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

Table 1 Key distinctions between clinical hypnosis and stage hypnosis

Aspect	Clinical hypnosis	Stage hypnosis
Primary purpose	Therapeutic: To facilitate healing and positive change for psychological, medical, or behavioral conditions (e.g., anxiety, pain, phobias)	Entertainment: To amuse, impress, and entertain an audience by showcasing unusual hypnotic phenomena
Guiding intent	Client-centered: The entire process is designed for the well-being, benefit, and empowerment of the individual client	Audience-centered: The process is designed to be dramatic, funny, and engaging for the people watching the show
Setting	Private & confidential: A professional clinical environment (e.g., hospital, therapy office, private practice)	Public & performative: A public stage, performance venue, or social gathering
Practitioner	Licensed healthcare professional: A trained and licensed professional (e.g., psychologist, physician, dentist, clinical social worker) with specific certification in hypnotherapy	Performer/entertainer: Often a charismatic performer with training in showmanship and rapid induction techniques, but typically without formal healthcare or psychological credentials
Training & certification	Rigorous & accredited: Requires graduate-level healthcare education followed by specialized, accredited training and certification from professional boards (e.g., ASCH, SCEH)	Unregulated: Training varies widely from mentorships to private courses. There are no formal, universally recognized educational or licensing standards
Ethical oversight	Strictly governed: Bound by the ethical codes and legal statutes of their respective healthcare professions (e.g., confidentiality, "do no harm")	No Formal governance: Lacks formal ethical oversight. The primary "rule" is to put on a good show, though responsible performers avoid outright harm
Subject selection	Client-initiated: Individuals actively seek therapy for a specific problem. Suitability is assessed, but the primary goal is to help the individual seeking treatment	Volunteer-based & screened: Participants are volunteers from the audience, often implicitly or explicitly screened for high suggestibility and extroversion to ensure compliance and a good performance
Consent	Informed & specific: A formal process where the client understands the therapeutic goals, methods, potential risks, and benefits, and gives explicit consent for treatment	General & implied: Volunteers agree to be on stage but may not fully understand what will be asked of them. Consent is often influenced by peer pressure and the desire to be part of the show
Techniques used	Individualized & evidence-based: Techniques are carefully selected and tailored to the client's specific needs, personality, and therapeutic goals	Standardized & rapid: Uses fast, authoritarian induction methods designed for maximum effect on a group in a short amount of time. The focus is on creating observable behaviors
Client safety & dignity	Paramount concern: Protecting the client's physical and emotional safety and dignity is the highest priority. Confidentiality is legally required	Secondary to entertainment: While most performers avoid true danger, participants may be put in embarrassing or undignified situations for comedic effect. There is no expectation of privacy
Duration of effect	Designed for long-term change: Aims to create lasting changes in perception, behavior, or symptom management that persist long after the session ends	Transient & short-lived: Effects are intended to last only for the duration of the show. Suggestions are typically removed before the participant leaves the stage
Documentation & follow-up	Standard practice: Sessions are meticulously documented in the client's confidential medical record. Follow-up is integral to assessing progress and adjusting treatment	None: No documentation, record-keeping, or follow-up care is provided to participants
Examples of use	Pain management (chronic pain, childbirth, surgery), anxiety reduction, habit control (e.g., smoking cessation), phobia treatment, PTSD symptom management	Making participants forget their names, believe they are a celebrity, dance uncontrollably, or react to absurd suggestions for the audience's amusement

This table offers a detailed comparison of clinical hypnosis and stage hypnosis across various operational areas. It compares the two practices on key aspects such as primary purpose, ethical standards, practitioner qualifications, techniques, and safety measures to highlight their core differences. The framework emphasizes that although both may involve a state of focused attention and suggestion, clinical hypnosis is a regulated, client-focused healthcare approach, while stage hypnosis is an unregulated, audience-focused form of entertainment. This distinction is vital for researchers, clinicians, and the public to prevent misunderstandings about the legitimate therapeutic uses of hypnotherapy. ASCH: American society of clinical hypnosis; PTSD: Post-traumatic stress disorder; SCEH: Society for clinical and experimental hypnosis.

