the neurocognitive modulation of pain by hypnotherapy.

On a neurochemical level, hypnosis appears to modulate key neurotransmitter systems. Dopaminergic activity, particularly in the striatum, is enhanced-supporting motivation, attention, and reward processing, all of which increase receptivity to suggestion. GABAergic tone is thought to increase during hypnosis, facilitating deep relaxation by dampening neural excitability[14]. Furthermore, endogenous opioids, such as endorphins and enkephalins, are released during hypnotic analgesia, activating opioid receptors in pain-regulating regions, including the periaqueductal gray and spinal cord. Preliminary evidence also suggests roles for serotonin and acetylcholine in modulating arousal, attention, and memory encoding during trance, though these effects are still under investigation, particularly in pediatric populations[15].

Of particular interest in children is the brain’s remarkable neuroplasticity. Pediatric hypnosis capitalizes on this developmental window, during which repeated hypnotic sessions-incorporating positive imagery, metaphors, and behavioral reframing-can strengthen beneficial neural circuits through long-term potentiation, the fundamental mechanism of learning and memory[16]. Functional magnetic resonance imaging (MRI) studies suggest that hypnotically induced alterations in connectivity between sensorimotor, limbic, and executive control networks can persist beyond the hypnotic state, supporting long-lasting therapeutic change[9]. For developing brains, this represents a powerful Hypnosis is not only a tool for symptom relief but also a method of reshaping maladaptive patterns and reinforcing adaptive ones[17].

Psychologically, two dominant frameworks inform our understanding of hypnosis. The neodissociation theory posits that hypnosis induces a division in consciousness, allowing suggestions to bypass usual cognitive filters while a “hidden observer” retains awareness[18]. In contrast, sociocognitive theories emphasize the influence of expectations, social context, and the therapeutic relationship, viewing hypnotic behavior as an enactment shaped by belief and motivation. These models are not mutually exclusive and likely work in tandem, especially in pediatric patients[19]. Children’s vivid imaginations, fluid cognitive structures, and natural responsiveness to social cues render them particularly susceptible to both dissociative and expectancy-driven mechanisms[20].

Developmental factors further amplify hypnotic responsiveness in children-especially those aged five to twelve-who consistently demonstrate higher suggestibility than adults. This is not due to gullibility, but reflects neurodevelopmental features such as an immature prefrontal cortex, greater reliance on imaginative cognition, and limited internal skepticism[4]. These attributes allow children to enter hypnotic states more easily and respond more deeply to metaphor, guided imagery, and sensory-based suggestions, making hypnosis particularly effective in pediatric settings[16].

Imagination, in fact, serves as the cornerstone of pediatric hypnotherapy. Techniques such as storytelling, guided imagery, and symbolic metaphors are developmentally tailored to engage a child’s sensory world and internal narrative. A child afraid of a medical procedure might imagine being in a superhero’s fortress or adjusting a pain “volume dial” in a brain-based control room[21]. These strategies are more than distractions-they actively engage brain regions involved in perception, regulation, and belief, creating a neurological basis for therapeutic transformation. Figure 3 summarizes the neuro-cognitive pathway of hypnosis, from influencing factors to clinical outcomes[8].

Finally, from an ethical and safety standpoint, clinical hypnosis in pediatric populations is considered safe when conducted by qualified professionals. It respects the child’s autonomy and emphasizes collaboration, never control. Informed consent from caregivers and assent from the child are essential[22]. As an adjunct-not a replacement-to standard care, hypnosis aligns with the principles of integrative medicine, offering a low-risk, high-benefit strategy that empowers children to manage symptoms, develop resilience, and participate actively in their own healing process[7]. It is important to note, however, that mechanistic insights-such as altered brain connectivity, neurotransmitter modulation, or engagement of neuroplastic processes-do not automatically translate into consistent clinical benefit. While these findings provide biological plausibility and support for the therapeutic potential of hypnosis, the strength of clinical outcomes in pediatric populations remains variable. It requires confirmation through well-designed, large-scale trials.

DISTINCTIONS IN HYPNOTHERAPY FOR PEDIATRIC AND ADULT POPULATIONS

While the core principles of hypnosis-inducing a state of focused attention and heightened suggestibility-remain consistent across all ages, the practice of hypnotherapy with children is a specialized discipline that differs fundamentally from its adult counterpart[21]. These distinctions are not superficial; they are rooted in the unique developmental, cognitive, and relational landscape of childhood, demanding significant adaptations in technique, therapeutic alliance, and ethical considerations[23].

The most profound divergence lies in cognitive and developmental factors. Children, particularly in their primary school years, possess a natural and powerful capacity for vivid imagination, coupled with a less developed critical filter. This makes them exceptionally receptive to hypnotic suggestion when delivered through the language they understand Storytelling, metaphor, and play[24]. A pediatric therapist might guide a child to imagine a superhero's shield for protection from pain or a magic glove for needle-related procedures. In contrast, adult hypnotherapy must often navigate a more established analytical mindset, potential skepticism, and a lifetime of ingrained beliefs. Consequently, adult-focused techniques frequently rely on more direct suggestions, structured scripts, and insight-oriented approaches that appeal to a mature cognitive framework[4].

These differences directly influence the therapeutic relationship and session structure. Establishing rapport with a child is an active, often playful process that involves using toys, drawing, or engaging in informal conversation to build trust and comfort. With adults, this alliance is typically forged through empathetic conversation and a more formal discussion of goals and concerns[25]. This leads to pediatric sessions being shorter, more flexible, and dynamic, accommodating a child's variable attention span. Furthermore, pediatric hypnotherapy is uniquely characterized by the integral role of parents, creating a triadic therapeutic alliance among the therapist, child, and caregiver. Parents provide crucial background information, offer support during the process, and are essential for reinforcing hypnotic strategies at home-a dynamic entirely absent from adult therapy, where confidentiality and individual autonomy are paramount[26].

Ultimately, the goals and ethical boundaries of therapy are significantly influenced by the client's age. Pediatric hypnotherapy is often targeted and symptom-focused, aiming for relatively rapid relief from specific issues such as procedural anxiety, enuresis, chronic pain, or phobias[27]. While adult hypnotherapy can also be symptom-focused, it frequently delves deeper into complex psychological exploration, trauma resolution, and the unpacking of intricate cognitive-emotional patterns. This distinction informs the ethical For adults, informed consent from the individual is sufficient[28]. For children, a dual process of obtaining informed consent from the legal guardian and, crucially, securing the age-appropriate assent (willing agreement) of the child is an ethical necessity, ensuring the intervention is collaborative, respectful, and empowering for the young client[29]. Table 2 summarizes the differences between pediatric vs. adult hypnotherapy.

METHODS OF CLINICAL HYPNOTHERAPY IN CHILDREN

Pediatric clinical hypnotherapy is a specialized therapeutic approach that leverages children’s rich imagination, developmental stage, and innate responsiveness to create a safe, engaging, and effective healing experience. In contrast to adult hypnotherapy, which often employs more structured or directive methods, pediatric hypnotherapy is highly adaptable, playful, and centered on the child’s needs and preferences[21]. It emphasizes gentle guidance, collaboration, and the therapeutic power of imagination. There are four core principles essential for a successful clinical hypnotherapy session in Child-centered and developmentally tailored, indirect and permissive language, imaginative engagement and playfulness, and strength-based and resource-oriented[7]. Table 3 summarizes the different categories of clinical hypnotherapy techniques for children.

Every session is customized to align with the child’s cognitive level, emotional maturity, interests, and specific challenges. Therapists often incorporate familiar characters, games, or themes the child enjoys, ensuring the experience feels relatable and safe. Rather than using commands, therapists employ permissive and open-ended language such as, “You might begin to notice…” or “Perhaps you can imagine…” This strategy encourages participation without pressure, enhancing the child’s sense of autonomy and reducing resistance[16,30]. Hypnotherapy taps into children's natural capacity for fantasy, pretend play, and storytelling. Therapeutic sessions are framed as creative adventures, making the process enjoyable and non-threatening while fostering emotional openness. The approach focuses on activating the child’s internal resources-such as resilience, creativity, and courage-to build confidence and develop effective coping mechanisms. Positive reinforcement is consistently embedded in the hypnotic work[21].

There are various techniques in pediatric hypnotherapy, including guided imagery and imaginative journeys, storytelling and metaphorical healing, permissive direct suggestions, ego-strengthening techniques, pain management strategies, creative aversion techniques, and future pacing. In guided imagery and imaginative Journeys**, c**hildren are led through vivid, multi-sensory visualizations to calming or magical “safe spaces” (e.g., enchanted forests, superhero hideouts, underwater kingdoms). These mental environments serve as therapeutic platforms where healing narratives unfold-for example, imagining a “worry monster” shrinking and being locked away during a session on anxiety[31]. In storytelling and metaphorical healing, therapists craft or adapt therapeutic stories embedded with metaphors relevant to the child’s experience[32]. For example, a tale about a young explorer overcoming a storm may represent a child managing emotional upheaval. These indirect messages are absorbed unconsciously, making them both powerful and non-confrontational. Permissive direct suggestions, when used, are always phrased in a gentle and empowering manner-e.g., “You might feel your body becoming more relaxed”, or “You can choose to feel more comfortable now”. These are often woven into stories or imaginative sequences[33]. In Ego-strengthening techniques, suggestions aimed at enhancing self-confidence, bravery, and competence are central to pediatric hypnotherapy. These may be embedded in scenarios where the child masters a challenge or overcomes a fear, reinforcing a sense of capability[34].

Various pain management strategies, such as glove anesthesia, mental control panels, altering sensory qualities, dissociation techniques, creative aversion techniques, and future pacing, can be used to reduce organic and functional pain in children. In glove anesthesia, children imagine wearing a magical glove that numbs their hand. The numbness is then mentally transferred to a specific area experiencing pain, reducing discomfort[35]. In mental control panels, children are guided to visualize an internal control panel with sliders or dials that can be turned down to relieve pain, anxiety, or other distressing sensations. Therapists can also alter sensory qualities to help children change the sensory characteristics of their discomfort-such as imagining pain becoming smaller, cooler, or changing color-thereby reframing the pain perception[36].

In dissociation techniques, children may be encouraged to imagine their pain floating away, being placed outside their body, or turning into something manageable and distant[37]. Creative aversion techniques can be used to manage habit disorders, such as thumb-sucking, where imaginative aversion can be gently introduced. For example, suggesting that the finger may taste unpleasant when placed in the mouth, while always maintaining a positive, supportive tone. In future pacing, children are encouraged to visualize themselves successfully using their new coping skills in upcoming real-life situations, reinforcing therapeutic gains and building confidence in their self-efficacy[38-40]. In all these techniques, the pediatric hypnotherapist should act as a warm, responsive guide-building rapport through playful interaction, active listening, and empathy. A soft, rhythmic voice and the ability to follow the child’s lead are essential. Flexibility is key, as the therapist must continuously adjust their approach based on the child’s cues and level of engagement to maintain the hypnotic focus[21]. A typical pediatric hypnotherapy session follows a structured, yet flexible format designed to meet the child’s developmental and emotional needs (Figure 4). It begins with rapport building and preparation, where the therapist engages the child through informal conversation or play to establish trust and gain insight into the child's interests and concerns[16]. This is followed by the induction phase, in which the child is guided into a focused, relaxed state using gentle and imaginative techniques such as visualizing themselves floating like a cloud or walking down a magical staircase[41]. The deepening stage follows, involving methods such as counting down or imagining shifts in bodily sensations-such as feeling heavier, lighter, warmer, or cooler-to enhance the depth of the hypnotic experience[1]. Once the child is comfortably immersed, the therapeutic intervention takes place, often involving guided imagery, metaphorical stories, or indirect suggestions carefully tailored to address the child’s specific challenge. The session concludes with re-alerting, where the child is gently and gradually returned to full awareness, typically feeling calm, safe, empowered, and in control[42].

