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Hypnosis May Reduce Stress for Children Undergoing Voiding Cystourethrography

By: Laurie Barclay, MD

Jan. 6, 2005 — Hypnosis may provide stress reduction for children undergoing voiding cystourethrography (VCUG), according to the results of a preliminary randomized study published in the January issue of Pediatrics.

"VCUG is a commonly performed radiologic procedure in children that can be both painful and frightening," write Lisa D. Butler, PhD, from Stanford University School of Medicine in California, and colleagues. "Given the distress that some children experience during the VCUG and the need for children to be alert and cooperative during the procedure, finding a psychological intervention that helps children to manage anxiety, distress, and pain is clearly desirable."

In this study, 44 children who were scheduled for VCUG were randomized to receive hypnosis (n = 21) or routine care (n = 23) while undergoing the procedure. The hypnosis group received a one-hour training session in self-hypnotic visual imagery by a trained therapist, and were instructed to practice several times before the procedure.

Mean age was 7.6 +/- 2.5 years; range: 4–15 years), and mean number of previous VCUGs was 2.95 +/- 2.51 (mode: 2; range: 1–15). There were 29 (66%) girls and 15 (34%) boys; ethnic and racial composition of the sample was 72.7% white, 18.2% Asian, 4.5% Latino, 2.3% black, and 2.3% Filipino.

Inclusion criteria were at least one previous VCUG provoking distress, at least four years of age at that time, and English spoken by both the child and the participating parent. Outcome measures included child reports of distress during the procedure, parent reports of how traumatic the present VCUG was compared with the previous one, observer ratings of distress during the procedure, medical staff reports of the difficulty of the procedure overall, and total procedural time.

Compared with the routine care group, the hypnosis group had benefits in four measured areas: parents reported that the procedure was significantly less traumatic for their children compared with their previous VCUG procedure; observational ratings of typical distress levels during the procedure were significantly lower; medical staff reported significantly less difficulty in conducting the procedure; and total procedural time was significantly shorter by almost 14 minutes.

Study limitations include lack of blinding of participants and staff; small, primarily white sample; and limited generalizability because subjects had already undergone at least one difficult VCUG. "Hypnotic relaxation may provide a systematic method for improving the overall medical care of children with urinary tract abnormalities and may be beneficial for children who undergo other invasive medical procedures," the authors write. "Because the VCUG is an essential part of the evaluation of urinary tract infections and vesicoureteral reflux in children, lower distress during the procedure may improve patient and family compliance with initial as well as follow-up evaluations."

The Innovations in Patient Care program at Lucile Packard Children's Hospital funded this study.

Pediatrics. 2005;115:e77-e85

Reviewed by Gary D. Vogin, MD

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