Table 2 A comparative framework of pediatric vs adult hypnotherapy

Feature	Pediatric hypnotherapy	Adult hypnotherapy
Cognitive & developmental approach	Leverages imagination and reduced critical filtering; techniques are concrete and story-based	Engages analytical reasoning and belief systems; techniques are more direct and insight-oriented
Therapeutic alliance & rapport	Built through playful interaction (e.g., games, drawing, storytelling) to foster trust	Built through empathetic conversation, active listening, and discussion of therapy goals
Imaginative engagement	Highly responsive to fantasy, symbols, and imaginative play	May be more analytical and less suggestible to symbolic or fantastical content
Communication style & techniques	Uses simple, multisensory imagery and playful metaphors (e.g., “magic glove”)	Uses abstract language, sophisticated metaphors, and direct cognitive-behavioral suggestions
Language style	Concrete, playful, and developmentally tailored	Abstract, metaphorical, and insight-driven
Session structure & pacing	Shorter, flexible, and dynamic to match attention span; includes playful transitions	Longer, more structured; allows sustained exploration of deeper issues
Session duration	Typically 20-40 minutes, adapted to the child’s mood and readiness	Typically 45-60 minutes with more consistent pacing
Therapeutic focus	Targets specific symptoms (e.g., pain, anxiety, enuresis); goal is rapid relief and empowerment	May address broader emotional patterns, trauma, and psychological insight
Support system involvement	Triadic alliance-parents contribute history, encourage participation, and reinforce strategies at home	Client works independently; support system involved only with consent (e.g., in family therapy)
Parental role	Actively involved during and between sessions	Not involved unless part of a joint therapeutic approach
Consent & ethical framework	Requires dual process: Informed consent from guardian + age-appropriate assent from the child	Solely requires informed consent from the adult client

This table provides a comparative summary of the essential differences in the application of hypnotherapy for pediatric vs adult clients. These distinctions are rooted in the unique developmental, cognitive, and social-relational context of childhood. The comparison underscores that effective pediatric hypnotherapy is not merely a simplification of adult techniques but a specialized discipline requiring a fundamentally different strategic approach, a flexible session structure, and a unique ethical framework centered on the child-parent dyad.

Table 3 Categorical framework of clinical hypnotherapy techniques for children

Category	Technique	Description	Primary clinical application
Foundational imaginative techniques	Guided imagery/"safe place"	Guiding the child to create a multi-sensory, immersive experience of a safe, pleasant, or empowering environment (e.g., a beach, spaceship, magical forest)	Anxiety reduction, establishing rapport, creating a receptive state for further therapeutic work
	Storytelling & therapeutic metaphor	Embedding therapeutic ideas within a narrative structure that reframes the child's problem and offers solutions indirectly (e.g., a story about a scared lion who finds its roar)	Problem-solving, reframing fears, enhancing coping skills in a non-threatening manner
Pain & physical symptom control	Symptom-modifying imagery	Utilizing mental imagery to directly alter the perception of a symptom. Includes: (1) Glove anesthesia: Transferring imagined numbness; (2) Control panel/dials: Adjusting intensity; and (3) Transforming qualities: Changing the color/shape/temperature of pain	Direct modulation of pain, discomfort, or other physical sensations (e.g., itch, nausea)
	Dissociative imagery	Guiding the child to imagine separating from the sensation, such as watching the pain on a screen, placing it in a box, or floating away from their body	Reducing the emotional component (suffering) of pain; managing overwhelming sensations
Behavioral & habit reversal	Imaginative rehearsal & future pacing	Guiding the child to mentally rehearse successfully navigating a future challenging situation (e.g., a medical procedure, a school presentation) while feeling calm and confident	Building competence and positive expectancy; reducing anticipatory anxiety
	Gentle aversion imagery	Associating an unwanted habit (e.g., nail-biting) with a mildly unpleasant but not frightening image or sensation (e.g., a bitter taste, a gritty texture)	Discouraging habits like thumb-sucking, nail-biting, or trichotillomania
Ego-strengthening and empowerment	Ego-strengthening suggestions	Using direct suggestions and metaphors focused on building the child's sense of self-worth, resilience, and inner resources (e.g., "You have a special strength inside you")	Universal application to improve self-esteem, coping, and a sense of agency. Often integrated into all other techniques
Core linguistic techniques	Permissive & indirect language	Phrasing suggestions in an open, invitational manner ("You might begin to notice...", "Perhaps you can imagine...") that respects the child's autonomy	Bypassing resistance, fostering a sense of control and collaboration, empowering the child
	Direct suggestion	Clear, positive, goal-oriented statements, often couched in permissive language ("And you can allow yourself to feel calm and relaxed")	Reinforcing desired changes, providing clear direction when the child is highly receptive