Parents or caregivers play an essential supportive role. They provide background information, encourage the child’s engagement, and often learn simple reinforcement techniques or receive audio recordings for home practice. Repeated exposure to hypnotherapy reinforces new neural pathways and coping strategies, enhancing long-term outcomes and strengthening the child’s sense of control and well-being. Involving the family also fosters a supportive environment that sustains therapeutic change beyond the session[16].

CLINICAL APPLICATIONS OF HYPNOSIS IN PEDIATRIC MEDICINE

Pediatric hypnotherapy has become a versatile and evidence-based therapeutic approach that assists children with a wide range of clinical conditions. By harnessing the child's imagination and suggestibility, hypnotherapy can be effectively used in various medical and psychological settings[7]. Its clinical applications include pain management-covering both acute procedural pain, such as needle phobia, and chronic pain conditions like headaches and fibromyalgia-as well as functional somatic disorders, including irritable bowel syndrome (IBS) and enuresis[43]. Additionally, it plays a valuable role in addressing behavioral and psychological issues such as anxiety, phobias, sleep problems, and habitual disorders. Hypnotherapy also functions as a supportive measure for symptom relief in chronic organic illnesses like cancer, cystic fibrosis (CF), and inflammatory bowel disease (IBD), particularly in reducing pain, nausea, and anxiety[44]. It enhances patient comfort during diagnostic and surgical procedures, supports neurodevelopmental [e.g., attention-deficit/hyperactivity disorder (ADHD)] and psychosomatic conditions [e.g., functional neurological disorders (FND)], and aids in addressing pediatric dermatological issues, including warts and eczema[42]. Through its flexibility and child-centered approach, hypnotherapy makes a significant contribution to comprehensive pediatric care. An expanding body of clinical research highlights the therapeutic benefits of hypnotherapy across a wide range of pediatric conditions[21]. Drawing upon key studies and well-established clinical observations, hypnotherapy has demonstrated both efficacy and safety in treating physical and psychological conditions in children and adolescents. This section synthesizes current evidence by condition, age group, and intervention method[45]. Tables 4 and 5 summarize the different clinical applications of hypnosis in pediatric medicine with the degree of recommendation.

Pain and related conditions management

Pain management (acute and chronic): Hypnotherapy has emerged as a promising, valuable, and increasingly recognized non-pharmacological intervention for the comprehensive management of both acute and chronic pain in children and adolescents. However, there is a need for larger RCTs, as significant heterogeneity exists in the evidence. Its efficacy stems from its unique ability to modulate the perception, emotional response, and cognitive appraisal of pain through carefully guided imagination, deep relaxation, and therapeutic suggestion[46]. Pediatric patients, with their inherently vivid imaginations, developmental neuroplasticity, and high suggestibility, are particularly well-suited for hypnotherapeutic interventions, which can significantly enhance comfort, markedly reduce procedural distress, and fundamentally improve overall coping mechanisms related to pain experiences[21].

In the realm of acute pain management, hypnotherapy is frequently and effectively employed in medical settings involving painful or anxiety-provoking procedures. These commonly include venipuncture, intravenous cannulation, lumbar punctures, bone marrow aspirations, wound care, burn dressing changes, dental procedures, and even minor surgical interventions[47]. Hypnotic techniques utilized in these situations primarily focus on potent strategies such as distraction, dissociation (creating a sense of detachment from the physical sensation), and the construction of elaborate, protective mental imagery designed to shift the child's attention dramatically away from the noxious stimulus[48]. For instance, a child might be guided to imagine vividly being transported to a safe and utterly calming place-such as floating weightlessly in outer space, swimming gracefully underwater with friendly dolphins, holding an impenetrable magical shield that completely blocks discomfort, or even transforming into a powerful superhero impervious to pain. These imaginative techniques are highly effective in reducing pre-procedural anxiety, significantly lowering reported pain ratings, and often leading to a decreased reliance on pharmacological analgesics or sedatives. Robust clinical studies have consistently demonstrated that children undergoing hypnotherapy during procedures report substantially less distress, exhibit reduced physiological signs of pain (e.g., lower heart rate, stable blood pressure, decreased cortisol levels), and often experience faster recovery times post-intervention, highlighting its physiological as well as psychological benefits[49].

Within the context of chronic pain, a pervasive and debilitating issue in pediatric populations (e.g., recurrent abdominal pain, migraines, fibromyalgia, complex regional pain syndrome, or persistent musculoskeletal discomfort), hypnotherapy offers a sustainable means of long-term coping, symptom modulation, and building emotional resilience[50]. Chronic pain in children often involves complex interplay of central sensitization (where the nervous system becomes over-reactive to pain signals), profound emotional distress (anxiety, depression), and maladaptive thought patterns (e.g., catastrophizing). Hypnotherapy directly addresses these multidimensional aspects[51]. Common techniques include sophisticated guided imagery to reframe pain sensations-for example, guiding the child to imagine a "pain dial" in their mind that they can voluntarily "turn down" or a "volume control" for discomfort. Glove anesthesia is another powerful technique, where the child learns to create imagined numbness in their hand, which can then be "transferred" to a painful area of the body[52]. Furthermore, ego-strengthening suggestions are crucial, aimed at building the child's self-efficacy, confidence, and belief in their inherent ability to manage discomfort and regain control over their lives[45]. These interventions not only profoundly alter the perception of pain but also significantly enhance the child’s sense of self-efficacy and control, diminish catastrophizing thoughts, and alleviate the burden of associated anxiety or depressive symptoms.

Crucially, the benefits of hypnotherapy go beyond reducing symptoms to improve important functional outcomes, such as regular school attendance, better sleep quality, increased participation in physical activities, and an overall boost in quality of life[53]. A key element of long-term success is teaching children self-hypnosis techniques, allowing them to practice these skills outside of therapy sessions on their own, which promotes independence, lasting symptom relief, and lifelong coping strategies[54]. Clinical hypnotherapy, utilizing techniques like guided imagery, relaxation, and self-hypnosis training, has consistently demonstrated significant reductions in pain intensity, anxiety, and distress in pediatric patients, often outperforming standard care[55]. This robust efficacy is substantiated by the highest tier of evidence, including RCTs, meta-analyses, and systematic reviews. Notably, research by Kohen et al[56] and Olness[57] revealed that children as young as three years old can effectively apply self-hypnosis techniques, with proficiency generally increasing with age. Their findings also indicated an inverse correlation between clinical success and the number of visits, suggesting that a child's responsivity to hypnotherapy can often be predicted within four sessions or fewer.

In both acute and chronic pain settings, the successful implementation of hypnotherapy is critically dependent on its delivery by trained and experienced clinicians who can expertly tailor scripts and techniques to the unique developmental level, cognitive capacity, and individual interests of each child[58]. Sessions typically involve a thoughtfully structured combination of initial rapport-building, gentle induction into the hypnotic state, careful deepening techniques, the delivery of individualized therapeutic suggestions, and "future pacing" to reinforce successful application of new skills in real-life scenarios[59]. Active involvement of caregivers is paramount, as they play a vital role in reinforcing techniques and supporting the child's practice at home, thereby ensuring the sustained integration of hypnotherapeutic benefits into daily life, which is a key component of a comprehensive, integrative pediatric pain management plan[21].

**Pediatric ** Headache is among the most common and disabling pain complaints in children and adolescents, with migraine and tension-type headaches accounting for the majority of cases. These headaches often arise from a complex interplay of genetic predisposition, stress, emotional dysregulation, sleep disturbances, and environmental triggers[60]. While pharmacological treatments remain foundational, increasing attention is being given to mind-body approaches-particularly clinical hypnotherapy-as both adjunct and primary modalities for pediatric headache management[61].

Hypnotherapy offers a non-invasive, safe, and empowering intervention that helps children regulate pain perception, reduce headache frequency and severity, and gain control over associated physiological and emotional responses[61]. Typically, children are guided into a focused, deeply relaxed state and taught self-hypnosis techniques such as visualizing a "pain control dial", a "healing breeze", or a comforting mental space where the headache dissolves like sugar in warm water. These imagery-based strategies are easily learned, often enjoyable, and can be applied autonomously by children as soon as symptoms begin. The flexibility of delivering hypnotherapy in-person or remotely (via telehealth) has further increased its accessibility and appeal[7].

The evidence base for hypnotherapy in pediatric headache is robust and continually expanding. A retrospective study by Kohen and Zajac[61] involving 144 children and adolescents taught self-hypnosis reported significant reductions in headache frequency (4.5-1.4 per week), intensity (10.3-4.7), and duration (23.6-3.0 hours), with no adverse effects. Similarly, a randomized clinical trial by Jong et al[62] compared hypnotherapy, transcendental meditation, and progressive muscle relaxation in children aged 9-18 with primary headaches. All three groups experienced a significant decrease in headache frequency and medication use, with 47% achieving ≥ 50% reduction at 9 months-demonstrating hypnotherapy’s effectiveness on par with other validated behavioral interventions.

Other research supports hypnotherapy’s superiority in certain domains. In a comparative trial, Gysin[63] found hypnosis/self-hypnosis to be more effective than behavioral therapy or medical counseling alone in reducing headache intensity and improving the sense of self-efficacy in children with chronic or episodic headaches. In a more psychosocially oriented study, Anbar and Zoughbi[64] observed that 96% of children reported improvement with hypnosis, and highlighted the importance of insight generation, especially among children whose headaches were linked to fixed stressors. Finally, Kohen[65] presented compelling case reports of adolescents with chronic daily headaches who found dramatic relief from self-hypnosis after failing to respond to both medication and other therapies-underscoring the potential of hypnotherapy even in treatment-resistant cases.

A key distinguishing feature of hypnotherapy is its integration of deep relaxation, cognitive reframing, and imaginative coping strategies into a single, child-friendly modality. It encourages an internal locus of control and a strong sense of self-mastery-critical qualities for managing chronic pain. It also carries an excellent safety profile, making it a particularly attractive option in pediatrics, where concerns about pharmacologic side effects and long-term drug exposure are especially salient[57]. Parental involvement plays a crucial supportive Parents help reinforce practice at home, track triggers and progress, and model calm responses to the child’s symptoms. When hypnotherapy is delivered by trained professionals and supported at home, it can not only reduce headache burden and medication reliance, but also equip children with lifelong self-regulation skills beneficial far beyond headache management[66]. In light of growing empirical validation and clinical success, hypnotherapy in pediatric headache is no longer considered an alternative or experimental approach. As of 2025, it stands as a first-line, evidence-based, non-pharmacological intervention for many pediatric headache disorders-especially those with stress-related or chronic components. It is an essential component of holistic pediatric care, blending psychological support with physiological relief in a developmentally attuned, empowering manner.

