Clinical hypnosis in pediatric care: An adjunctive tool or therapeutic illusion

Table 5 Clinical applications of hypnotherapy in pediatric and adolescent health: A comprehensive evidence-based overview

Condition treated	Age group	Ref.	Method used	Outcome measures	Efficacy	Level of evidence
Pain (acute & chronic, including procedural pain)	5+ years, often up to adolescence	Chester et al[47], Kendrick et al[49], Miller et al[51]	Guided imagery, relaxation, direct suggestion, self-hypnosis training	Pain intensity (self-report, behavioral observation), anxiety, distress, need for analgesia, hospital stay duration	Significant reduction in pain, anxiety, and distress; reduced need for medication; shorter hospital stays. Often superior to standard care/other psychological interventions	RCTs, meta-analyses, systematic reviews
Pediatric headache	Children & adolescents (mean approximately 13 years) with recurrent headaches	Kohen and Zajac[61]	Self-hypnosis training for self-regulation	Headache frequency, intensity, duration	Frequency reduced from 4.5/week to 1.4/week; intensity from 10.3 to 4.7; duration from 23.6 hours to 3 hours; P < 0.01	Level III (retrospective cohort)
	9-18 years with primary headaches (migraine, tension-type)	Jong et al[62]	Randomized trial: Hypnotherapy vs transcendental meditation vs progressive muscle relaxation	≥ 50% reduction in headache frequency; pain coping; anxiety/depression	All groups improved; approximately 47% achieved ≥ 50% reduction at 9 months; no significance difference between interventions	Level I (randomized controlled trial)
	Children & adolescents with unspecified chronic/episodic headaches	Gysin[63]	5-session hypnosis/self-hypnosis vs behavioral therapy	Frequency, intensity, sense of control	Hypnosis showed superior improvements in symptom control and self-regulation	Level II (comparative trial)
	Mean age of 15 years of children with stress-associated headaches	Anbar and Zoughbi[64]	Hypnosis + relaxation & imagery; insight exploration	Frequency/intensity change; relation to stressor type	96% improved overall; insight generation improved outcomes in patients with fixed stressors	Level III (retrospective chart review)
	Adolescents with chronic daily headache	Kohen[65]	Tailored self-hypnosis instruction	Frequency, intensity, duration	Notable symptom reduction in cases unresponsive to other therapies	Level IV (case reports)
IBS & FAP	School-age children, adolescents (e.g., 5-18 years)	Rutten et al[68], Vlieger et al[70], Vlieger et al[72]	Gut-directed hypnotherapy, self-hypnosis training (individual or group sessions, sometimes home-based eHealth)	Abdominal pain severity/frequency, adequate pain relief, quality of life, daily functioning, school absence, somatization	Significant reduction in pain, improved quality of life; often superior to standard medical treatment, with long-term improvements sustained at follow-ups	RCTs, cohort studies, systematic reviews
Nocturnal enuresis (bedwetting)	8-13 years	Edwards and van der Spuy[77]	6 standardized hypnotherapy sessions over 6 weeks	Decrease in enuretic episodes over 6 months	Significantly effective compared to no-treatment controls; trance induction not essential	Controlled clinical trial
	7-12 years	Seabrook et al[76]	Hypnotherapy with nightly audiotapes vs alarm therapy (RCT)	Success (14 dry nights), failure, relapse, self-esteem measures	Alarm therapy more effective (55.3% vs 19.4% success); hypnotherapy had lower relapse (non-significant)	RCT
Anxiety disorders (general anxiety, dental anxiety, phobias)	5-17 years	Minosh et al[81]	Hypnotherapy by trained nurse practitioner, long-term follow-up	Parent/child subjective rating (1-5 scale)	55% of anxiety cases rated good-to-excellent; no adverse effects reported	Prospective pilot study
	6-10 years	Erappa et al[82]	Hypnosis vs acupressure vs audiovisual distraction	PR, RR, AR	All methods effective, but hypnosis most significant in reducing PR, RR, and AR	Randomized controlled trial
	5-7 years	Girón et al[83]	Hypnosis vs tell-show-do	FLACC scale, heart rate, skin conductance	Significantly lower anxiety and pain in hypnosis group across all measures	Randomized controlled trial
