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While pediatric integrative medicine (PIM) emphasizes an "evidence-based practice using multiple therapeutic modalities"; paradoxically, literature reviews examining the prevalence and/or efficacy of such mind⁻body approaches often address PIM modalities separately. Such contributions are relevant, yet documentation of how to deliver combined complementary approaches in children and youth are scarce. Nevertheless, integrative practitioners in clinical practice routinely mix approaches to meet the individual needs of each patient. Best practices are flexible, and include blending and augmenting services within the same session, and/or connecting modalities sequentially for an incremental effect, and/or referring to outside resources for additional interventions. Resonating with integrative medicine's definition, this article's goal is to demonstrate paradigms that "bring together complementary approaches in a coordinated way within clinical practice" by linking clinical hypnosis, the trail-blazer modality in PIM's history, with mindfulness, biofeedback, acupuncture, and yoga. Following the consideration of the overlap of guided imagery with hypnosis and an abridged literature report, this clinical perspective considers the selection of modalities within a collaborative relationship with the child/teen and parents, emphasizing goodness-of-fit with patients' contexts, e.g., symptoms, resources, interests, goals, and developmental stage. Case vignettes illustrate practical strategies for mixing approaches.

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At least 8 million children would need specialized pediatric palliative care (PPC) services annually worldwide, and of the more than 42,000 children and teenagers dying annually in the United States, at least 15,000 children would require PPC. Unfortunately, even in resource-rich countries the majority of children dying from serious advanced illnesses are suffering from unrelieved, distressing symptoms such as pain, dyspnea, nausea, vomiting, and anxiety. State of the art treatment and prevention of those symptoms requires employing multi-modal therapies, commonly including pharmacology, rehabilitation, procedural intervention, psychology, and integrative modalities. This article describes the current practice of integrating hypnosis into advanced pain and symptom management of children with serious illness. Three case reports of children living with a life-limiting condition exemplify the effective use of this clinical modality to decrease distressing symptoms and suffering. Hypnosis for pediatric patients experiencing a life-limiting disease not only provides an integral part of advanced symptom management, but also supports children dealing with loss and anticipatory loss, sustains and enhances hope and helps children and adolescents live fully, making every moment count, until death.

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Training in pediatric hypnosis has been part of clinical hypnosis education in the United States since 1976. Workshops expanded over time and are now taught by highly experienced pediatric clinicians across the globe. In 1987, a small vanguard of North American faculty, academic pediatricians, and pediatric psychologists taught a 3-day pediatric hypnosis workshop at the national meeting of the Society for Developmental and Behavioral Pediatrics (SDBP). This model of annual tri-level concurrent workshops (introductory, intermediate, and advanced) was sponsored by the SDBP for 24 years. In 2009, the National Pediatric Hypnosis Training Institute (NPHTI) assembled, and in 2010, offered its first annual workshops. This article documents this history of pediatric hypnosis education and describes NPHTI's remodeling and ongoing refinement toward a state-of-the-art curriculum with innovative methodology based upon (1) current research about adult experiential and small group learning; (2) design principles for presentations that maximize adult learning and memory; and (3) evaluations by participants and faculty. These underpinnings-including clinical training videos, individualized learning choices, emphasis on personalized, goal-oriented sessions, and advances in faculty selection, and ongoing development-are applicable to adult training models. Integration of developmental and self-regulation strategies may be more unique to pediatric hypnosis skills training programs. The conclusion proposes expansion of pediatric hypnosis education and elimination of related barriers toward goals that all children learn self-hypnosis (SH) for mind-body health.

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This review article addresses the process, intention, and therapeutic value of clinical hypnosis with children and adolescents. A brief historical perspective is followed by a digest of the published laboratory and clinical research that has accelerated substantially over the past two decades. This review lends appropriate credence to the benefits and integration to clinical practice of this powerful tool for teaching young people self-regulation skills. The breadth of application is described, and several clinical vignettes are provided as examples of what is possible. In addition to the provision of the most relevant citations in the pediatric, psychological, and neuroscience literature, this synopsis concludes with information regarding availability of skill development training in pediatric clinical hypnosis.

