The Healing Power of Children’s Imagination for Medical Procedures: Help for Pain, Anxiety, and Fear Charlotte Reznick, Ph.D. Alternative Journal of Nursing, November 2007 Her Website

Medical procedures and surgery can be terrorizing to a child. The worry, anxiety, fear of pain, and feeling out of control can send kids over the edge – from hysterical crying to aggressive and acting-out behavior, to hiding and crawling up in a fetal position. As nurses and practitioners you can help the parents and caregivers you work with learn techniques to give their children back control. Control over how they respond to whatever they have to face. You can help them reduce pain, anxiety, and fear, and speed up their healing process using the positive power of their imagination.

In my therapeutic practice, over the past 25 years, I have found that children can create pictures from their mind's eye to heal their troubles. Through learning and practicing visualization, kids can develop self-care skills to help themselves in a variety of medical situations. I teach children and teens a toolbox of nine core imagery skills to mix and match as needed. You can do that too. Their personal kit includes: the relaxing balloon breath, discovering a safe special place, meeting wise animal friends and wizards as guides, receiving gifts from these inner guides to assist, connecting to the wisdom of their heart and gut feelings, dialoging with symptoms and feelings, and using color and energy for healing and pain control.

The impact of positive images while in a relaxed state is tremendous. After one group session using the magic garden and healing pond imagery, three boys were relieved of the pain of their stomachache, headache, and mouth sore respectively. During another group, an adolescent girl with a pounding headache eliminated her pain without medication, and later successfully taught the simple imagery technique to her friends at school.

Practice definitely makes perfect when preparing for medical situations. Even simple deep breathing becomes very challenging when a child is anxious or fearful. One way to explain the importance of repeated rehearsal is using the metaphor of sports. In order to do well at the game, the team needs to practice. The more they practice the better they get. Depending on a child’s age, use developmentally appropriate examples (e.g. learning to tie shoes, ride a bike, and drive a car). Practicing as much as possible before any procedure will increase the likelihood of being able to actually use imagery techniques when needed. But, if you don’t have that much time, do the best you can, and perhaps suggest the parents bring along a CD or tape at the time of the procedure for general relaxation or with specific instructions.

You can also teach how to create an ‘anchor’ for the younger children by pairing a touch on the hand, arm, or leg (or anywhere they choose) as they go into their imagery state. The touch can activate a self-hypnotic state when needed. Older children can anchor themselves.

Kids can make up their own creative scenarios. Included are suggestions to help you on your way. Keep in mind that in reading the scripts use your most soothing, slow voice with soft music in the background if possible. Depending on the child’s age, adjust the vocabulary and specifics. You’ll notice many words and phrases are repeated in these scripts for impact and to prepare for medical procedures.

(1) Teach the Balloon Breath as a Foundation Tool

The balloon breath is a simple technique of breathing slowly and deeply into the belly while focusing attention about two inches below the navel. This type of diaphragmatic breathing helps center and calm children.

Sample Script: The Balloon Breath
“Let’s take a few minutes to be aware of your breathing. Put your hands over your belly so you can notice your breath going there. That’s right. Breathe slowly, about two to three inches just below your belly button, so your belly rises and falls as you breathe in and out. Good. Let’s breathe in even slower, to the count of one … two … three. Now, breathe out just as slowly … one … two … three.”

Repeat until comfortable, practice 1-3 minutes each session, several times a day.

(2) Introduce the Power of Imagery

Introduce your patients to the power of imagery by starting with some everyday images.

Sample Script: Intro to Imagery
“Let’s combine our relaxing, breathing, and imagination. Imagine a lemon cut in quarters and imagine its taste as you bite into it. Notice what happens in your mouth. Compare that to your favorite food (e.g. chocolate or mashed potatoes, or…?)”

Choose some of the other images suggested below. The idea is to incorporate as many senses as possible to enrich the imagery experience. Some kids don’t “see” an image but feel it or sense it, or even hear it. For example: “Close your eyes (if you like) and imagine…

number of: rooms (windows) in your house / restrooms at your school /trees in yard
sounds of: a dog barking / rain on the window / birds chirping
smell of: popcorn / freshly baked cookies / a flower
feel of: kitten’s (puppy’s) fur / warmth of the sun / sand (mud) going through toes
taste of: chocolate / a lemon / potato chips / an apple

(3) Face Fear by Developing Bravery and Courage

In facing painful medical procedures, you can develop a child’s strength and courage. When you teach them these skills it will be far easier to get them out of the house and into the medical office without turmoil. You may want the children to listen to the Discovering Your Special Place CD before medical procedures so they can practice deep relaxation and creative imagery to more readily accesses the relaxed state when they need it. http://www.imageryforkids.com/shop.asp

Here’s one way to build confidence.