	3-12 years	Rienhoff et al[84]	Hypnosis + low-dose midazolam (0.4 mg/kg)	Venham score (behavior) & Wong-Baker scale	Good compliance; effective for short-term use. Slight decline in behavior over repeated sessions	Retrospective longitudinal observational study
Sleep disorders	7-17 years with Insomnia (sleep onset delay, nocturnal awakenings)	Anbar and Slothower[86]	Retrospective chart review, self-hypnosis training	Sleep onset latency, frequency of awakenings, somatic complaints	90% improved sleep-onset latency; 52% resolution & 38% improvement in nocturnal awakenings; 87% improvement in related somatic symptoms	Level III (retrospective study)
	8-12 years sleep problems post-trauma (grief/Loss-related)	Hawkins and Polemikos[87]	Qualitative group-based hypnotherapy, self-hypnosis	Caregiver interviews, Southampton sleep management schedule	All participants learned self-hypnosis; qualitative improvement in sleep initiation and sleep-related anxiety reported by children and caregivers	Level IV (qualitative study)
	8-12 years with sleep terror disorder/disorders of arousal	Kohen et al[88]	Case series: Self-hypnosis training ± imipramine	Polysomnography, symptom frequency, long-term follow-up	All 4 children in case report became asymptomatic over 2-3 years; similar success in 7 more patients treated with hypnosis alone	Level IV (case series)
Habit disorders (e.g., habit cough, tic disorders, trichotillomania)	8-year-old child with habit cough (case study)	Anbar[96]	Self-hypnosis; flexible rapport-building approach	Resolution of persistent cough	Rapid and complete symptom resolution in 1 session	Level IV (case report)
	6-17 years (n = 33) with Tics (Tourette syndrome)	Lazarus and Klein[94]	Self-hypnosis + videotaped training	Tic control via subjective report over 6 weeks	79% showed improvement; 96% responded within 3 visits	Level IV (retrospective case series)
	8-12 years (n = 4) with Tourette syndrome	Kohen and Botts[95]	Self-hypnosis (relaxation + imagery)	Tic frequency, medication reduction	Immediate and sustained improvement; reduced/ceased medication	Level IV (case series)
	6-15 years (n = 5) with trichotillomania	Kohen[98]	Self-monitoring, dissociative techniques, self-hypnosis	Symptom resolution and behavior control	All children achieved control with individualized techniques	Level IV (case series)
	7 years (case study) with thumb sucking	Grayson[97]	Hypnotic imagery, role-modeling, validation in trance	Cessation of habit	Successful resolution in one session	Level IV (case report)
ASD	5-10.99 years with GI symptoms, anxiety, and behavior in ASD with DGBI	Mitchell et[102]	Synbiotics alone vs synbiotics + GDHT, 12-week RCT	GI scores, anxiety levels, irritability behaviors, microbiota composition	GDHT group showed significant reductions in GI pain, anxiety, and irritability; synbiotics helped both groups	Level II (randomized controlled trial)
	6-year-old child with atypical autism & severe ego deficits	Gardner and Tarnow[103]	Adjunctive hypnotherapy with music integration	Specific behavior change, social/cognitive skill improvement	Behavioral goals achieved; sustained gains at 18-month follow-up	Level IV (case report)
	6-12 years (approximately) who need dental cooperation and hyperactivity in ASD	Sartika et al[104]	Hypnotherapy before dental scaling (quasi-experimental)	Cooperative attitude, calculus index	Significant improvement in cooperation and reduction in calculus (P = 0.000)	Level III (Quasi-experimental design)
	14-15 years with engagement, anxiety, attention in ASD	Austin et al[105]	Virtual reality hypnosis (4 sessions, feasibility study)	Engagement, parental reports on behavior and anxiety	No change in autistic symptoms, but improved engagement and relaxation; parental satisfaction noted	Level V (feasibility/pilot study)
ADHD	Children (mean age approximately 10) with ADHD	Calhoun and Bolton[100]	Hypnotherapy by psychologists/physicians; attempts to hypnotize 11 children, 1 completed full session	Pre- and post-hypnosis behavioral observations	Significant improvement in behavior in the successfully hypnotized child	Low (small sample, non-randomized)
