Pediatric Anesthesia. 2024;00:1–4. wileyonlinelibrary.com/journal/pan | 1 © 2024 John Wiley & Sons Ltd. It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change. —Charles Darwin 1 | INTRODUCTION Anxiety in the pediatric population world-wide manifests as uncon- trollable worry, fear, panic, and hyperarousal. Anxiety is an overesti- mation of risk, and an underestimation of inner resources to resolve or cope. Pooled estimates in 2020 indicate that one in five youth globally were experiencing increased anxiety symptoms, which is double that of the pre-pandemic period. 1 Children admitted electively or urgently to hospital are also often in a heightened state of awareness, arousal and anxiety. Managing hospital-induced anxiety is clearly of relevance to patients and their families, as reducing fear and anxiety is rated the number three top consumer research priority in pediatric anesthesia, second to safety and more effective communication. 2 Hypnotic techniques are becoming integrated in many areas of pediatric care. They are not, as yet, well established in pediatric anes- thesia and pain management, but do provide a very valuable adjuvant to standard care. Original evidence is needed to promote its wide- spread use. In this volume, the research article “Avoiding pain during propofol injection in paediatric anaesthesia: hypnoanalgesia of the hand versus intravenous lidocaine” by Polomeni et al., we commend the authors on highlighting hypnosis research applied to pediatric an- esthesia, and on their large sample size and positive findings. 1.1 | Hypnosis as therapy Therapeutic hypnosis can be defined as “a state of focused attention, reduced peripheral awareness, dissociation, and increased response to suggestions.” 3 It is an established non-pharmacological technique with the power to reduce anxiety and improve a youth's confidence, competence, and connection. Hypnosis can modify the perception of threat, transforming verbal messages into internal visual and audi- tory images with the activation of the occipital and temporal brain areas. 4 The self-control is achieved with hypnosis in hospital, using internal coping resources, provides patients with valuable life skills that extend far beyond the acute care setting. Research on the neural correlates of hypnotic phenomena in- dicate dynamic brain activity changes affecting key neural brain networks; for example, the central executive network, salience net- work, and the default network. 5,6 The central executive network (the posterior parietal cortex and dorsolateral prefrontal cortex) is Received: 10 May 2024 | Accepted: 16 May 2024 DOI: 10.1111/pan.14942 PERSPECTIVE Innovative change not as yet fully integrated in pediatric anesthesia Gillian Lauder 1 | Leora Kuttner 2 1 BC Children's Hospital, Vancouver, British Columbia, Canada 2 Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada Correspondence Gillian Lauder, BC Children's Hospital, Vancouver V6H 3V4, Canada. Email: glauder@cw.bc.ca Section Editor: Thomas Engelhardt Abstract Pediatric hypnosis is an extremely valuable adjuvant therapeutic tool to reduce pain and ameliorate anxiety in children undergoing procedures and pediatric anesthesia. This perspective summarises; why Integrating hypnosis into practice has this poten- tial, some techniques that are particularly useful in this setting, the training oppurtu- nities to learn more, and recommendations for future pediatric anesthesia hypnotic research. There is definite capacity for change by Integrating hypnosis into our practice. Not only will this ensure more capable, confident children who present for peri-operative care but also reduce costs and the environmental impact of the phar- maceutical agents we currently employ for sedation and anxiolysis. KEYWORDS age; adolescent, age; child, pain; miscellaneous