Review of a Workshop conducted by Dr. Leora Kuttner, Pediatric Clinical Psychologist & Clinical Professor of Pediatrics BC Children's Hospital and University of British Columbia, Vancouver, Canada, At the Child Life Conference in Nashville, Tennessee, U.S.A.., June 2005.
"Hypnosis is an ideal therapy for children and teens, "says Dr. Kuttner. She defines it as "An alternative state of awareness, often but not always involving relaxation, in which an individual develops heightened concentration through which suggestions are accepted that allow use of natural mental and physical skills to optimal levels. "All humans and particularly children have the capacity to use the imaginative process to bring changes in behaviour, belief and feelings and free themselves from dysfunctional responses and to relieve pain. This process bypasses critical reasoning by utilizing creativity, imagination and playfulness. The child's perceptions and sensations are enhanced and changed. Muscles relax, there is a change in the respiratory pattern, a change in the pulse, decreased tone, eye closure in older children and adults and sometimes drooling. As early as the 18th century Hypnosis was the subject of research: The Austrian Franz Anton Mesmer, 1766. Self-hypnosis proved effective with injured soldiers during the two world wars. Due to the work of Drs Ernest & Josephine Hilgard of Stanford University, Hypnosis was recognized by the American Medical Association in 1955. It is immensely helpful with pediatric patients affected by anxiety, sleep difficulties, acute, recurring and chronic pain, however it is contra-indicated for children with surgery pending, with a low-IQ, brain-damage or with the fragile, psychotic child.
Children facing distressing experiences turn to adults they can trust. Prediatric hypnosis started when mother said she would kiss the skinned knee and make it better. When the parent or clinician uses hypnotic language-words that invite the child to enter the experience such as ":How would you like to ---" rather than "I want you to ---" the child feels he has some control and his self-control and coping skills increase. The adult should speak at the child's level and interests and get involved in the imagery.
One example used a transitional object, a Teddy Bear, to help a sleep disorder. What does Teddy do when he goes to sleep? You hold him the way he likes to be held, don't you? Like this. He feels so cozy. Pat him-He's getting sleepy now. Let his head get comfortable. His arms want to go to sleep too. His eyes are closing. He feels sleepy all over-over-so cozy, so comfortable, so safe, ready to sleep, he's falling into a soft sleep.
Use a child's favorite story to weave a new story. Once there were three little mice. The baby mouse got sick and the Doctor said, "We'll make him better. Bring him to my hospital and ---.
For children aged 3-10, Hypno-analgesia using The Magic Glove dramatically reduces the child's pain and anxiety when a procedure, such as starting an IV, is necessary. Procedure: Explain that you are going to apply the Magic Glove to protect his arm. "You will know what is going on but you won't be bothered. You'll feel some pressure, but it won't bother you. "Use firm strokes over the child's hand, over each finger, up over the wrist, up to the elbow and the upper arm. Stroke firmly but gently, repeating that the glove is going to protect them. Test that the other hand has full sensation with a pencil tip and test the arm with the magic glove. Confirm the difference with the child. Now the IV can be started. When the procedure is finished, remove the glove and test that there is no longer a sensation difference.
Studies cited included research involving self-hypnosis vs. Propranolol in the treatment of Juvenile Classic Migraine using single blind placebo, cross-over design. Thirty-three children aged 6-12 yrs. with more than four headaches per month were studied. In three months children on the placebo had 13.3 headaches, on Propranolol had 14.9 headaches and using self-hypnosis had 5.8 headaches.
Children were able to self-regulate body processes previously believed not subject to voluntary control such as enuresis. Kohen et al (1984) -reviewed data for 257 children with enuresis treated at Behavioral Pediatrics Program at Minneapolis Children's Medical Centre, Minnesota, U.S.A. - 44% achieved complete dryness, 31% significantly improved. Banerjee, Srivstav & Palan (1993) comparison of treatment with hypnotherapy to treatment with imipramine in 2 groups of children with enuresis (25 in each group, 5-16 yrs.) After 3 months treatment 76% on imipramine and 72% on hypnosis achieved positive results.
Hypnotic language that conveys support, hope, love, courage, energy, affection and promises some release from suffering helps children let go of their fear and pain. It involves attentive listening. When children discover that a worrisome or painful experience is made less troubling, the child's feeling of mastery is enhanced. There is less dependence upon drugs and restraints. Dr. Kuttner said in closing, "No other psychological tool is so efficacious in creating comfort out of discomfort with none of the adverse side effects."