	Children (median age 122) with low self-esteem in ADHD, epilepsy, anxiety	Hazard et al[112]	Standardized hypnosis protocol, single therapist, prospective single-center study	Self-esteem measured via Jodoin 40 scale, Piers-Harris self-concept scale, and self-rated score	Statistically significant improvement in self-esteem (P ≤ 0.05), no side effects	Moderate (pilot exploratory study)
	11-year-old child with ADHD & written language disorder	Hery-Niaussat et al[113]	SCED, 4 hypnosis sessions over 8 weeks	Reading tests, phonological processing, attention, self-esteem	Statistically significant improvement in text reading (P = 0.028), attention (P = 0.031), and self-esteem (P = 0.002)	Moderate (SCED, but detailed measures)
Oncology support	Children (3 cases, female) with cancer-related anxiety	Talebiazar et al[121]	Classical hypnotherapy, 8 sessions with 1-month follow-up	HADS at 5 time points	Significant reduction in hospital anxiety during and after intervention	Level 4 (case report)
	Children (11-17 years) with Cancer-related distress & QoL	Grégoire et al[120]	Hypnosis-based group intervention with monthly 2-hour sessions	Self-reported emotional well-being, relaxation, assertiveness, and parent-child communication	High acceptability; perceived improvement in quality of life, emotional regulation, and family coping	Level 3 (pilot/quasi-experimental)
	Children and adolescents (0-25 years) with cancer and had Procedural anxiety & pain in	Nunns et al[118]	Meta-analysis of RCTs, 8 hypnosis studies included	Procedural anxiety, fear, distress, and pain	Large, statistically significant reductions in procedural anxiety (d = 2.30) and pain (d = 2.16)	Level 1a (meta-analysis of RCTs)
	CINV	Richardson et al[119]	Meta-analysis of 6 RCTs (5 in pediatric population)	Frequency/severity of anticipatory and acute CINV	Statistically significant reduction in anticipatory and acute CINV; effect comparable to CBT	Level 1a (meta-analysis of RCTs)
Asthma	Children with chronic asthma	Alexander et al[128]	Relaxation training (5 sessions after control phase)	Pulmonary function, muscle tension, heart & respiratory rates, skin conductance	No significant improvement in pulmonary function; relaxed state achieved	Level III (quasi-experimental, physiological measures)
	Pediatric to adolescent age (exact age not specified)	Morrison[127]	Hypnotherapy over 1 year	Hospital admissions, medication use, airflow, patient-reported improvement	Reduced admissions, reduced drug use, improved perceived symptoms; variable objective airflow	Level II (controlled clinical trial, small sample)
	Pediatric (age varied across 251 RCTs)	Moher et al[129]	Systematic review of CAM RCT reporting (including hypnosis and relaxation interventions)	CONSORT adherence, Jadad score, allocation bias, adverse event reporting	Revealed poor methodological quality and underreporting in pediatric CAM RCTs	Level I (systematic review of RCTs -methodology focus)
	8-18 years with chronic dyspnea (non-organic)	Anbar[125]	Self-hypnosis instruction (1-2 sessions) with follow-up	Dyspnea frequency/severity, associated symptoms, self-reported resolution, treatment withdrawal	13/16 resolved within 1 month; 11/16 attributed improvement to hypnosis; no recurrence during follow-up	Level IV, retrospective chart review; small number, good follow-up
Cystic fibrosis	7-18 years	Belsky and Khanna[134]	Self-hypnosis (pilot RCT with matched control)	Locus of control, trait anxiety, self-concept, peak expiratory flow rate	Significant psychological and physiological improvements in the experimental group vs control	Level II (small RCT with limitations)
	7-49 years (mean 18.1)	Anbar[122]	Self-hypnosis taught in 1-2 sessions, patient-reported outcomes	Symptom control (pain, headache, taste of medication), self-reported efficacy	86% success rate; no adverse effects; high subjective benefit	Level IV (case series with self-report and no control)
Inflammatory bowel disease (IBD)	12-65 years with IBS-type symptoms in IBD	Hoekman et al[137]	Gut-directed hypnotherapy (RCT)	≥ 50% reduction in IBS-SSS score at 6 months	No superiority over standard medical treatment	Level I (RCT)