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Although the evidence is clear that hypnosis has been an effective treatment for recurrent headaches in children, review of the literature revealed no previous reports of hypnosis for youth with the condition of chronic daily headache. Two adolescents with continuing chronic daily headaches were taught self-hypnosis through careful attention to individual strengths and finding the hypnotic elements within the clinical encounters. Self-reports of intensity, frequency, and duration of headaches described substantial benefit from learning and practicing self-hypnosis after little to no benefit from pharmacologic and other nonpharmacologic therapies. These results and analogous success with several other adolescents with chronic daily headache support the further use of self-hypnosis training for this condition. As a self-regulation technique that is quickly and easily learned by most young people, self-hypnosis training holds considerable promise for effectively treating and perhaps preventing chronic daily headaches in children and adolescents.

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The author sent surveys to 178 consecutive youths previously referred for hypnosis for headaches. The survey sought current status of headaches: treatment, application of self-hypnosis, headache intensity, frequency, duration after self-hypnosis, generalization of self-hypnosis to other problems, and attitudes regarding self-hypnosis and life stresses. Of 134 delivered surveys, 52 were returned complete. Years after treatment, 85% (44/52) reported continued relief with self-hypnosis, 44% (23/52) reported decreased headache frequency, 31% (16/52) noted decreased severity, and 56% (29/52) reported that self-hypnosis reduced headache intensity. Many (26/52) emphasized the value of self-hypnosis to life stresses. In children and adolescents, self-hypnosis is associated with significant improvement of headaches and with an enduring positive effect for many years following training. Results suggest common and spontaneous generalizability of self-hypnosis by young people to modulation of other problems in their lives.

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OBJECTIVE: To describe the effect of treatment with self-hypnosis for youth with recurrent headaches. STUDY DESIGN: A retrospective review was conducted of outpatient clinical records of 178 consecutive youths referred to the Behavioral Pediatrics Program (University of Minnesota) from 1988 to 2001 for recurrent headaches. All patients were taught self-hypnosis for self-regulation. Intensity, frequency, and duration of headaches before, during, and after treatment were measured. Outcomes included number and frequency of visits, types of medication, and nature of self-hypnosis practice. RESULTS: Data were available for 144 patients in this patient self-selected and uncontrolled observation. Compared with self-reports before learning self-hypnosis, children and youths who learned self-hypnosis for recurrent headaches reported reduction in frequency of headache from an average of 4.5 per week to 1.4 per week (P < .01), reduction in intensity (on a self-rating scale of 0 to 12) from an average of 10.3 to 4.7, P < .01, and reduction in average duration from 23.6 hours to 3.0 hours, (P < .01). There were no adverse side effects of self-hypnosis. CONCLUSIONS: Training in self-hypnosis is associated with significant improvement of chronic recurrent headaches in children and adolescents.

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Clinical hypnosis is an established part of the comprehensive treatment of numerous problems in ambulatory pediatrics. Two cases illustrate its utility with pediatric inpatients. These cases demonstrate clinical hypnosis as a teachable, practical, and nonpharmacologic intervention that warrants further investigation in the inpatient setting.

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Although hypnosis has been used for centuries, there are few reports of systematic, professional training. The most thorough codification of instructional content is the Standards of Training in Clinical Hypnosis (SOTCH) (Elkins & Hammond, 1994), endorsed by The American Society of Clinical Hypnosis (ASCH), and The Society of Clinical and Experimental Hypnosis (SCEH) for annual workshops. This curriculum is organized around two assumptions: training is presented to adult professional who know their own objectives; and each participant has a favorite learning style that should be accommodated. The workshop follows the content and time recommendations of the SOTCH. Some content is scheduled with spaced opportunity for practice. Concepts are organized in a spiral pattern, then presented and reviewed several times, each time in more detail, and in ways that accommodate different learning styles.

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