**Pediatric functional somatic ** Functional somatic syndromes in children, encompassing conditions like IBS, functional abdominal pain (FAP), and enuresis, are characterized by real and distressing symptoms despite the absence of identifiable organic pathology[67]. These pervasive conditions often lead to significant disruptions in a child's daily life, affecting school attendance, social engagement, and overall psychological well-being. Thankfully, hypnotherapy has emerged as a compelling, evidence-supported therapeutic option for these disorders. Its effectiveness lies in its unique ability to influence autonomic, GI, and urinary function through powerful psychophysiological mechanisms and imaginative engagement[13].

IBS and FAP stand as some of the most extensively studied pediatric conditions where hypnotherapy has demonstrated remarkable efficacy. These challenging disorders are often intensified by stress, anxiety, and dysregulation of the crucial gut-brain axis. Gut-directed hypnotherapy (GDHT), a highly structured approach that masterfully employs metaphors and guided imagery to target digestive function directly, has shown considerable success[68]. In pediatric patients, the therapeutic process typically involves guiding the child to visualize profoundly calming or empowering scenarios directly within their GI system. For example, a child might imagine a "healing river" gently flowing through their abdomen, soothing discomfort, or visualize a "friendly helper" calming a "stormy stomach"[69]. A 2007 RCT by Vlieger et al[70] compared GDHT to standard medical therapy (SMT) in 53 children aged 8-18 with FAP or IBS. While both groups saw a reduction in pain, hypnotherapy demonstrated significantly superior outcomes. At one-year follow-up, 85% of the hypnotherapy group achieved successful treatment compared to only 25% in the SMT group (P < 0.001), indicating that GDHT is highly effective for children with these chronic conditions. A 2017 randomized pilot study by Gulewitsch and Schlarb[71] compared GDHT- and unspecific hypnotherapy (UHT) as self-help formats for children and adolescents with chronic abdominal pain. Of 45 participants, 32 completed the 12-week intervention. Both the GDHT and UHT groups demonstrated similar reductions in pain days and duration; however, pain intensity specifically decreased only in the UHT condition. Overall, 11 participants achieved clinical remission and 13 showed significant improvement across both conditions. The findings suggest high efficacy for standardized home-based hypnotherapy in this population, potentially filling a treatment gap, with a note that higher initial pain severity was linked to higher dropout rates[71]. A 2012 long-term follow-up study by Vlieger et al[72] investigated the sustained efficacy of gut-directed HT vs SMT in children with FAP or IBS. After an average of 4.8 years, HT remained significantly superior, with 68% of patients in remission compared to 20% in the SMT group (P = 0.005). The HT group also showed significantly lower pain intensity and frequency scores (P < 0.01) and reduced somatization scores (P = 0.04). These findings demonstrate that the beneficial effects of GDHT are long-lasting, making it a highly valuable treatment option for these pediatric conditions.

In an attempt to investigate factors that could affect the efficacy of hypnosis to relieve FAP, a 2023 exploratory study by de Bruijn et al[73] investigated whether specific genetic polymorphisms (COMT, OPRM1, and MAO-A), previously linked to adult hypnotizability, predict HT response in 144 children aged 8-18 with FAP disorders. The study found no significant association between variations in these polymorphisms and treatment success after three months of HT (P > 0.05). Furthermore, no associations were observed with secondary outcomes like adequate pain relief, anxiety, depression, or hypnotic susceptibility. The findings suggest that these particular polymorphisms do not predict hypnotherapy response in pediatric patients with FAP disorders.

Clinical trials and strong long-term studies have consistently shown that pediatric gut-focused hypnotherapy results in significant and meaningful decreases in symptom severity, the frequency of painful episodes, and related functional disability[74]. Moreover, its effects are often notably long-lasting, with improvements persisting for months or even years after treatment ends. In addition to reducing symptoms, hypnotherapy can also positively affect GI motility, reduce visceral hypersensitivity (the increased perception of normal gut sensations), and help normalize autonomic nervous system responses, offering a truly comprehensive biopsychosocial approach. Its non-invasive, medication-free nature makes it especially attractive to families who are cautious about drug treatments or whose children do not respond to standard therapies[73].

Enuresis, particularly nocturnal enuresis (bedwetting), affects a substantial portion of school-aged children and can carry a significant emotional and social burden. While spontaneous remission is common with age, persistent cases often lead to profound embarrassment, reduced self-esteem, and disrupted sleep patterns for both the child and family[75]. Hypnotherapy provides a highly child-friendly and empowering intervention that actively encourages desired behavioral change. It works through subconscious conditioning, vivid imagery rehearsal, and powerful ego-strengthening suggestions, tapping into the child's inner resources for control and confidence[16].

During hypnotherapy sessions, children may be guided to imagine internal "bladder alarms" that signal them to wake up or "control panels" in their minds that help them manage nighttime urination. Alternatively, they might engage with stories where a character successfully learns to control bedwetting[76]. Therapists consistently incorporate confidence-building suggestions to reduce feelings of shame and foster a strong sense of mastery and achievement. Importantly, hypnotherapy respects the child's individual pace and provides a completely non-threatening, non-punitive environment-a crucial factor for success given the sensitive nature of enuresis[77].

Research strongly supports the efficacy of hypnotherapy for treating nocturnal enuresis, particularly in pediatric populations. Multiple controlled studies, including randomized clinical trials, have demonstrated its therapeutic value. For instance, Edwards and van der Spuy[77] reported significant reductions in wet nights in boys aged 8-13 years following six standardized weekly hypnotherapy sessions, even without formal trance induction-highlighting the accessibility of the intervention. Seabrook et al[76], in a randomized clinical trial involving children aged 7-12 years, found that while alarm therapy yielded higher immediate success rates (55.3% vs 19.4%), hypnotherapy was associated with a lower (though not statistically significant) relapse rate and similar compliance. Earlier work by Olness[78] also demonstrated long-term benefits of hypnosis that often-surpassed pharmacological treatments like imipramine. Hypnotherapy can be employed both as a standalone intervention and in combination with behavioral techniques, enhancing outcomes by improving self-esteem, motivation, and emotional regulation, especially in children for whom traditional interventions have proven insufficient.

Behavioral and psychological disorders

Pediatric hypnotherapy is a versatile and highly effective tool for addressing a broad spectrum of behavioral and psychological disorders in children and adolescents. These conditions frequently stem from, or are significantly exacerbated by, emotional dysregulation, chronic stress, trauma, or various developmental challenges[79]. Hypnosis offers a non-invasive, child-centered therapeutic modality that powerfully leverages imagination, heightened suggestibility, and inherent self-regulation capacities to address underlying psychological processes and promote adaptive behaviors[80]. Among the most common and well-supported indications for hypnotherapy in pediatric behavioral health are anxiety disorders and phobias, sleep disturbances, and habit disorders.

**Anxiety disorders and ** Hypnotherapy is particularly effective in managing anxiety-related conditions in children, including generalized anxiety disorder, separation anxiety, social phobia, test anxiety, insomnia, and specific phobias such as trypanophobia (needle phobia) or dental anxiety[79]. A growing body of research supports its efficacy across both psychological and procedural anxiety contexts. For instance, Minosh et al[81] conducted a prospective study involving 53 children treated for anxiety, nocturnal enuresis, or insomnia. They found that 55% of those with anxiety disorders and 59% with enuresis achieved good-to-excellent long-term outcomes. No adverse effects were reported, highlighting the safety and moderate effectiveness of hypnotherapy in pediatric populations.

In dental settings, RCTs have demonstrated even more compelling evidence for hypnosis as a tool for anxiety and pain reduction. Erappa et al[82] compared hypnosis with acupressure, audiovisual aids, and no intervention in 200 children aged 6-10 receiving local anesthesia. Hypnosis led to the most significant reductions in anxiety indicators, including pulse rate, respiratory rate, and observed anxiety behavior, outperforming all other interventions. Similarly, Girón et al[83] found that hypnosis was significantly more effective than the standard tell-show-do behavioral technique in lowering anxiety and pain during pulpotomy procedures, as measured by the FLACC scale, heart rate, and skin conductance throughout all treatment phases.

Children often experience anxiety as a vague, overwhelming sensation that is difficult for them to articulate, understand, or control. Hypnotherapy provides them with developmentally tailored tools-imaginative, concrete, and empowering-to externalize these internal experiences and foster a sense of mastery. Typical techniques include guided imagery (such as visiting a personalized "safe place"), metaphorical storytelling (like a brave character conquering a fear), and ego-strengthening suggestions that reinforce emotional stability, confidence, and control[16].

In cases of procedural or phobia-related anxiety, systematic desensitization can be embedded within the hypnotic trance. For example, a child with needle phobia might imagine themselves as a superhero who grows stronger and braver with each imagined encounter with a needle, eventually translating this confidence into real-life calm. A large-scale observational study by Rienhoff et al[84] involving over 300 children aged 3-12 treated with both midazolam and hypnosis found that these techniques ensured consistently good compliance over one to two treatment sessions. While behavioral deterioration was observed in the third session, hypnosis remained effective in maintaining child cooperation and managing anxiety-related behaviors. Taken together, these findings demonstrate that hypnotherapy is not only effective in reducing acute anxiety symptoms but also builds long-term emotional regulation skills. It equips children with lasting coping mechanisms that extend well beyond the therapy setting, making it a valuable and evidence-based tool in pediatric behavioral and procedural care.

**Sleep ** Sleep disturbances-including insomnia, bedtime resistance, night awakenings, nightmares, and sleep terrors-are common among children, especially during periods of stress, grief, or developmental transition. These issues often overlap with anxiety, somatic complaints, and emotional dysregulation[85]. Hypnotherapy offers a safe, non-pharmacological intervention that targets both the psychological roots and behavioral manifestations of pediatric sleep disorders. Through personalized imagery, ego-strengthening techniques, and relaxation training, children are empowered to manage their internal experiences, leading to improvements in sleep quality and emotional well-being[21].

Neurodevelopmental disorders commonly present with sleep disturbances. In a pivotal retrospective chart review by Anbar and Slothower[86], 84 school-aged children (ages 7-17) with insomnia were treated using self-hypnosis techniques. Remarkably, 90% of those with prolonged sleep-onset latency experienced a significant reduction in the time it took to fall asleep. Additionally, 52% of children with frequent nocturnal awakenings reported complete resolution, while another 38% reported notable improvement. The study also found that 87% of children with related somatic complaints (e.g., chest pain, abdominal pain, habit cough) showed marked improvement following hypnotic intervention, highlighting hypnotherapy’s broad therapeutic potential beyond sleep itself. Similarly, Hawkins and Polemikos[87] explored the use of hypnotherapy in a small group of bereaved children (ages 8-12) suffering from sleep difficulties. Through a qualitative, group-based intervention, children were taught self-hypnosis to manage sleep initiation problems and night terrors. Reports from both children and caregivers indicated improved sleep patterns and a reduction in bedtime anxiety. This study reinforces that even young children can successfully learn and apply hypnotic techniques to self-regulate and overcome emotionally driven sleep disruptions, particularly in the context of grief or separation. Furthermore, Kohen et al[88] demonstrated the efficacy of hypnosis in treating sleep terror disorder, a type of parasomnia, in children aged 8-12. A combination of brief pharmacological support with imipramine followed by self-hypnosis training enabled complete resolution of night terrors in all four cases studied, with effects sustained over 2-3 years. Additional cases were similarly treated with hypnosis alone, reinforcing its potential to address even severe parasomnias when appropriately applied.