Sample Script: Developing Bravery and Courage
“Close your eyes gently and focus on your balloon breath. Imagine where your worry (or fear) is in your body? What color is it? What shape or image does it have? Now, imagine where your brave part is in your body? Look all around inside. What color is it? What shape is it? Now focus on your brave area. Breathe in the color of your brave part (e.g. yellow or _?) through your body. You can start from (wherever the brave part is) and breathe out from there. Notice how your brave part expands just by breathing. Take all the time you need and see how much of your body you can fill up with bravery and courage. Let me know when brave has spread as far as it can. Continue to take some slow balloon breaths. See if bravery and courage can fill up your whole body. Now notice what happens to worry when you breathe your brave feelings right into it.” (Might cover it up, change its color, or disappear). Take your time.

As far as the child gets is good. With practice, bravery will likely grow. When the child can breathe brave feelings throughout the body, then suggest:

“Now keep breathing your brave color past your physical body …six inches…one foot…two feet…up to three feet. Imagine a bubble of bravery all around you. This bubble of bravery and courage will protect you when you visit the doctor (hospital). Feeling your brave confidence helps you stay calm no matter whatever or whomever we meet.”

(4) Pay Attention to the Wisdom of Inner Guides

An animal friend (or wizard) can be used as a guide and helper, a valuable tool to access inner wisdom. These imaginary guides are kind, loving, and have a child's best interest at heart. "Gifts" from them are used as unique ways to receive power and assistance. For example, before a fearful medical procedure, one seven-year-old boy’s power animals, a pride of lions, stood guard around his hospital bed to give him courage and keep him safe during several invasive tests. Another eleven-year-old girl received the gift of a spiral-moving rainbow to heal chronic stomach pains, along with rainbow glasses to see the world in a more positive light.

Sample Script: Meeting Your Animal Friend
“Take some time to focus on your balloon breath. Allow yourself to imagine a safe special place. And let yourself go there …down your path … open your door … step in. Good. Get nice and comfortable. When you’re ready, ask for one of your animal friends (or wizard or wise person for older kids) to appear. Be surprised at who shows up to help you. Tell your animal friend all about your problem. Ask for help … what you need to know, or what you need to do so you no longer have to suffer having this problem. Notice what gift your animal friend offers. It may be a thought, a word, or something you can see or feel. Whatever your gift is, it will help you to overcome your fear and feel safe again with whatever you must face. Ask your animal friend any questions to help you understand your gift. Take all the time you need. When you are ready, focus on your balloon breath, and slowly open your eyes.”

Notice that the inner guide might not be able to take away the problem, illness, or impending surgery, but is there to help relieve suffering in the situation.

(5) Prepare for Painful Procedures using
Ice-cream Imagery as an Anesthetic

Preparing for painful tests should include lots of positive images and mental rehearsal of everything going well. Depending on a child’s age, you can include more or less details about the specific procedure. Here’s one pain numbing imagery that kids really enjoy.

Sample Script: Reducing Pain with Ice-Cream
“Now imagine your favorite flavored ice-cream or frozen dessert in a cup. Remember its color, and texture and smell and taste. Imagine that with every slow deep breath you take, the cup grows larger and larger, filling up with more and more yummy ice-cream. Imagine tasting your delicious ice-cream, so cool and refreshing. Now imagine putting some of this very cold ice-cream right on the exact spot(s) where you’re going to have your IV (or needle, shot, biopsy, etc.). Wow is that cold! But it is refreshing and very numbing. You can really feel your arm (leg, back…) cooling and numbing from your favorite ice-cream. And as you continue your balloon breath slowly, the numbing cream works even more. Take your time… (Wait a minute or two). You can hardly feel anything in that spot now. And if that spot, that spot that you might feel any pain at all, is really, really large, you can even lay down in what has now become a bathtub of numbing ice-cream that is cool, refreshing, creamy and icy. There is as much as you need to totally numb any painful spots leaving you comfortable and peaceful. … So all you need to do is start your slow balloon breath, remember your favorite delicious ice-cream flavor, and wherever you have any pain or discomfort, put some on and it will numb any hurtful feelings during and after your medical procedure.”

