A child being treated for leukaemia may have dozens of needle procedures over two or three years: blood tests, cannulas, lumbar punctures, bone marrow samples. Each one is brief. Together they can become the part of treatment a child dreads most, and the dread tends to build with each visit.
This is one of the areas where hypnosis has been tested most carefully in children, largely through a series of trials led by the psychologist Christina Liossi.
The lumbar puncture trial
In a study published in 2003, eighty children aged 6 to 16 who were having regular lumbar punctures as part of cancer treatment were randomly assigned to one of four groups.
- Direct hypnosis with standard medical treatment: straightforward suggestions of numbness and comfort
- Indirect hypnosis with standard medical treatment: permissive, story-based suggestions
- Attention control with standard medical treatment: the same amount of time with a therapist, without hypnosis
- Standard medical treatment alone
The children rated their own pain and anxiety, and trained observers scored their visible distress.
What it found
- Children in both hypnosis groups reported less pain and less anxiety, and showed less distress, than children in either control group.
- Direct and indirect suggestions worked equally well. The style did not matter.
- More hypnotizable children benefited more.
- When the therapist was no longer present and children were asked to use self-hypnosis alone, the benefit faded over later procedures.
That last finding is as useful as the first. Children needed continued support. Being taught once was not enough.
Adding hypnosis to anaesthetic cream
Local anaesthetic cream is now routine before children’s needle procedures. Later trials asked whether hypnosis adds anything to it.
In one, published in 2009, forty-five children with cancer aged 6 to 16 who were having venepuncture were randomly assigned to:
- Anaesthetic cream alone
- Anaesthetic cream plus attention from a therapist
- Anaesthetic cream plus self-hypnosis
Children in the self-hypnosis group reported less anticipatory anxiety, less pain and less anxiety during the procedure, and were rated as less distressed by observers, than children in the other two groups. The effects were large, and they held up over later procedures in this study.
Their parents were less anxious too.
An earlier trial by the same group, in children having lumbar punctures, had found the same pattern.
Why hypnosis suits this problem
- Children are good at it. Imagination is how they already deal with the world, and responsiveness to hypnosis is at its highest in middle childhood.
- Much of the suffering is anticipation. Fear in the waiting room, the night before, in the car. Hypnosis works well on anticipation.
- Fear and pain feed each other. A frightened child tenses and feels more.
- Procedures are repeated. A skill learned once can be used again and again, and a good experience shapes how the next one is expected to feel.
- It gives the child something to do. In a situation where almost everything is done to them, that matters.
What it looks like
Sessions are short and playful, and built around the individual child.
- A favourite place or activity: a football match, a beach, flying on a dragon
- A magic glove or a numbing switch to make the skin feel different
- A story in which the child is the hero
- Blowing the hurt away with long slow breaths, or blowing bubbles
- A dial to turn feelings down
- A cue the child can use, with a parent’s help
The child chooses the content. A nine-year-old who loves horses will have a very different session from one who loves space.
What the wider evidence says
Reviews of psychological approaches for needle procedures in children have generally found that hypnosis and distraction have the best support, though the overall quality of evidence is rated low to moderate, and many trials are small and come from a few research groups.
What parents can do
Before
- Be honest. Say what will happen in simple words. Do not promise it will not hurt.
- Ask for a play specialist or psychologist. Children’s cancer units usually have them.
- Ask about anaesthetic cream and make sure it goes on in good time.
- Practise at home when nothing is at stake: slow breathing, a favourite place, a glove.
- Let the child choose what they can: which arm, sitting on your lap, what to watch.
During
- Stay calm. Children read your face.
- Coach, do not reassure. “Blow out slowly, tell me what the dragon can see” helps. Repeating “it’s okay, it’s nearly over” tends to increase distress.
- Avoid apologising and avoid criticism.
- Do not hold the child down if it can be avoided. Ask staff to pause.
After
- Praise the effort: “You kept your arm so still.”
- Talk about what went well. Memory of a procedure shapes fear of the next.
- Keep practising between procedures.
Limits
- It does not replace pain relief. Cream, sedation or a general anaesthetic should be used as the team advises. In many centres lumbar punctures and bone marrow tests are done under general anaesthetic, which changes what is needed.
- Not every child takes to it. Very young children may do better with simple distraction.
- It needs keeping up.
- A very distressed or traumatised child needs specialist psychological help.
Finding help
Ask the treatment team first. Hospital play specialists, clinical psychologists and some nurses and doctors are trained in these techniques. A child with cancer should not be taken to a private hypnotherapist without the team’s knowledge.
The bottom line
In children having repeated cancer procedures, randomised trials found that hypnosis reduced pain, anxiety and distress, including when added to anaesthetic cream. It works best with continuing support, in the child’s own imagery, alongside proper pain relief.
Next in the series: Self-Hypnosis and Weight: What a Year-Long Trial Found
This article is for general information and is not medical advice.