Hypnotic strategies for sleep commonly include calming bedtime scripts, progressive muscle relaxation, and guided imagery tailored to the child’s interests and developmental level. For example, children might be led to imagine floating gently on a cloud, drifting along a peaceful river, or being protected by a magical animal companion. These scripts not only lower physiological arousal but also create positive, soothing mental associations with sleep, replacing anxiety-driven narratives with safe and empowering ones[89,90]. Evidence from clinical studies and expert practice indicates that hypnotherapy reduces sleep latency, improves sleep continuity, and decreases nighttime fear and arousals, particularly when combined with psychoeducation and cognitive reframing. As sleep quality improves, children often experience a range of cascading benefits, including better mood regulation, enhanced attention and learning, and improved interpersonal functioning, making hypnotherapy a valuable and versatile modality in pediatric behavioral health[86-88].

**Tic, functional neurological, and habit ** Tic disorders-including Tourette syndrome, FND, and other habit disorders such as nail biting, thumb sucking, trichotillomania, and habit cough- present complex diagnostic and therapeutic challenges in pediatric populations. These conditions often stem from underlying psychological factors such as anxiety, boredom, trauma, stress, or the need for self-regulation and self-soothing[91,92]. Although these behaviors may initially serve adaptive or protective functions, they often become entrenched through repetitive reinforcement, ultimately resulting in physical harm, social embarrassment, and diminished self-esteem.

Hypnotherapy has emerged as a safe, developmentally sensitive, and highly effective intervention for these disorders in children. Rather than relying on aversive or punitive strategies, hypnosis emphasizes positive suggestion, vivid imagination, self-regulation, and empowerment[7,93]. Its versatility allows for both diagnostic and therapeutic benefits, particularly in cases where conventional biomedical approaches have yielded limited success.

**Tic disorders and Tourette ** In tic disorders, hypnotherapy has been shown to help children become more attuned to premonitory urges-the sensations that precede tics-and develop voluntary control over tic expression through metaphoric, dissociative, and imagery-based techniques. Children may be guided to imagine a “switch” they can mentally activate to reduce tic frequency or redirect the urge into a less noticeable or calming behavior. This approach complements traditional behavioral therapies such as habit reversal training and is often perceived by children as more playful and engaging[94,95]. In a case series of 33 children with Tourette syndrome, self-hypnosis training supplemented with instructional video modeling led to symptom improvement in 79% of participants-96% of whom responded within three sessions[94]. Similarly, Kohen and Botts[95] documented a sustained reduction in tic frequency and a decreased reliance on medication through the use of relaxation and imagery techniques. These findings support hypnosis as an effective and child-friendly adjunctive therapy.

FND: FND encompasses a spectrum of psychogenic conditions, including functional movement disorders, psychogenic non-epileptic seizures, and functional gait abnormalities. Hypnotherapy plays a dual role Diagnostically, it can produce temporary symptom resolution during trance, which helps confirm the psychogenic origin of symptoms. Therapeutically, hypnosis supports emotional reprocessing, reduces somatic hypervigilance, and facilitates motor retraining through visualized normalization of movement[79]. Children are encouraged to “reset” or “reboot” dysfunctional body systems by mentally rehearsing symptom-free states, often resulting in substantial symptom improvement when integrated within multidisciplinary care plans.

**Habit disorders and body-focused repetitive ** Habit disorders such as thumb sucking, nail biting, trichotillomania, and habit cough can significantly interfere with social functioning and physical well-being. These behaviors are often maintained by unconscious reinforcement mechanisms and may be exacerbated by stress or trauma[91]. Hypnotherapy has demonstrated effectiveness in managing these disorders through individualized interventions focused on metaphorical imagery, ego-strengthening, and behavioral reframing[7,91,93].

For example, Anbar[96] reported the rapid resolution of a habit cough in a child using a rapport-based, functional understanding of symptoms paired with hypnosis. Grayson[97] similarly documented the elimination of thumb-sucking in a 7-year-old girl after a single hypnosis session involving imaginative modeling and affirmation. Kohen[98] treated pediatric trichotillomania through a combination of self-monitoring, dissociative strategies, and customized imagery, successfully helping children gain control without inducing guilt or shame. These interventions consistently emphasize internal mastery and self-efficacy.

Across tic, FND, and habit disorders, hypnotic strategies include empowering imagery (e.g., visualizing protective paint on fingernails), ego-strengthening affirmations, and developmentally tailored metaphors. Children may visualize their fingers resisting the urge to bite or imagine hair becoming stronger each time they resist pulling. In tic and habit disorders, suggestions may also incorporate gentle, symbolic aversion (e.g., fingers tasting “sour” only when placed in the mouth) delivered within a nurturing and affirming therapeutic frame. Parental involvement is crucial in reinforcing treatment gains. Caregivers are coached to provide consistent, nonjudgmental support, celebrate small successes, and encourage practice of hypnotic techniques at home[4,79]. While further large-scale RCTs are warranted, the current body of clinical evidence and expert consensus support the integration of hypnotherapy into treatment plans for pediatric tic disorders, FND, and habit disorders. It offers rapid symptom relief, enhances self-awareness and emotional regulation, and promotes lasting behavioral change-all within a framework that empowers the child and fosters hope and engagement.

NEURODEVELOPMENTAL AND PSYCHOSOMATIC CONDITIONS

Pediatric hypnotherapy is increasingly recognized as a valuable adjunctive approach in the comprehensive management of certain neurodevelopmental and psychosomatic conditions[99]. This is particularly true when traditional therapies alone may not fully address comorbid symptoms such as anxiety, sleep disturbances, or associated functional impairments. While hypnotherapy is not positioned as a primary or standalone treatment for the core deficits of neurodevelopmental disorders, it offers meaningful benefits in significantly improving quality of life and enhancing symptom control in children with conditions like autism spectrum disorders (ASD), ADHD, tic disorders, and FND[100].

ASD

While hypnotherapy is not a primary treatment for the core neurodevelopmental characteristics of ASD, mounting evidence supports its role as a highly valuable adjunctive intervention, particularly for managing the frequently co-occurring challenges seen in autistic individuals. These challenges include heightened anxiety, emotional dysregulation, sensory sensitivities, behavioral rigidity, low self-esteem, and significant difficulties with cooperation in unfamiliar or demanding settings such as clinical or dental procedures[101].

Several studies have demonstrated the therapeutic potential of hypnosis when tailored to the unique needs of autistic children. For example, Mitchell et al[102] conducted a RCT assessing GDHT in autistic children with disorders of gut-brain interaction. While synbiotics alone improved GI symptoms, the combination of synbiotics and GDHT significantly reduced anxiety and irritability, with sustained improvement in GI pain, indicating GDHT’s value in addressing both physiological and behavioral symptoms through a biopsychosocial lens. Similarly, Gardner and Tarnow[103] reported successful use of adjunctive hypnotherapy in a child with atypical autism and severe ego deficits. By incorporating music-a preferred interest and strength of the child-into hypnotherapy, the intervention led to improvements not only in targeted behaviors but also in broader social and cognitive skills, with effects maintained at 18-month follow-up. This highlights the importance of personalization and strength-based approaches in hypnosis with autistic populations.

Sartika et al[104] found that hypnotherapy prior to dental scaling in autistic children significantly improved cooperation and reduced oral health complications such as calculus accumulation. This evidence suggests that hypnosis can modulate behavioral responses to stressful stimuli, enhance compliance, and make necessary medical or dental procedures less traumatic. Additionally, Austin et al[105] explored the feasibility of virtual reality (VR)-based hypnosis in adolescents with ASD. While core autistic symptoms remained unchanged, participants were attentive and engaged, with parents reporting increased relaxation and willingness to participate-suggesting that hypnotic engagement, through novel modalities like VR, may help bridge therapeutic gaps by increasing accessibility and comfort.

Taken together, these studies underscore the versatility of hypnotherapy in addressing diverse ASD-related concerns-from anxiety and GI distress to cooperation and emotional self-regulation. Hypnotherapeutic techniques such as guided imagery, safe space visualization, metaphor-based coping scripts, and ego-strengthening affirmations can be adapted to support autistic children in emotionally overwhelming or inflexible states. Moreover, when sleep disturbances are present-a common issue in ASD-hypnosis can promote relaxation and improve sleep onset through calming bedtime scripts and anxiety modulation[106]. Crucially, the success of hypnotherapy in ASD depends on a neurodiversity-affirming, highly individualized approach. Interventions must be designed with sensitivity to the child’s communication preferences, sensory processing profile, and interests. Leveraging special interests (e.g., music, animals, or fantasy themes) and using concrete, literal language can significantly enhance receptivity and therapeutic engagement[107]. When integrated into a multidisciplinary care framework and administered by clinicians trained in both hypnotherapy and autism care, hypnotherapy can substantially improve quality of life and psychological resilience in autistic children-empowering them with tools for better self-regulation, reduced anxiety, enhanced cooperation, and a stronger, more positive sense of self.

ADHD: Supporting anxiety and sleep dysregulation

Children with ADHD often face a constellation of challenges beyond core symptoms of inattention, impulsivity, and hyperactivity. These include heightened anxiety, sleep disturbances, low self-esteem, and specific learning difficulties-each of which can significantly affect quality of life, academic performance, emotional resilience, and social adaptation[108]. While traditional ADHD management often relies on pharmacotherapy and behavioral interventions, hypnotherapy has emerged as a valuable adjunctive tool-particularly effective in addressing these co-occurring symptoms and promoting overall emotional and neurocognitive regulation[109].

Hypnotherapy does not aim to alter the neurocognitive underpinnings of ADHD directly, but it targets high-impact associated issues like anxiety, sleep dysregulation, and emotional dysregulation. For instance, hypnotic techniques-such as guided imagery, progressive muscle relaxation, breathing-focused induction, and metaphorical storytelling-help children learn to self-soothe, reduce physiological arousal, and transition more smoothly into sleep[110]. Children are often guided to imagine calming scenarios, such as gently floating on a cloud, slowing down a buzzing engine, or entering a safe "focus zone", which fosters internal regulation and empowers them to cope more adaptively with overwhelming stimuli[111].

