For a small child, an operation is a series of frightening unknowns: a strange building, strangers in masks, being parted from a parent, and a mask placed over the face. The moment of going under anaesthetic is often the worst part of all.
It matters beyond the day itself. Children who are very anxious at this point are more likely to have behaviour changes afterwards: nightmares, clinginess, bedwetting, tantrums, fear of doctors.
The usual approach
Many hospitals give an anxious child a sedative medicine by mouth beforehand, commonly midazolam. It works for many children. It also has drawbacks: it tastes unpleasant, some children become more agitated instead of calmer, and it can delay waking.
So anaesthetists have looked for alternatives, including hypnosis.
The trial
In a French study published in 2005, fifty children aged 2 to 11 who were due to have surgery were randomly assigned to one of two groups:
- Hypnosis as premedication, delivered by the anaesthetist
- Midazolam by mouth, 30 minutes before surgery
Anxiety was scored with a standard scale when the child arrived, on entering the operating theatre, and when the anaesthetic mask was fitted. Parents completed a behaviour questionnaire on days 1, 7 and 14 afterwards.
What it found
At the mask. Fewer children in the hypnosis group were anxious as the anaesthetic was given: 39 per cent, against 68 per cent with midazolam.
Afterwards. Behaviour problems were roughly halved in the hypnosis group:
- Day 1: 30 per cent, against 62 per cent
- Day 7: 26 per cent, against 59 per cent
The authors concluded that hypnosis appeared effective as premedication for children having surgery, easing anxiety at induction and reducing behaviour problems in the days after.
How much weight can it bear?
It was one trial of fifty children in one hospital, so it needs confirming. A Cochrane review of non-drug methods for helping children at induction of anaesthesia has looked at this field as a whole, and the evidence for most approaches is limited.
Still, the result fits with a large body of research showing that children respond well to hypnosis and imagery around medical procedures.
What hypnosis looks like for a child
Nothing formal. For a young child it is absorbing, imaginative play:
- A favourite story, with the child as the hero
- A favourite place: the beach, a football pitch, a den
- A magic journey: flying on a carpet, riding in a spaceship
- The mask as part of the story: an astronaut’s or pilot’s mask, with special air
- Blowing: blowing up an imaginary balloon, or blowing out candles
- Counting or watching something in the story
The anaesthetist talks continuously in a calm, engaging voice, drawing the child’s attention into the story while the anaesthetic is given.
What parents can do
Beforehand
- Tell the truth, simply. “The doctor will give you some special sleep so they can fix your tummy. You won’t feel anything. I’ll be there when you wake up.”
- Do not promise it will not hurt at all, or spring it as a surprise.
- Timing: a few days ahead for a young child, a week or more for an older one.
- Play it through with a toy doctor’s kit and a teddy.
- Read a picture book about going to hospital.
- Visit or watch a video of the ward if the hospital offers it.
- Practise a “special place.” At bedtime, help your child imagine somewhere lovely in detail.
- Practise blowing bubbles or a pretend balloon.
On the day
- Bring a comforter: a soft toy or blanket.
- Bring a tablet or a book for waiting.
- Stay calm yourself. Children read your face. Anxious parents make for anxious children.
- Follow the team’s lead on whether you can be present at induction.
- Use the story. “Shall we go to your special place now?”
- Describe, don’t dramatise. “You’ll smell some funny air” works better than “Don’t be scared.”
Afterwards
- Expect some clinginess or disturbed sleep for a few days.
- Let them play out what happened.
- Praise how they coped.
- Speak to your doctor if changes last more than a couple of weeks.
Words that help and words that do not
| Instead of | Try |
|---|---|
| “Don’t be scared.” | “You’re doing really well.” |
| “It won’t hurt.” | “You might feel a little squeeze.” |
| “It’ll be over soon.” | “Let’s blow up that balloon together.” |
| “Be brave.” | “Hold my hand and tell me about your den.” |
Ask the hospital
- Is there a play specialist? Many children’s wards have one.
- What does the team do to help anxious children?
- Can a parent come to the anaesthetic room?
- Is a sedative likely, and what are the options?
Tell them if your child is very anxious or has had a bad experience before.
The bottom line
A child’s fear before an operation is worth taking seriously, because it affects how they are afterwards. Stories, imagination and a calm parent are powerful, and one trial suggests hypnosis can do as well as a sedative, or better.
Next in the series: Hypnosis for Sleepwalking, Night Terrors and Nightmares
This article is for general information and is not medical advice. Follow the guidance of your child’s surgical and anaesthetic team.