The table provides a structured, categorical framework outlining the major clinical hypnotherapy techniques used with children. It organizes these techniques into key domains-including foundational imaginative strategies, pain and symptom control methods, behavioral and habit-reversal approaches, ego-strengthening interventions, and core linguistic techniques. For each category, the table describes the specific techniques, their underlying therapeutic mechanisms, and their primary clinical applications. This framework highlights how hypnotherapy leverages imagery, storytelling, dissociation, mental rehearsal, empowerment strategies, and both permissive and direct suggestion to address a broad range of pediatric needs, from anxiety and pain management to behavioral modification and emotional resilience.

Table 4 Clinical applications of hypnosis in pediatric medicine with degree of recommendation

Medical domain	Specific applications & conditions	Degree of recommendation
Pain management	Acute procedural pain: Venipuncture, intravenous cannulation, lumbar puncture, bone marrow aspiration, burn dressing, dental procedures, post-operative pain, suturing, catheterization. Chronic/recurrent pain: Functional abdominal pain, migraines, tension headaches, fibromyalgia, sickle cell crises, juvenile arthritis, CRPS, neuropathic, and phantom pain	A
Anxiety & phobias	Procedural anxiety, preoperative fear, needle phobia (trypanophobia), dental phobia, “white coat” syndrome, generalized anxiety, separation anxiety, social and performance anxiety, panic attacks	A
Oncology	Pain from procedures and treatment, chemotherapy-induced nausea and vomiting (especially anticipatory), procedural anxiety, fatigue, emotional coping, and appetite improvement	A
Gastroenterology	IBS, functional abdominal pain, dyspepsia, cyclic vomiting syndrome, functional nausea, encopresis, constipation, rumination syndrome, IBD-related pain, and anxiety	B
Neurology/behavioral health	Tics, Tourette's, habit cough, PNES, FND, sleep disorders, nocturnal enuresis, anger and impulse control issues, and bruxism	B
Dermatology	Atopic dermatitis (itch-scratch cycle), warts, trichotillomania, excoriation disorder, psoriasis, and neurodermatitis	B
Pulmonology	Asthma-related anxiety, hyperventilation syndrome, procedural anxiety in cystic fibrosis, and treatment adherence (e.g., nebulizers/inhalers)	B
General health & wellness	Stress management, focus and concentration (non-ADHD specific), self-esteem, habit cessation (e.g., nail biting), body image, sleep hygiene, relaxation training, and reinforcement of a healthy lifestyle	B
Urology	Nocturnal enuresis, functional voiding disorders, urgency/frequency syndromes, and anxiety during urodynamic testing	B
Rehabilitation & physical therapy	Enhancing pain tolerance during therapy, improving motivation, managing movement fear, and recovering from injury	C
Endocrinology & metabolism	Support for insulin injections, blood glucose monitoring, and coping with chronic illness stress (e.g., diabetes)	C

The degree of recommendation reflects the strength of evidence and expert consensus supporting the clinical use of hypnosis for specific pediatric conditions. It is adapted from clinical guideline grading systems to reflect the pediatric hypnotherapy context: A (strong recommendation): Based on high-quality evidence from multiple randomized controlled trials (RCTs), systematic reviews, or meta-analyses. Indicates a high degree of confidence in the efficacy and safety of pediatric hypnosis for the specified condition. B (moderate recommendation): Supported by moderate-quality studies (e.g., cohort studies, case-control studies, or limited RCTs) and/or strong expert consensus. Indicates hypnosis is likely effective and appropriate for use, but may benefit from further research. C (emerging or limited evidence): Based on case series, case reports, or expert opinion without robust clinical trials. Hypnosis may be used as a complementary tool, with promising potential; however, more rigorous studies are needed to confirm its efficacy. ADHD: Attention-deficit/hyperactivity disorder; CRPS: Complex regional pain syndrome; FND: Functional neurological disorder; PNES: Psychogenic non-epileptic seizures; IBDs: Inflammatory bowel diseases; IBS: Irritable bowel syndrome.

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.