Emerging research strongly supports this approach. In a pioneering early study by Calhoun and Bolton[100], hypnotherapy was trialed as a potential alternative treatment for children with hyperkinesis and behavior disorders. Though the sample was small and challenges in hypnotizability limited its broad application, the study reported a notable behavioral improvement in the successfully hypnotized participant, laying early groundwork for hypnotherapy’s potential in ADHD-related behavioral modulation. More recently, Hazard et al[112] conducted a pilot exploratory study examining the effect of hypnosis on self-esteem in children with ADHD, idiopathic epilepsy, and anxiety disorders. Using structured hypnosis sessions and validated self-evaluation tools (such as the Jodoin 40 scale and Piers-Harris Self-Concept Scale), they demonstrated statistically significant improvements in self-esteem, without any adverse effects. This highlights the important role of hypnotherapy in bolstering emotional health and psychological resilience among children managing neurodevelopmental conditions. In another compelling case study, Hery-Niaussat et al[113] investigated the impact of therapeutic hypnosis on a child with ADHD and a coexisting written language disorder. The intervention, consisting of four structured hypnosis sessions over eight weeks, resulted in significant improvements in reading fluency, attention, and self-esteem. Although based on a single-case experimental design, this study highlights the potential of hypnotherapy to address overlapping cognitive-linguistic and attentional challenges, particularly when conventional interventions are ineffective.

In clinical settings, practitioners often incorporate interactive metaphors tailored to children's developmental stages-such as superheroes mastering their impulses, magical calming objects, or adventure journeys into a “quiet mind cave”-to maximize engagement and therapeutic responsiveness. Additionally, children who learn self-hypnosis techniques report greater confidence, improved sleep initiation, fewer nocturnal awakenings, and reduced anxiety. These changes not only improve day-to-day functioning but also create a more receptive psychological state for other interventions, including medication titration or behavioral therapy[7]. Currently, clinical hypnotherapy is increasingly viewed not as a fringe or supplementary technique but as a credible and evidence-informed intervention for children with ADHD-especially those presenting with anxiety, sleep difficulties, learning disorders, or low self-esteem. When delivered by trained clinicians, hypnosis offers a non-invasive, empowering, and child-friendly strategy to support holistic development and psychological well-being in this vulnerable population. However, despite promising preliminary findings, the limited scope of current research makes it premature to draw firm conclusions about hypnosis as a reliable treatment for these conditions.

Symptom management of organic disease

While often associated with behavioral or functional disorders, hypnotherapy has increasingly demonstrated significant value as an adjunctive intervention in managing symptoms linked to chronic and organic pediatric illnesses. Children confronting diagnoses such as cancer, CF, and IBD not only endure profound physical symptoms but also experience substantial psychological stressors. These stressors can exacerbate their primary condition, diminish treatment adherence, and severely impact their quality of life. Pediatric hypnotherapy, through its remarkable capacity to modulate perception, reduce distress, and enhance coping mechanisms, offers a safe, non-pharmacological strategy to improve overall well-being, alleviate symptom burden, and foster robust psychological resilience in these medically complex young populations[114].

**Oncology ** Children undergoing cancer treatment frequently endure a multifaceted spectrum of distressing symptoms-including severe procedural pain, anticipatory anxiety, chemotherapy-induced nausea and vomiting, fatigue, and psychological distress related to repeated hospitalizations and invasive interventions. Hypnotherapy has emerged as a highly promising, non-pharmacological intervention to alleviate these burdens, empowering young patients with concrete psychological tools to manage both acute physical discomfort and profound emotional stress[115,116].

During procedures such as lumbar punctures, bone marrow aspirations, or central line access, clinical hypnosis is frequently employed to significantly reduce procedural pain and anxiety. Children are often guided to dissociate from the clinical environment through vivid imagery, such as floating in space, being protected by a “magic shield”, or visiting a tranquil, imaginary sanctuary. These approaches not only reduce the perception of pain but also improve procedural cooperation and emotional regulation[117]. A meta-analysis by Nunns et al[118] showed large, statistically significant reductions in both procedural anxiety (d = 2.30) and pain (d = 2.16) in children receiving hypnosis, outperforming several other non-pharmacological interventions. Chemotherapy-induced nausea and vomiting, particularly anticipatory nausea-a conditioned response exacerbated by repeated exposure-is another domain where hypnosis shows profound benefit. According to a systematic review by Richardson et al[119], hypnosis resulted in a clinically meaningful reduction in both anticipatory and acute nausea and vomiting among pediatric cancer patients, with effects comparable to cognitive-behavioral therapy, yet with fewer demands on cognitive processing.

From an emotional and psychosocial perspective, hypnotherapy plays a crucial role in fostering resilience, autonomy, and effective coping mechanisms. In a pilot group intervention by Grégoire et al[120], children aged 11-17 and their parents participated in monthly hypnosis-based sessions. Both groups reported improved emotional regulation, reduced stress, and enhanced family communication. Children learned specific self-regulation strategies-such as breathing techniques and positive reframing-to manage fear, sadness, and feelings of helplessness during treatment. Furthermore, individual case studies offer compelling support for hypnosis in managing cancer-related anxiety. For example, Talebiazar et al[121] conducted a structured hypnotherapy protocol with three female pediatric oncology patients, resulting in significant reductions in hospital-related anxiety, sustained through a one-month follow-up. Likewise, Anbar[122] demonstrated that self-hypnosis, taught in just one or two sessions, was successfully used by 86% of children and adolescents to manage symptoms including procedural discomfort, treatment-related anxiety, and even taste aversion from medications. Collectively, these studies underscore that hypnotherapy is far more than an adjunct to pediatric oncology care-it is a robust, adaptable therapeutic modality that directly targets both the somatic and psychological dimensions of cancer treatment. When appropriately tailored and delivered by trained clinicians, hypnotherapy substantially enhances quality of life, increases emotional resilience, and fosters meaningful engagement in the treatment process for children and adolescents facing cancer.

**Bronchial ** Bronchial asthma remains one of the most prevalent chronic respiratory diseases in childhood, characterized by episodic airway inflammation, bronchoconstriction, and reversible airflow obstruction. These episodes often manifest as wheezing, shortness of breath, coughing, and chest tightness, substantially affecting a child’s daily functioning and psychosocial well-being[123]. Beyond the physical pathology, a critical aspect of asthma management lies in addressing its psychosomatic dimensions-particularly anxiety, fear, and panic, which can independently precipitate or worsen bronchoconstriction. These emotional triggers create a self-reinforcing loop that intensifies both psychological and physiological symptoms[124].

While bronchodilators and anti-inflammatory agents remain the foundation of treatment, clinical hypnotherapy has emerged as a promising adjunctive intervention that targets the emotional and behavioral components of asthma. Hypnotherapy primarily disrupts the anxiety-dyspnea cycle by fostering deep relaxation, slowing respiratory rate, and reducing muscular tension in the chest[125]. Children are typically taught self-hypnosis techniques tailored to their developmental stage, often involving vivid imagery-such as picturing “open tunnels” in their lungs or feeling a “cool breeze” soothing their chest. These tools provide portable, immediate coping strategies for managing panic and promoting a sense of control, which can ultimately reduce attack severity and improve adherence to medical treatment[126].

The clinical literature offers compelling support for this integrative approach. A key example is the work of Morrison[127], who studied sixteen chronic asthmatic patients with poor pharmacologic control and reported that, following one year of hypnotherapy, hospital admissions fell from 44 to 13 and cumulative inpatient days dropped by 249. Additionally, systemic corticosteroids were reduced or withdrawn in the majority of patients, with side effects notably diminished. Although objective measures of airflow showed variability, the reduction in healthcare utilization and medication dependency underscored hypnotherapy’s practical benefits. Complementing this, Anbar[126] conducted a retrospective review of 17 pediatric patients with chronic dyspnea who had normal resting pulmonary function but persistent breathing complaints. Thirteen of the 16 children taught self-hypnosis reported full symptom resolution within one month, and many attributed their recovery directly to the use of hypnosis techniques. This study not only highlights the utility of hypnosis in symptom control but also underscores its relevance in functional or psychogenic breathing disorders that mimic asthma.

In contrast, Alexander et al[128] evaluated the physiological effects of relaxation training in 14 children with severe asthma. Despite evidence of relaxation, as indicated by decreased heart rate and muscle tension, pulmonary function did not improve significantly, suggesting that while relaxation states can be achieved, they do not necessarily translate into measurable changes in lung function in all individuals. This distinction between subjective relief and objective improvement highlights the need to assess both domains when evaluating therapeutic outcomes. The broader landscape of pediatric complementary and alternative medicine (CAM), including hypnotherapy, has been critically examined by Moher et al[129] in a systematic review of 251 RCTs. The authors concluded that although RCTs are increasingly used, the overall quality of reporting remains suboptimal. Deficiencies such as poor allocation concealment and inconsistent outcome reporting limit the strength of conclusions, highlighting the urgent need for more rigorous and transparent trial designs. Nevertheless, their review underscores the growing recognition of CAM, including hypnotherapy, as a valuable area of pediatric research. Taken together, these studies support the growing consensus that clinical hypnotherapy is a safe, well-tolerated, and empowering adjunct to standard asthma management in children. By equipping patients with tools to modulate emotional triggers and build self-efficacy, hypnotherapy not only mitigates the psychological burden of asthma but also contributes to tangible improvements in daily functioning, medication use, and healthcare utilization. As evidence accumulates and methodological rigor improves, hypnotherapy is poised to play an increasingly important role within holistic, child-centered asthma care.

CF: CF is a chronic, life-shortening genetic disorder that primarily affects the respiratory and digestive systems. Children and adolescents with CF endure complex daily treatment routines-including airway clearance techniques, nebulized medications, enzyme replacement therapy, and frequent hospitalizations[130]. These demands, coupled with progressive pulmonary decline, often lead to psychological challenges such as anxiety, treatment fatigue, procedural distress, and depressive symptoms. The cumulative burden can significantly impair quality of life, emotional regulation, and treatment adherence[131].

Clinical hypnotherapy has emerged as a supportive and empowering tool to address these multifaceted challenges. Hypnotic techniques can reduce the perception of breathlessness, ease coughing episodes, and promote a state of deep relaxation during physiotherapy or nebulizer sessions. Children may be guided to visualize “fresh air flowing through crystal-clear tubes” or “lungs opening like flowers in the sun”, which fosters a positive, calming mental environment and facilitates deeper, more effective breathing. This imagery not only reframes distressing treatments but also increases the child's sense of agency and control over their condition[132]. Psychologically, hypnosis has demonstrated utility in decreasing anticipatory anxiety related to medical procedures and hospital stays. It can reduce discomfort during venipuncture, improve mood stability, and counter feelings of helplessness or social withdrawal, especially in adolescents coping with the social isolation and uncertainty inherent to CF. Teaching self-hypnosis enables these patients to apply adaptive coping strategies during daily stressors, leading to enhanced autonomy and resilience[133].

Empirical support for this approach is increasingly robust. In a pilot RCT, Belsky and Khanna[134] demonstrated that children aged 7-18 who practiced self-hypnosis showed significant improvements in psychological domains, including locus of control, self-concept, and trait anxiety, compared to matched controls. Importantly, these children also exhibited improved peak expiratory flow rates immediately following hypnosis sessions, indicating both psychological and physiological benefits. Complementing this, Anbar[122] conducted a case series involving 49 patients aged 7 to 49 years who were taught self-hypnosis by their pulmonologist. The patients used hypnosis for a variety of CF-related challenges-including relaxation, procedural pain, headaches, taste aversion to medications, and symptom control. Notably, 86% of reported applications were effective, and no patient experienced worsening of symptoms. Many participants continued to practice hypnosis independently for six months or longer, suggesting the high acceptability and sustainability of the intervention. Together, these findings support the integration of hypnotherapy into comprehensive CF care. While not a substitute for medical management, hypnotherapy provides an evidence-based, non-pharmacologic adjunct that enhances symptom control, reduces emotional distress, improves adherence, and supports overall well-being. As awareness and clinician training increase, hypnotherapy may become a core supportive therapy in multidisciplinary CF programs.