(6) After Surgery (and Other Times)
Incorporate Color to Relieve Pain

When children are very focused and involved with their personal imageries, they are distracted from their pain. One seven-year-old girl created a “color therm-o-meter” that could raise or lower different emotions and pain. She initially worked with feelings; they seemed easier for her then the pain itself. She increased ‘blue’ calmness and decreased ‘orange’ fear; then increased ‘pink’ love and decreased ‘black’ anger. This helped her progress directly to reducing her pain in a similar manner. In a twist of procedure, another 12 year-old boy found that by first increasing his pain, he realized he had some control over it. He then used this ‘control’ to lower his pain to an acceptable level.

A variation of the technique used for developing bravery can be used in reducing pain. Here is an easy imagery formula that may relieve or totally eliminate pain.

1. Start with doing the balloon breath (preferably eyes closed).
2. Ask your child “Where in your body do you feel the pain?
3. Three questions:
(1) What color is it?
(2) What shape is it?
(3) How heavy is it?
Whatever answers you get from your child is fine. Tell them that. Use words like “good”, “fine”, “okay” after each response. Be accepting and positive, validating whatever your child tells you.
4. Have them continue to slowly balloon breath three or four times in between rounds.
5. Repeat the 3 Questions and your reaction to them.
Over the course of three to five to ten minutes, there is generally a change from dark (e.g. red or black), sharp (e.g. square or triangle), and heavy (e.g. 10 tons) to light in color (e.g. white, yellow or light blue), round, and light in weight (e.g. 1 lb.). I’ve seen this work with all kinds of pain. The length of this process depends on your child’s openness to relaxation and the intensity of pain. Sometimes you might suggest a symptom dialogue with the bits of pain that are left in order to find out what your child needs to know, understand, or do to let go of the rest of the discomfort. Other times they can imagine the bits of pain melting through their body (through their skin, belly button, or whatever they come up with). If they get stuck and don’t get any answers, you can call in an animal friend (inner guide) to give them words of wisdom or a gift to help.

After medical procedures and surgery, you may have your child listen to the Creating a Magical Garden and Healing Pond CD http://www.imageryforkids.com/shop.asp, to help speed up the healing process and relieve pain, and to create their personal inner magical garden, a metaphor for developing a healthy body.

(7) Help for Getting Needed Rest and Sleep

You can use imagery tools to assist in sleep. For example, one five-year-old girl called upon her animal friend, a unicorn named Ruby to help, Ruby lived on top of a cloud in her rainbow special place and came "every single, pingle, wingle, tingle night" to help with her problem of not sleeping by sprinkling white powder on her head and slowly saying "falling asleep" as she drifted off to her favorite dream.

Relaxation and imagery CDs offer comfort and help children fall asleep more easily. Both Discovering Your Special Place and Creating a Magical Garden and Healing Pond have been extremely successful in helping children fall asleep and sleep through the night. http://www.imageryforkids.com/shop.asp

A Final Reminder

Nurses and practitioners, it is not necessary to have the perfect script, or years of experience for facility with this work. What is important is your sincerity, your respect for your children and their process, and perhaps most significant, is your allowing your kids to touch their natural inner wise healer and bring it forth. As a young pre-teen discovered and eagerly reported to me: “Your imagination can help you heal.”

Many blessings,
Dr. Charlotte

Charlotte Reznick Ph.D. specializes in helping children and adolescents develop the emotional
skills necessary for a happy and successful life. A licensed educational psychologist and
Associate Clinical Professor of Psychology at UCLA, Dr. Reznick is the creator of Imagery For
Kids™: Breakthrough for Learning, Creativity, and Empowerment and is the author/producer
of the therapeutic CDs Discovering Your Special Place and Creating a Magical Garden and
Healing Pond. An international workshop leader on the healing power of children's
imagination, Dr. Reznick maintains a private practice in Los Angeles, California. For
information about her articles, speaking, CDs, and forthcoming book, visit www.ImageryForKids.com