REFERENCES
Olness K. Hypnosis and hypnotherapy with children. New York: Guilford Press, 1996
Kuttner, L. Pain Management in Children. Child and Adolescent Psychiatric Clinics of North America 1997; 6(4): 783-796
Sugarmann. L.I. Hypnosis in a primary care practice: developing skills for the "new morbidities" J Dev & Behav Pediatrics 1996; 17(5):300-5
Kuttner L. Helpful strategies in working with pre-school children in pediatric practice. Pediatr Annals 1991; Vol 20; 3; March 120-127
Kuttner L. A Child in Pain (A guide for parents) Hartley & Marks Publishers, Inc. 1996. Second Printing by Dr. L. Kuttner, 2004
Kuttner L. "No Fears, No Tears: Children with cancer coping with pain" 17 min. Fanlight Productions. 800-937-4113. Fax: 617-469-3379. 4196 Washington Street, Suite 2, Boston MA 02131
Kuttner L. "No Frears, No Tears - 13 Years Later (1998). 46 minute videotape Fanlight Productions. 800-937-4113. Fax: 617-469-3379
COURSES
For courses in Hypnosis contact Society for Developmental and Behavioral Pediatrics at www.sdbp.com
"Hypnosis is an ideal therapy for children and teens, "says Dr. Kuttner. She defines it as "An alternative state of awareness, often but not always involving relaxation, in which an individual develops heightened concentration through which suggestions are accepted that allow use of natural mental and physical skills to optimal levels. "All humans and particularly children have the capacity to use the imaginative process to bring changes in behaviour, belief and feelings and free themselves from dysfunctional responses and to relieve pain. This process bypasses critical reasoning by utilizing creativity, imagination and playfulness. The child's perceptions and sensations are enhanced and changed. Muscles relax, there is a change in the respiratory pattern, a change in the pulse, decreased tone, eye closure in older children and adults and sometimes drooling. As early as the 18th century Hypnosis was the subject of research: The Austrian Franz Anton Mesmer, 1766. Self-hypnosis proved effective with injured soldiers during the two world wars. Due to the work of Drs Ernest & Josephine Hilgard of Stanford University, Hypnosis was recognized by the American Medical Association in 1955. It is immensely helpful with pediatric patients affected by anxiety, sleep difficulties, acute, recurring and chronic pain, however it is contra-indicated for children with surgery pending, with a low-IQ, brain-damage or with the fragile, psychotic child.
Children facing distressing experiences turn to adults they can trust. Prediatric hypnosis started when mother said she would kiss the skinned knee and make it better. When the parent or clinician uses hypnotic language-words that invite the child to enter the experience such as ":How would you like to ---" rather than "I want you to ---" the child feels he has some control and his self-control and coping skills increase. The adult should speak at the child's level and interests and get involved in the imagery.
One example used a transitional object, a Teddy Bear, to help a sleep disorder. What does Teddy do when he goes to sleep? You hold him the way he likes to be held, don't you? Like this. He feels so cozy. Pat him-He's getting sleepy now. Let his head get comfortable. His arms want to go to sleep too. His eyes are closing. He feels sleepy all over-over-so cozy, so comfortable, so safe, ready to sleep, he's falling into a soft sleep.
Use a child's favorite story to weave a new story. Once there were three little mice. The baby mouse got sick and the Doctor said, "We'll make him better. Bring him to my hospital and ---.
For children aged 3-10, Hypno-analgesia using The Magic Glove dramatically reduces the child's pain and anxiety when a procedure, such as starting an IV, is necessary. Procedure: Explain that you are going to apply the Magic Glove to protect his arm. "You will know what is going on but you won't be bothered. You'll feel some pressure, but it won't bother you. "Use firm strokes over the child's hand, over each finger, up over the wrist, up to the elbow and the upper arm. Stroke firmly but gently, repeating that the glove is going to protect them. Test that the other hand has full sensation with a pencil tip and test the arm with the magic glove. Confirm the difference with the child. Now the IV can be started. When the procedure is finished, remove the glove and test that there is no longer a sensation difference.
Studies cited included research involving self-hypnosis vs. Propranolol in the treatment of Juvenile Classic Migraine using single blind placebo, cross-over design. Thirty-three children aged 6-12 yrs. with more than four headaches per month were studied. In three months children on the placebo had 13.3 headaches, on Propranolol had 14.9 headaches and using self-hypnosis had 5.8 headaches.
Children were able to self-regulate body processes previously believed not subject to voluntary control such as enuresis. Kohen et al (1984) -reviewed data for 257 children with enuresis treated at Behavioral Pediatrics Program at Minneapolis Children's Medical Centre, Minnesota, U.S.A. - 44% achieved complete dryness, 31% significantly improved. Banerjee, Srivstav & Palan (1993) comparison of treatment with hypnotherapy to treatment with imipramine in 2 groups of children with enuresis (25 in each group, 5-16 yrs.) After 3 months treatment 76% on imipramine and 72% on hypnosis achieved positive results.
Hypnotic language that conveys support, hope, love, courage, energy, affection and promises some release from suffering helps children let go of their fear and pain. It involves attentive listening. When children discover that a worrisome or painful experience is made less troubling, the child's feeling of mastery is enhanced. There is less dependence upon drugs and restraints. Dr. Kuttner said in closing, "No other psychological tool is so efficacious in creating comfort out of discomfort with none of the adverse side effects."
REFERENCES
Olness K. Hypnosis and hypnotherapy with children. New York: Guilford Press, 1996
Kuttner, L. Pain Management in Children. Child and Adolescent Psychiatric Clinics of North America 1997; 6(4): 783-796
Sugarmann. L.I. Hypnosis in a primary care practice: developing skills for the "new morbidities" J Dev & Behav Pediatrics 1996; 17(5):300-5
Kuttner L. Helpful strategies in working with pre-school children in pediatric practice. Pediatr Annals 1991; Vol 20; 3; March 120-127
Kuttner L. A Child in Pain (A guide for parents) Hartley & Marks Publishers, Inc. 1996. Second Printing by Dr. L. Kuttner, 2004
Kuttner L. "No Fears, No Tears: Children with cancer coping with pain" 17 min. Fanlight Productions. 800-937-4113. Fax: 617-469-3379. 4196 Washington Street, Suite 2, Boston MA 02131
Kuttner L. "No Frears, No Tears - 13 Years Later (1998). 46 minute videotape Fanlight Productions. 800-937-4113. Fax: 617-469-3379
COURSES
For courses in Hypnosis contact Society for Developmental and Behavioral Pediatrics at www.sdbp.com