IBD: Children and adolescents diagnosed with IBD-which includes Crohn’s disease and ulcerative colitis-face a chronic, relapsing condition marked by unpredictable cycles of intense abdominal pain, diarrhea, fatigue, rectal bleeding, and emotional distress[135]. The burden is compounded by frequent invasive procedures, complex medication regimens, and the psychological impact of living with an incurable, fluctuating disease. As a complementary strategy within multidisciplinary IBD management, hypnotherapy has emerged as a promising and evidence-informed modality, particularly for its capacity to modulate the gut-brain axis, reduce stress-related exacerbations, and enhance patients' psychological resilience[136]. GDHT, already established as a highly effective treatment for IBS, is increasingly being adapted for patients with IBD, especially those experiencing IBS-type symptoms during disease remission. A RCT by Hoekman et al[137] demonstrated that although GDHT was not statistically superior to SMT in reducing symptom severity in patients with quiescent IBD and coexisting IBS-like symptoms, both strategies yielded meaningful symptom relief, positioning hypnotherapy as a viable, patient-centered option within this clinical context.

In pediatric populations, clinical hypnosis shows notable potential as an adjunctive therapy. In a pilot randomized controlled study by Lee et al[138] involving adolescents with Crohn’s disease, participants who received self-hypnosis training alongside one in-person session experienced significant improvements in parent-reported quality of life, particularly in social and school functioning, as well as a marked reduction in abdominal pain and school absences. These findings reinforce the acceptability, feasibility, and impact of hypnosis on psychosocial and somatic symptoms in young patients. In earlier work, Shaoul et al[139] explored the use of tailored hypnotherapy in six children with IBD who were facing severe symptoms despite ongoing conventional treatment. Most patients exhibited substantial clinical improvement, including resolution of abdominal pain, decreased inflammatory markers, and enhanced emotional stability, with no reported adverse effects. This case series highlighted the potential for hypnotherapy to address both the physical and emotional components of IBD in children.

Supporting the psychoneuroimmunological foundation of hypnosis in IBD, Mawdsley et al[140] conducted a physiological study in adults with active ulcerative colitis, finding that a single session of gut-focused hypnosis significantly reduced key inflammatory markers, including serum interleukin-6, rectal mucosal substance P, histamine, and IL-13. These biochemical changes were accompanied by improved mucosal blood flow and reduced autonomic arousal, underscoring the biological plausibility of hypnosis as an adjunct to anti-inflammation. Moreover, in a landmark prospective randomized study by Keefer et al[141], patients with quiescent ulcerative colitis who received 7 sessions of GDHT demonstrated prolonged clinical remission at 1 year compared with controls (68% vs 40%), with an average of 78 more days in remission. This is the first controlled trial to show that hypnotherapy may significantly influence long-term disease trajectory in IBD, potentially by stabilizing autonomic and immunological reactivity to stress.

Clinically, children undergoing hypnotherapy for IBD are often taught to use healing visual metaphors-such as soothing a “burning bowel” or visualizing immune cells repairing the mucosa-which may enhance their perceived control over symptoms and treatment. Such interventions also reduce procedural anxiety during frequent diagnostic tests and may support adherence to challenging dietary and medical regimens[142]. Although hypnotherapy is not a replacement for biologics or immunosuppressants, it is a powerful adjunct that enhances comprehensive care. Its ability to attenuate symptoms, reduce psychological distress, and improve quality of life during both flare-ups and remission phases makes it an indispensable component of biopsychosocial IBD management, particularly in pediatric settings. In organic disease settings, hypnosis may appear helpful as an adjunct for symptom relief; however, the evidence is primarily derived from small clinical trials and case series, and its contribution beyond general supportive care remains to be clarified.

**Support during medical procedures and ** Medical procedures and diagnostic investigations are frequently highly distressing for children, often eliciting significant fear, anticipatory anxiety, and acute physiological stress responses. Pediatric patients undergoing surgery, complex imaging [such as MRI, computed tomography (CT) scans], or other unfamiliar and potentially invasive procedures may experience profound emotional dysregulation, resistance, and even develop long-term psychological sequelae if these experiences are perceived as traumatic[35]. Hypnotherapy offers an exceptionally valuable, non-pharmacological tool to proactively help children manage procedural anxiety, dramatically enhance their cooperation, and potentially improve a range of clinical outcomes through targeted psychological and physiological regulation[27].

**Surgical preparation and recovery ** Preoperative anxiety in children is a well-documented concern, associated with numerous adverse outcomes. These include heightened pain perception, increased requirements for anesthesia and analgesia, delayed post-operative recovery, and greater post-operative behavioral disturbances (e.g., increased irritability, sleep problems). Hypnotherapy has demonstrably proven effective in alleviating anticipatory anxiety and fostering a vital sense of calm, confidence, and control in pediatric surgical candidates[143].

Using carefully tailored hypnotic scripts and guided imagery, children can be guided to vividly visualize a safe, soothing environment where they feel completely at ease, or rehearse a successful and peaceful surgical experience from beginning to end. For example, a child may imagine “taking a brave journey in a comfortable spaceship where the doctors and nurses are kind, helpful astronauts”, creating a positive and empowering narrative around the entire surgical process[16]. Hypnotherapeutic suggestions are also strategically employed to prime the mind for a smooth and comfortable anesthesia induction, minimize intraoperative stress responses, and actively support accelerated post-operative healing. Post-surgical suggestions might focus on visualizing rapid wound healing, significantly reduced pain and swelling, improved appetite, and a swift return to normal daily activities[144]. Studies consistently suggest that children receiving preoperative hypnotherapy not only experience substantially lower anxiety levels but also exhibit a reduced need for post-operative analgesics, experience quicker discharge times from the hospital, and encounter fewer overall complications. This proactive approach significantly contributes to a more positive surgical experience and a faster recovery[145].

Imaging procedures (MRI, CT scans, and claustrophobia reduction): Diagnostic imaging procedures-especially MRI and CT scans-pose unique and formidable challenges for children. The enclosed space of an MRI scanner, the loud and unfamiliar noises, the absolute physical stillness required for extended periods, and the general fear of strange equipment can trigger intense anxiety, claustrophobia, and panic[146]. Consequently, these crucial procedures are often delayed, interrupted, or necessitate pharmacological sedation, increasing healthcare costs and potential medication-related risks. Hypnotherapy offers a powerful alternative to significantly reduce distress and vastly improve procedural compliance through expertly guided imagery, systematic desensitization, and deep relaxation techniques[147].

For instance, a child undergoing an MRI might be guided to imagine they are inside a personalized "rocket ship" preparing for an exciting journey to a favorite planet, with the scanner's noises reframed as the thrilling sounds of the mission. Pre-procedure sessions can strategically include exposure to recorded sounds of an MRI and practice hypnosis to simulate the feeling of lying still in a confined space, building familiarity and confidence[148]. By equipping children with these effective hypnotic coping strategies, many can successfully undergo complex scans without the need for pharmacologic sedation, leading to safer, more efficient, and more cost-effective diagnostic processes[149].

Moreover, the utilization of self-hypnosis or brief, targeted hypnosis techniques, delivered by trained personnel or via accessible digital tools (e.g., specialized apps, audio recordings), has shown considerable promise in helping children prepare for and complete diagnostic imaging with greater success[21]. Hypnosis also actively reduces physiological arousal, manifesting as a lower heart rate, blood pressure, and cortisol levels, thereby contributing to a more cooperative, relaxed, and positive state throughout the entire procedure[44]. This not only benefits the child's immediate experience but also potentially impacts the quality of the diagnostic images obtained. Although hypnosis can reduce procedural anxiety and distress, its feasibility in busy clinical environments is challenged by time constraints and limited availability of trained practitioners, underscoring the need for pragmatic trials.

PEDIATRIC DERMATOLOGY

Dermatologic conditions in children, particularly those with chronic or relapsing patterns such as warts and atopic dermatitis (AD) (eczema), frequently exhibit significant psychosomatic components, making them exceptionally amenable to integrative mind-body interventions like hypnotherapy[150]. Psychological stress, emotional dysregulation, and ingrained behavioral responses (like scratching) often profoundly influence the onset, persistence, and exacerbation of dermatologic symptoms in pediatric patients. By adeptly leveraging imagination, focused attention, and deep relaxation, hypnotherapy offers a non-invasive, empowering, and child-centered modality to comprehensively address both the physical manifestations and the psychological aspects of skin disease[151].

Warts

Warts, caused by various strains of the human papillomavirus (HPV), are highly prevalent in school-aged children and adolescents. These benign skin lesions, though often medically harmless, can be psychologically distressing due to cosmetic concerns, social embarrassment, and potential peer ridicule[152]. Their resistance to standard treatments such as cryotherapy, topical acids, or surgical removal-many of which are uncomfortable or even painful-has prompted interest in more patient-friendly, mind-body interventions. Hypnosis stands out as one of the most extensively studied and historically significant non-pharmacological options for treating warts, both cutaneous and genital[153].

Warts are among the earliest conditions for which the therapeutic value of hypnosis was formally validated. The immune-mediated nature of wart regression makes them an ideal target for psychoneuroimmunological modulation, and several clinical trials have investigated the potential of hypnosis to enhance immune function and facilitate clearance of HPV-induced lesions. In landmark studies by Spanos et al[154] and Spanos et al[155], hypnosis was shown to outperform placebo, topical salicylic acid, and no treatment in promoting the regression of cutaneous warts on the hands and feet. Participants who underwent hypnotic suggestion-such as envisioning the wart dissolving or disappearing-demonstrated significantly greater wart loss than the control group, independent of their baseline hypnotizability. Beyond cutaneous warts, hypnosis has also been explored for managing genital HPV infections. In a pivotal study by Barabasz et al[156], hypnosis was compared directly to SMT in both urban and rural women with HPV-related genital warts. At 12 weeks, hypnosis not only produced a statistically significant reduction in lesion size and number (P < 0.04) but also demonstrated a fivefold higher complete clearance rate compared to medical treatment alone. These findings suggest that hypnosis may engage immune mechanisms in a way that is clinically meaningful, particularly for recalcitrant or recurrent cases.

Hypnotherapeutic techniques typically employ vivid, multi-sensory imagery and age-appropriate suggestion strategies designed to stimulate the immune response. For children, this might include imagining a magical laser beam shrinking the wart, a healing sunbeam dissolving it, or an "immune army" being dispatched to attack the virus. These scripts are customized based on the child's developmental stage and personal interests, which maximizes receptivity and engagement. The flexibility and non-invasive nature of hypnotherapy make it especially suitable for young patients who may fear pain or have contraindications to physical interventions[157].

The plausible mechanisms underlying the observed wart regression include improved immune surveillance, enhanced local blood flow to the affected tissues, and reduction in psychological stress, which is known to suppress immune function. Importantly, hypnosis offers a painless, empowering, and cost-effective treatment modality, particularly for those with multiple lesions or significant treatment anxiety[158]. While hypnosis should not yet replace conventional treatments as a first-line option in all cases, the growing evidence base strongly supports its integration as a valuable adjunct or alternative, especially in children with treatment-resistant warts or high distress levels. Continued exploration of its mechanisms and efficacy through well-controlled studies is warranted and encouraged[159].

