August, 2006

Scope of the Issue

There were 2,310,000,in-hospital surgeries (DeFrances & Podgornik, 2006) and 2,318,000 out-patient surgeries (Hall and Lawrence, 1998) performed on children under the age of 15 in the years 2004 and 1996 respectively.

Children and Surgery

Children have a kaleidoscope of fears around surgery. Some of these fears are of mutilation, needles, loss of control, pain, the unknown, separation from family and friends, and fear of the unfamiliar staff, routines, and equipment in the hospital (Petrillo & Sanger, 1983; Timmerman, 1983).

Their anxiety can increase their pain and slow their recovery. It can also lead to lack of cooperation with staff. Surgery can also cause regressive behavior, including nightmares, bedwetting, and acting out behaviors that can last for months; this can be a significant problem for families (Bar-Mor, 1997). With over 4 million pediatric surgeries per year, speeding recovery even slightly could provide significant savings.

Research in Mind/Body Interventions

Pre-operative preparation for pediatric surgical patients has been found helpful in improving children’s following instructions in the hospital. It can also reduce problems at home after the surgery (Bar-More, 1997; O-Connor-von, 2000). Reducing children’s anxiety, and increasing their sense of control is also beneficial – leading to shorter hospital stays, shorter procedure time, and less need for some medications (Butler & Simons, 2005; Lambert, 1996; Jones, 1979.

Surgical prep programs have also been found to increase patient satisfaction with the surgical experience (Brewer and Lausat, 1997). Surgical preparation with guided imagery has been found to reduce pain and anxiety, and accelerate recovery in adult surgical patients. Tusek, Church and Fazio (1997) studied 130 patients undergoing abdominal surgery for colorectal disorders.

The imagery group needed significantly less pain medication, had faster return of bowel function, and reported less pain and anxiety. Daake and Gueldner (1989) found that patients who participated in guided imagery pre-operatively had less need for pain medication post-operatively, and Holden-Lund (1988) documented faster wound healing in patients who relaxed with guided imagery.

Clinical studies have also shown that patients who use relaxation and guided imagery have fewer complications, reduced bleeding, are more comfortable after surgery, and spend less time in the hospital (Tuset, Church, and Fazio).

Mind-body studies have also been done involving the pediatric population. Distraction using a video game reduced children’s anxiety both before surgery and during administration of anesthesia (Patel, Schieble, et al, 2006). Jones (1979)
used hypnosis/imagery in addition to general anesthesia in children undergoing spinal surgery. The imagery group needed less chemical anesthesia. Lambert (1996) studied 52 children undergoing a variety of surgeries. Those who received guided imagery/hypnosis pre-operatively had shorter hospital stays and reported less pain.

Guided imagery/self-hypnosis has been shown to help children tolerate procedures (including needle sticks) with less need for sedation, and less pain and anxiety. Olness (1981) successfully used imagery with 25 pediatric cancer patients who tolerated procedures including bone marrow aspiration, lumbar puncture, and chemotherapy with less pain and nausea than a control group.

Hypnosis and cognitive behavioral therapy were both successful in lowering children’s pain and anxiety, with hypnosis being the more successful of the two in relieving their anxiety (Liosi & Hatira, 1999). A guided imagery tape enabled children undergoing MRI to remain still and avoid sedation (Smart, 1997). In children undergoing repeat voiding cystourethrography, the children using hypnosis reported less distress, the parents reported that the procedure was less traumatic, and medical staff reported greater ease of conducting the procedure, as well as shorter procedural duration (Butler & Symons, 2005).

While larger, better designed studies are required, two reviews of the medical literature acknowledged the potential of hypnosis in reducing pain and distress during pediatric oncology procedures (Richardson, Smith, et al, 2006; Wild, Espie, 2004).


Guided imagery is an effective way to help pediatric patients and families cope with the stress of surgery and hospitalization, cooperate with invasive procedures, and speed readiness for discharge from hospital.


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