One of the most memorable lessons I learned during my first course through the National Pediatric Hypnosis Training Institute (NPHTI) had very little to do with formal hypnosis techniques. Instead, it was a lesson about language. Throughout the course, faculty repeatedly emphasized that every conversation with a child is an opportunity to either strengthen or undermine healing. Long before we formally induce a hypnotic state, children are already listening closely to the words we choose, interpreting our tone, and building expectations about what is about to happen.
In many ways, every pediatrician practices a small amount of therapeutic suggestion every day. Whether we recognize it or not, our explanations, reassurance, and framing influence not only how children think about illness, but also how they experience symptoms and treatment. This phenomenon is closely related to what researchers call the nocebo effect.
The placebo effect is familiar to most physicians: positive expectations can improve subjective symptoms and even measurable physiological outcomes. The nocebo effect is its less appreciated counterpart. Negative expectations increase the likelihood or severity of unpleasant symptoms, adverse effects, anxiety, pain, and even poor treatment outcomes. Importantly, these symptoms are not imagined. They are real experiences generated through complex interactions between cognition, emotion, autonomic regulation, neurochemistry, and the brain’s predictive processing systems.
For pediatricians, this has profound implications.
Children are particularly sensitive to suggestion because they naturally engage in imaginative thinking, readily absorb cues from trusted adults, and often have limited prior experiences with illness to counterbalance what they are told. Parents, too, look to us as trusted interpreters of uncertainty. The way we communicate becomes part of the treatment itself.
One of the instructors at NPHTI frequently quoted Yoda from Star Wars: “Do or do not. There is no try.” At first glance, it sounds like a humorous movie reference, but it illustrates an important principle in therapeutic communication. Asking a child to “try” a visualization subtly implies that success is uncertain or perhaps unlikely. Instead, we can simply invite them to begin: “Let’s imagine…” or “Let’s start by picturing…” If the child struggles, we normalize that learning any new skill takes practice and that it becomes easier over time. The goal is not perfection but confidence, curiosity, and gradual mastery.
This same philosophy extends beyond hypnosis into everyday pediatric practice.
Another principle emphasized during hypnosis training is ego strengthening—using language that reinforces a child’s sense of competence, resilience, and safety. Rather than inadvertently suggesting vulnerability or failure, we intentionally highlight strengths. Instead of saying, “Don’t be scared,” we might say, “You’re doing a really good job staying calm.” Instead of warning that something is “going to hurt,” we might explain that they may “feel some pressure,” “some warmth,” or “some discomfort for a few seconds.” These alternatives are not deceptive; they are often more accurate descriptions of what many children actually experience. More importantly, they avoid unnecessarily amplifying anticipatory fear.
Research on procedural pain has repeatedly demonstrated that language shapes pain perception. Simply warning children that an injection “will hurt” can increase pain ratings compared with more neutral or positively framed language. Likewise, parental anxiety and clinician expectations are remarkably contagious. Children continually scan adults for cues about how threatening a situation should feel. Calm, confident communication from trusted adults becomes part of the intervention.
Perhaps nowhere is this more relevant than when discussing medication side effects.
As physicians, we have both ethical and legal obligations to discuss potential adverse effects. The answer is certainly not to withhold information or minimize genuine risks. Rather, the challenge is to communicate risk honestly while avoiding the creation of unnecessary negative expectations.
Imagine a parent asks about side effects of a vaccine or a newly prescribed medication. One approach might be to provide a lengthy list of every possible adverse effect before mentioning that most children tolerate it well. While factually correct, this approach can inadvertently prime parents to vigilantly monitor for every symptom, increasing the likelihood that normal variations or unrelated symptoms will be interpreted as medication-related.
A more balanced approach might sound like this:
“Like any medication, there are some possible side effects. The good news is that most children do very well with this medicine. In my own practice I’ve prescribed it for many children, and the vast majority tolerate it without any significant problems. The most common side effects, if they occur, are usually mild and temporary. Serious reactions are very uncommon, but I always want families to know what to watch for.”
Notice that nothing has been omitted. The information is identical, but the framing is different. The clinician communicates confidence while remaining transparent. Positive expectations are encouraged without crossing the line into false reassurance.
The same principle applies when discussing prognosis. Children frequently internalize labels that adults casually assign. Statements such as “You’ll probably always struggle with this,” “You have a weak immune system,” or “Your body doesn’t handle pain very well” can unintentionally become part of a child’s identity. In contrast, language that emphasizes growth and adaptation—”Your nervous system is learning,” “Your body is remarkably good at healing,” or “Many children improve with practice and time”—fosters hope while remaining scientifically defensible.
This is not about positive thinking replacing evidence-based medicine. Rather, it recognizes that communication itself is an evidence-based intervention. Every conversation alters expectations, and expectations influence physiology. Modern neuroscience continues to demonstrate that the brain constantly predicts future experiences, and those predictions shape perception, pain, autonomic function, and symptom generation. Our words become part of those predictions.
Perhaps the most important lesson I took away from pediatric hypnosis training is that suggestion is not confined to formal hypnosis sessions. Every office visit contains elements of suggestion because every child enters the room expecting us to help them understand what is happening. In that sense, physicians occupy a uniquely influential role. We cannot avoid shaping expectations; we can only choose whether to do so intentionally.
As integrative pediatricians, we often speak about treating the whole child. Choosing our words carefully is one of the simplest, least expensive, and most powerful therapeutic tools we possess. By communicating honestly while cultivating realistic hope, reinforcing resilience, and framing treatments in ways that minimize unnecessary fear, we may reduce the nocebo effect while simultaneously strengthening one of the oldest medicines in pediatrics: the healing relationship between physician, child, and family.