AD (eczema)

AD is a chronic, relapsing inflammatory skin disease characterized by intense pruritus, xerosis (dryness), and visible eczema lesions. A hallmark feature of AD is the itch-scratch cycle, in which persistent itching leads to compulsive scratching, which in turn worsens inflammation and provokes further itching. This self-perpetuating loop significantly contributes to sleep disturbance, mood dysregulation, social withdrawal, and reduced quality of life, especially in children[160]. Psychological stress and emotional distress-whether stemming from environmental triggers, interpersonal dynamics, or internal anxiety-are well-documented contributors to disease flares and scratching behavior, often exacerbating symptoms beyond dermatological control[161]. Hypnotherapy has emerged as a promising adjunctive strategy in the management of AD, particularly in moderate-to-severe or treatment-resistant cases. It targets both physiological symptoms and psychological contributors by disrupting the itch-scratch cycle, modulating stress responses, and enhancing emotional regulation[162]. Children can be guided through gut-directed or skin-focused imagery, such as envisioning a "cooling mist" soothing their inflamed skin, imagining their hands protected by "velvet gloves" to prevent nighttime scratching, or visualizing itch signals being turned down like a volume knob. Self-hypnosis techniques empower children to take control of their symptoms, creating a sense of autonomy and self-efficacy in managing their condition[163].

The efficacy of hypnosis in eczema has been substantiated in a growing number of clinical studies. Stewart and Thomas[164] demonstrated statistically significant improvements in both subjective symptoms and objective measures in adults and children with severe, treatment-resistant eczema. Follow-up at up to 18 months indicated sustained benefits in itching, sleep disturbance, and mood, with nearly all children showing improvement immediately after the intervention. Delaitre et al[165] further corroborated these findings in a prospective clinical study, where 26 of 27 adult patients experienced significant improvement or resolution of eczema symptoms following hypnosis sessions. The mean Eczema Area and Severity Index score improved dramatically from 12 to 2.8, suggesting hypnosis may even reduce the need for systemic therapies in certain individuals. Derrick et al[166] explored self-hypnosis and guided imagery in children over 5 years with moderately severe chronic eczema. Although statistical significance was not achieved, the study still reported clinically observable improvements, highlighting the technique's potential and the need for larger sample sizes in future pediatric research.

Incorporating hypnotherapy into eczema care also brings behavioral and emotional advantages. It enables patients to address itching driven by anxiety, frustration, or boredom-a frequent pattern in pediatric populations. Parental involvement is integral, providing external support and reinforcing relaxation techniques and positive behaviors at home[16]. Hypnosis also enhances treatment adherence, particularly in children who are resistant to applying topical therapies due to discomfort or sensory sensitivities. While hypnosis should not replace standard dermatologic treatments, including moisturizers, corticosteroids, or immunomodulators, it serves as a potent, non-pharmacological adjunct. Its non-invasive nature, excellent safety profile, and capacity to address both mind and body make it especially valuable for children with emotionally reactive eczema, scratching-induced flares, or resistance to conventional care[164]. In conclusion, hypnotherapy is a scientifically supported, child-friendly, and empowering intervention for atopic dermatitis. Its integration into holistic care strategies offers not only symptom relief but also long-term improvements in psychological resilience, emotional well-being, and treatment outcomes.

ADVANTAGES OF HYPNOSIS IN PAEDIATRICS

Hypnosis offers a unique and compelling array of advantages that render it particularly well-suited for integration into pediatric healthcare. Its utility extends beyond symptom management, fostering a safe approach, empowering, and is highly effective for children and adolescents. Perhaps one of its most compelling advantages is its nature as a non-pharmacological intervention[26]. This inherently minimizes concerns regarding systemic side effects, drug interactions (especially vital for children on complex polypharmacy), or potential dependency often associated with pharmaceutical solutions. For pediatric patients who may be highly sensitive to medications or for whom certain drugs are contraindicated, hypnotherapy provides a safe, gentle, and often preferred alternative or powerful adjunct to traditional medical approaches. Its application frequently reduces, or even eliminates, the need for sedatives, anxiolytics, or opioid analgesics during distressing procedures, thereby enhancing safety and simplifying post-procedure recovery[167].

A cornerstone advantage of hypnotherapy in pediatrics is its profound capacity to empower children by teaching them self-regulation strategies. Unlike many passive interventions, hypnosis actively engages the child's internal resources. Through expertly guided imagery, relaxation techniques, and positive suggestions, children learn concrete, transferable skills to manage pain, alleviate anxiety, regulate emotions, and overcome behavioral challenges with growing autonomy[16]. These mastery skills not only promote remarkable resilience during acute illness, chronic disease, or challenging medical procedures but also serve as invaluable, lifelong tools for emotional regulation, stress reduction, and overall well-being. This shift towards an internal locus of control can significantly boost a child's self-efficacy and confidence[54].

Furthermore, pediatric hypnotherapy often proves to be remarkably cost-effective over time. While initial sessions require the expertise of trained professionals and a dedicated time investment, the long-term benefits can lead to substantial financial savings. This includes a reduced reliance on costly medications, fewer emergency department visits for functional symptoms, decreased need for repeated specialist consultations, and avoidance of expenses associated with sedation for procedures[21]. Moreover, teaching children self-hypnosis or providing access to guided audio recordings extends the therapeutic benefits with minimal ongoing expense, making it a highly sustainable intervention[168]. A 2002 comparative study by Lang and Rosen[169] found that using adjunct self-hypnotic relaxation with sedation during outpatient interventional radiologic procedures significantly reduced costs compared to standard sedation alone. Their analysis revealed an average saving of $338 per case with hypnosis, costing$300 vs $638 for standard sedation. This cost-effectiveness held true even if hypnosis extended procedural room time, highlighting its economic benefit in these settings.

Crucially, the very process of hypnosis inherently enhances the therapeutic relationship between the child and the healthcare provider. Pediatric hypnotherapists must cultivate a strong foundation of rapport and trust, utilizing empathy, creativity, and genuinely child-centered communication[30]. This collaborative and supportive dynamic fosters a profound sense of safety and connection, which is paramount in pediatric care. Such a positive bond not only deepens therapeutic engagement and compliance with medical recommendations but also positively influences broader health outcomes by significantly reducing procedural fear, increasing adherence to necessary medical care, and mitigating the potential for medical trauma[170]. Finally, hypnotherapy's inherent child-friendliness and adaptability are distinct benefits. It leverages a child's natural capacity for imagination, storytelling, and play, making the therapeutic process engaging and non-threatening. This adaptability allows therapists to tailor interventions to individual developmental stages, cognitive styles, and personal interests, maximizing receptiveness and efficacy across a diverse range of conditions and ages[132]. Taken together, these multifaceted advantages firmly position clinical hypnosis as a powerful, versatile, child-affirming, and increasingly indispensable tool within modern, holistic pediatric practice.

Challenges and limitations in pediatric hypnotherapy

Despite its growing recognition and demonstrated value as a powerful tool in pediatric care, the broader clinical application of hypnosis faces several significant challenges and inherent limitations that can hinder its widespread implementation and acceptance. Addressing these obstacles is crucial for unlocking its full potential[171]. One of the most significant barriers is the lack of widespread specialized training and accessibility to qualified practitioners. Certified pediatric hypnotherapists are relatively few, and comprehensive hypnosis training is not routinely or adequately included in standard medical, nursing, or psychological curricula[172]. This scarcity creates a critical workforce gap, limiting availability and access, particularly in rural or underserved areas where access to highly trained professionals may be minimal or virtually nonexistent. This geographic disparity disproportionately affects populations already facing healthcare inequities[173].

Another considerable obstacle is the pervasive presence of misconceptions and skepticism surrounding clinical hypnosis, prevalent among both healthcare providers and the public, including families. Popular media often sensationalize and portray hypnosis inaccurately, leading to unfounded concerns about loss of control, manipulation, "mind control", or pseudoscientific practices[174]. These deeply ingrained myths can understandably deter busy clinicians from referring patients or integrating evidence-based hypnotherapy into comprehensive treatment plans. Similarly, such misconceptions can provoke resistance, fear, or anxiety from parents who mistakenly believe that hypnosis is experimental, unproven, or even dangerous[175]. Aggressive and accurate education for both healthcare professionals and caregivers on the evidence-based, therapeutic nature, and safety profile of clinical hypnosis is essential to effectively overcome this fundamental barrier[176].

The inherent variability in individual responses to hypnosis also represents a known limitation. While many children respond remarkably well to hypnotic interventions, some may exhibit lower hypnotizability due to a range of factors. These can include developmental stage (e.g., very young children may have limited imaginative capacity), specific cognitive profiles (e.g., certain neurological differences), personality traits, or the complex nature of the presenting issue[177]. Hypnotherapy is not a universal "cure-all" and its effectiveness can indeed vary significantly between individuals, necessitating a personalized approach and realistic expectations[178].

Parental involvement and informed consent represent another critical layer of complexity unique to pediatric practice. Effective hypnotherapy with children often necessitates consistent collaboration and robust support from parents or primary caregivers, both for providing comprehensive background information to the therapist and, crucially, for reinforcing therapeutic techniques and suggestions outside of formal sessions[21]. In situations where parental understanding, belief, or support is limited, or where significant skepticism or conflicting views exist within the home environment, the continuity and long-term reinforcement of hypnotherapeutic gains can be severely compromised. Additionally, obtaining truly informed consent requires thorough communication to ensure that parents fully comprehend the process, its benefits, and its limitations, which can be time-consuming but essential[179].

Lastly, time constraints in busy clinical settings pose a significant practical challenge. Effective pediatric hypnotherapy requires a calm, unhurried, and comfortable environment that allows sufficient time for building a strong rapport, engaging the child’s imagination deeply, and delivering therapeutic suggestions effectively[30]. In the fast-paced, high-volume environment of many modern healthcare settings, particularly in acute care units, bustling outpatient clinics, or general pediatric practices, carving out sufficient dedicated time for a complete hypnotherapy session may be simply not feasible[180]. This underscores the urgent need for greater institutional support, the development of truly integrated care models, and the exploration of brief intervention protocols or accessible home-based practice tools (e.g., recorded sessions, mobile apps) to bridge this gap[26]. Therefore, while clinical hypnosis holds immense promise for revolutionizing aspects of pediatric care, addressing these multifaceted challenges through expanded, high-quality training programs, targeted public and professional education campaigns, rigorous clinical research to further solidify the evidence base, and strategic structural support within healthcare systems will be absolutely essential for maximizing its impact, ensuring equitable accessibility, and ultimately integrating it as a mainstream, accepted, and highly valued therapeutic modality.

Current guidelines and training in pediatric hypnotherapy

The effective, ethical, and safe use of clinical hypnosis in pediatric populations is unequivocally predicated on rigorous training, professional certification, and unwavering adherence to established guidelines. As the evidence base for pediatric hypnotherapy expands, so too does the emphasis on formalizing its educational and regulatory frameworks to ensure competent and responsible practice.