	Adolescents (mean age 158) with Crohn’s disease	Lee et al[138]	1 session CH + self-hypnosis (RCT pilot)	QoL, abdominal pain, school absences	Improved parent-reported QoL & pain reduction	Level II (pilot RCT)
	10-17 years with IBD	Shaoul et al[139]	4-12 sessions tailored hypnosis	Symptom resolution, reduced inflammatory markers	Symptom resolution in most cases; well-tolerated	Level IV (case series)
	Adults with UC-active	Mawdsley et al[140]	1 session gut-focused hypnosis	IL-6, SP, IL-13, rectal blood flow	Significant reduction in inflammatory markers	Level II (controlled physiological study)
	Adults with UC- quiescent	Keefer et al[141]	7 sessions of gut-directed hypnotherapy vs control	Relapse rate over 1 year	68% maintained remission vs 40% in control	Level I (RCT)
Atopic dermatitis	Adults & children	Stewart and Thomas[164]	Hypnotherapy; individualized sessions	Subjective (patient reports), objective clinical assessments, long-term follow-up	Significant immediate and sustained improvement in itching, sleep disturbance, and mood (P < 0.01); maintained up to 2 years	Level II (Quasi-experimental study with control, non-randomized)
	Adults (mean age: 34.5 years)	Delaitre et al[165]	Hypnosis (mean of 6 sessions, range 2-16)	EASI score before and after intervention	Improvement/resolution in 26 of 27 patients; mean EASI score reduced from 12 to 2.8	Level III (prospective clinical cohort without control group)
	Children (> 5 years)	Derrick et al[166]	Self-hypnosis using guided imagery	Clinical assessment of eczema symptoms over 18 weeks	Mild-to-moderate benefit observed; did not reach statistical significance	Level IV (Pilot study; no control group, low statistical power)
Viral warts	Adult women with HPV-related genital warts	Barabasz et al[156]	Hypnosis vs standard medical therapy	Number and size of lesions; complete clearance at 12 weeks	Statistically significant reduction in lesions with hypnosis (P < 0.04); complete clearance 5 × more likely in hypnosis group than medical therapy	Level II (randomized controlled clinical trial)
	Adults with common warts (cutaneous)	Spanos et al[154]	Hypnotic suggestion vs placebo vs no treatment	Wart regression rates; vividness of imagery	Hypnosis and suggestion led to greater wart regression than placebo or no treatment; imagery vividness predicted better outcomes	Level II (experimental controlled design)
	Adults with common warts (cutaneous)	Spanos et al[155]	Hypnosis, salicylic acid, placebo, no treatment	Wart count at 6-week follow-up	Only hypnosis group had significantly more wart regression vs control; equal treatment expectation across all groups	Level I (randomized controlled trial)

This table summarizes the clinical use of hypnotherapy across a variety of pediatric and adolescent conditions. It includes the condition treated, the age group, authors and year of publication, methodology, outcome measures, clinical efficacy, and the level of evidence as defined by standard evidence hierarchies. Level of evidence follows a simplified hierarchy. Level I: Systematic review/meta-analysis of randomized controlled trial (RCTs); level II: Single RCT or controlled clinical trial; level III: Quasi-experimental studies or non-randomized designs, and level IV-V: Case reports, expert opinion, or descriptive studies. AD: Atopic dermatitis; ADHD: Attention-deficit/hyperactivity disorder; AR: Anxiety rating; ASD: Autism spectrum disorder; CAM: Complementary and alternative medicine; CBT: Cognitive behavioral therapy; CINV: Chemotherapy-induced nausea and vomiting; DGBI: Disorders of gut-brain interaction; EASI: Eczema area and severity index; FAP: Functional abdominal pain; FLACC: Face, legs, activity, cry, consolability pain assessment scale; GI: Gastrointestinal; HADS: Hospital Anxiety and Depression Scale; HPV: Human papillomavirus; IBS: Irritable bowel syndrome; IBS-SSS: Irritable bowel syndrome severity scoring system; IL-6: Interleukin-6; IL-13: Interleukin-13; PR: Pulse rate; QoL: Quality of life; RCT: Randomized controlled trial; RR: Respiratory rate; SCED: Single-case experimental design; SP: Substance P; UC: Ulcerative colitis.