**Certification and accreditation ** To guarantee that clinicians are equipped with the specialized skills and ethical framework necessary for safe and effective practice, multiple reputable professional bodies offer comprehensive certification and accreditation programs. Notably, leading organizations such as the American Society of Clinical Hypnosis, the Society for Clinical and Experimental Hypnosis, and the Society of Psychological Hypnosis (APA Division 30) provide structured, multi-level training pathways[181]. These programs typically encompass extensive didactic education, rigorous supervised clinical practice, and thorough competency evaluations. Increasingly, these accreditation programs are integrating specific pediatric-focused modules, recognizing the unique developmental considerations and ethical nuances involved in working with children[182]. Such training emphasizes evidence-based practice, developmental appropriateness, the critical process of informed consent (involving both the child and guardians), and foundational ethical principles. Participation in these accredited programs ensures that practitioners possess the theoretical knowledge, practical skills, and ethical grounding required to deliver high-quality, safe, and effective hypnotherapy to pediatric patients[183].

Role of pediatricians, psychologists, and therapists

In the practical landscape of clinical practice, an array of healthcare professionals play pivotal roles in both delivering and coordinating hypnotherapy interventions for children. Pediatricians, particularly those specializing in developmental-behavioral pediatrics, pain management, or integrative medicine, often serve as the crucial "gatekeepers" or initial points of contact[79]. Their role involves identifying appropriate candidates for hypnotherapy, providing preliminary education to families, and making informed referrals to trained specialists. Clinical psychologists and licensed therapists with specific specialization and certification in pediatric hypnosis are typically the primary direct providers of hypnotherapy[7]. Their extensive expertise in behavioral strategies, developmental psychology, nuanced communication with children, and psychological assessment makes them ideally suited to conduct the in-depth therapeutic sessions. Beyond these core providers, other allied health professionals such as nurses, child life specialists, occupational therapists, and even physical therapists who have received specialized training in hypnotic communication and brief hypnotic techniques can contribute meaningfully to integrated care, especially in dynamic hospital settings, outpatient clinics, or rehabilitation centers[183]. They can utilize hypnotic principles for pain distraction, anxiety reduction during procedures, or to enhance cooperation with physical therapies.

Importance of multidisciplinary collaboration

The paramount importance of multidisciplinary collaboration in pediatric hypnotherapy cannot be overstated. Hypnotherapy is most effective and truly transformative when seamlessly integrated into a comprehensive, holistic care model that includes active input and coordination from all relevant medical, psychological, educational, and familial stakeholders[180]. For instance, consider a child undergoing hypnotherapy for chronic pain or anxiety associated with a complex chronic illness like IBD or cancer[3]. Their therapeutic journey benefits immensely from continuous communication and coordination among the treating pediatrician or subspecialist, the primary mental health professional (hypnotherapist), the school counselor or educational support team, and the child's family[21]. This highly collaborative approach ensures that hypnotherapy aligns perfectly with broader medical treatment goals, that therapeutic messages and strategies are consistently reinforced across different environments (clinic, home, and school), and that all team members work synergistically towards the child's overall well-being. Such integrated care models not only optimize clinical outcomes but also foster a more supportive and coherent environment for the child and their family[184].

As clinical awareness and the evidence base continue to expand, there is a growing trend towards embedding foundational hypnosis training into medical and psychology residency programs and incorporating it into continuing professional development curricula for various healthcare disciplines[185]. Ensuring that a broader spectrum of healthcare providers across diverse specialties has access to standardized, high-quality, and pediatric-focused hypnosis training will be absolutely key to significantly expanding its safe, ethical, and effective utilization within mainstream clinical settings[16].

Future directions and research gaps in pediatric hypnotherapy

Despite the compelling and growing body of evidence supporting the efficacy of pediatric hypnotherapy across various clinical domains, several important areas remain critically underexplored. These represent significant opportunities for future advancement, research, and broader implementation, ultimately aiming to solidify hypnotherapy's role within mainstream pediatric care[4].

One of the most pressing and foundational needs is the conduct of large-scale, methodologically rigorous RCTs. While numerous smaller studies, controlled trials, and extensive case series have consistently demonstrated promising and often remarkable outcomes, especially in functional somatic disorders, chronic pain management, and procedural anxiety, broader and more robust RCTs are essential[186]. These trials are crucial not only to definitively validate efficacy across diverse pediatric populations and clinical settings but also to establish standardized treatment protocols, explore optimal dosages (e.g., number and frequency of sessions), and enhance the generalizability of the findings. Such high-quality research is fundamental for achieving wider acceptance, informing clinical guidelines, and securing reimbursement from healthcare systems[187].

Another critical future direction is the systematic integration of hypnotherapy training into core pediatric residency, fellowship, and allied health professional programs. Currently, formal instruction in clinical hypnosis remains highly limited, often confined to elective workshops, specialized continuing medical education courses, or post-graduate certifications. Embedding comprehensive, developmentally appropriate hypnosis training into standard medical and psychological curricula would not only dramatically increase provider familiarity and competency but also play a pivotal role in overcoming long-standing skepticism by firmly grounding the modality in scientific rigor and clinical relevance[188]. Early and widespread exposure could cultivate a new generation of clinicians who are inherently comfortable offering or confidently referring for hypnosis as a fundamental component of a multimodal, integrative care approach. This also entails developing clear competencies and learning objectives specifically for pediatric applications.

Technological innovation offers expansive and exciting avenues for future expansion, particularly through the development and validation of telehypnosis platforms and sophisticated digital therapeutic interventions[189]. The global coronavirus disease 2019 pandemic unequivocally underscored the feasibility, safety, and widespread acceptance of virtual care delivery[190]. Preliminary efforts in telehypnosis, where guided sessions are delivered effectively via secure video conferencing platforms, have already shown immense promise in terms of accessibility and efficacy, especially for families in remote areas or those with mobility challenges[191]. Moreover, the creation of rigorously evidence-based mobile applications, immersive VR tools, and interactive gamified programs tailored explicitly to pediatric hypnosis could revolutionize accessibility, ensure standardized and high-quality delivery, and profoundly appeal to digitally native children and adolescents[192]. These technologies could facilitate self-hypnosis practice, provide instant coping strategies, and offer engaging content that enhances therapeutic engagement and adherence.

Furthermore, a significant research gap lies in comprehensively investigating the long-term effects and the robust cost-effectiveness of pediatric hypnotherapy. While acute benefits are well-documented, studies examining whether early hypnotherapy interventions result in sustained symptom improvement, durable reductions in medication reliance (e.g., for pain or anxiety), fewer emergency department visits, decreased hospitalizations, or significantly improved psychosocial functioning over extended periods (months to years) are critically needed[193]. Rigorous economic analyses would be invaluable in demonstrating that while hypnosis may require an initial investment of time and resources, its downstream benefits-such as improved treatment adherence, significantly reduced procedural distress, enhanced patient empowerment, and decreased overall healthcare utilization-can translate into substantial and meaningful cost savings for families, healthcare systems, and society at large. These economic arguments are crucial for advocating for policy changes and broader reimbursement models[5].

Ultimately, future research should also focus on identifying predictors of responsiveness to hypnotherapy in pediatric populations, enabling more precise patient selection and personalized treatment approaches. Investigating the neurobiological mechanisms underlying hypnotherapy's effects in children, perhaps through neuroimaging or psychophysiological measures, could further legitimize the field and unlock new therapeutic targets. Additionally, exploring the application of hypnotherapy in newer or less-studied pediatric conditions with significant psychological components could reveal untapped potential[194]. Therefore, while pediatric hypnotherapy already holds great promise and is increasingly supported by evidence, continued, dedicated, and innovative research, coupled with strategic efforts to integrate training and leverage technological advancements, are vital to optimize its delivery, expand its reach, and unequivocally solidify its rightful role as a central, accepted, and highly effective modality within mainstream pediatric healthcare.

Limitations

Despite the promising findings and expanding clinical use of hypnotherapy in pediatric medicine, this review acknowledges several limitations that affect both the current literature and the broader integration of hypnosis into routine pediatric care. Firstly, while many studies support the efficacy of clinical hypnosis across a wide range of pediatric conditions, the overall evidence base remains heterogeneous. Variability in study design, small sample sizes, lack of standardized protocols, and differing outcome measures limit the generalizability and comparability of results. Although RCT exist for certain conditions-such as procedural pain and functional abdominal disorders-many other indications rely heavily on observational studies, case series, or expert consensus. This imbalance in the level of evidence across domains calls for more large-scale, methodologically rigorous studies to establish more straightforward guidelines and protocols.

Secondly, hypnotizability varies widely among individuals, and multiple factors, including age, developmental level, personality traits, and prior exposure to stress or trauma, influence children’s responsiveness to hypnosis. While this individual variability can sometimes be leveraged therapeutically, it also complicates efforts to predict treatment success and develop universally applicable interventions. Another challenge lies in accessibility and training. There is a shortage of clinicians-particularly pediatricians and child psychologists-with formal training in clinical hypnotherapy, and existing certification programs are not yet integrated into most pediatric residency or fellowship curricula. This results in a bottleneck in service availability, especially in underserved areas. Additionally, misconceptions about hypnosis persist among both healthcare providers and the general public, often fueled by media portrayals of stage hypnosis. These misconceptions contribute to skepticism, hesitation, and underutilization of a potentially valuable therapeutic tool.

Parental involvement, although generally beneficial, can sometimes serve as a barrier to using hypnotherapy for child management. Some parents might be hesitant to consent to hypnosis because of cultural beliefs, unfamiliarity, or concerns about safety or control. This highlights the need for improved public education and enhanced clinician confidence when discussing hypnotherapy as part of integrated pediatric care. Lastly, time constraints in busy clinical settings may make it hard to incorporate hypnosis into routine care. While brief interventions and self-hypnosis training can be effective, initial sessions need dedicated time, a calm environment, and specialized skills-all of which can be difficult to allocate in fast-paced or resource-limited healthcare systems. Recognizing these limitations is essential to guiding future research, clinical training, and policy development. Addressing them through targeted educational initiatives, standardized treatment frameworks, and robust clinical trials will be critical in advancing the safe and effective use of pediatric clinical hypnotherapy on a broader scale.

CONCLUSION

Clinical hypnosis represents a promising, non-pharmacological intervention in pediatric medicine, harnessing children’s natural imaginative abilities and capacity for focused attention. Evidence indicates potential benefits across a range of conditions-including pain management, functional somatic syndromes, anxiety disorders, dermatological conditions, and supportive care in chronic illness-while also fostering self-regulation and resilience. However, the strength of evidence varies considerably, with robust support in some areas (e.g., acute pain, anxiety) but more limited or preliminary data in others. Barriers such as limited clinician training, misconceptions among healthcare providers and families, and variability in individual responsiveness continue to constrain its broader adoption. To establish hypnosis as a reliable component of integrative pediatric care, further large-scale, RCTs, standardized treatment protocols, and long-term outcome studies are essential. Incorporating hypnotherapy into pediatric training curricula and exploring innovative delivery models such as telehypnosis may expand accessibility. At present, clinical hypnosis should be regarded as a safe and potentially valuable adjunct, but its definitive role in pediatrics remains to be fully determined.