Biofeedback in Pediatrics: A Q&A with the Seattle Children’s Biofeedback Team

Biofeedback is a technique that helps children, adolescents and young adults learn how to voluntarily control their body’s response to stress and pain to improve their health. We sat down with the Seattle Children’s Biofeedback team to learn more about exactly what biofeedback is and how it can help pediatric patients.

Question: For anyone that is not familiar with Biofeedback, could you explain what it is?

Answer: Biofeedback therapy is one type of mind-body medicine that often uses sensors and screens to show a patient their body’s biometric responses in real time. Patients are then coached on how to become aware of what is happening in their body and employ techniques to change how the body responds.

Q: What is the biggest misconception about biofeedback therapy?

A: That we are the “relaxation” or “meditation” experts. Some of our techniques do borrow from the meditation or mindfulness world and so we’re often miscategorized. Biofeedback therapy is sometimes misconstrued as a “magic bullet” for all kinds of conditions where a patient will miraculously get better. Rather it is more like going to a gym to build muscle strength, but for the nervous system. Once a patient gains proficiency in these techniques, we often try to trigger their stress response in-office, as best as possible, so they can develop the resilience to manage their body’s response to that stressful condition. In short, it is nervous system training, with the goal that the patient can meet and manage their stress response appropriately given the circumstance.

Q: How does biofeedback work for kids—are the techniques different than for adults?

A: The techniques are not significantly different in a pediatric population versus an adult population. The major differences lie in how the techniques are introduced and coached. They work in the same principle though, observing the body’s response to stimuli and regulating that response as desired. 

Q: What conditions in children and adolescents are most commonly treated with biofeedback?

A: At Seattle Children’s, the most prevalent condition patients are referred for is head pain (headache, migraine, and other variants in these families). However, we see a lot of abdominal pain, nausea, and orthopedic pain patients as well. Occasionally do we receive referrals for other less common conditions such as Raynaud’s phenomenon or “white coat” hypertension, but they may be a good candidate for biofeedback therapy as well.

Q: How long does a typical course of biofeedback therapy last, and how soon might a patient expect to see results?

A: The biofeedback therapy program at Seattle Children’s is typically six sessions long, with each session being one hour in length.  There is also a “check-in” and “check-out” session with a provider who specializes in ensuring a patient is a safe and appropriate candidate for biofeedback therapy. 

Onset of results varies on patient’s condition, length and type of symptoms, and level of engagement in biofeedback practices. We have seen patients’ conditions improve significantly in as little as a week while others may have minimal to no symptom change after the entire series depending on the case. Most see maximum improvement in symptoms after about three to six months of routine, regular practice. 

Q: Should patients expect to need ongoing biofeedback therapy throughout their life?

A: Not typically. Often patients adapt to these skills and “generalize” them if they practice consistently in the beginning. Generalization is the phenomenon we observe when patients engage with their skills unconsciously and continue to regulate their body’s response. This can also occur in a conscious but more passive manner as well. 

Our program occasionally offers “refresher” sessions to patients should they need to adjust their practices to manage their symptoms better. If a patient needs a refresher session, then only one or two visits are required to return to successful practice. Ultimately, we are trying to help patients to gain the agency necessary to feel empowered in regulating their body’s response to pain or stress without outside intervention. 

Q: Are there any risks, side effects, or children for whom biofeedback is not recommended?

A: Although somewhat rare, there are a few relative contraindications to biofeedback therapy. 

Conditions like obsessive-compulsive disorder (OCD) may be exacerbated by biofeedback therapy if a provider is unaware that a patient has this condition.  In this case the patient may become fixated on “making the numbers right” or “correct” which could exacerbate the condition.  If a biofeedback therapist knows that this is a condition the patient is dealing with, then they can adjust therapy appropriately to avoid potential exacerbation of symptoms. 

Patients with untreated or unmanaged post-traumatic stress disorder (PTSD) may not be ideal candidates for biofeedback therapy. This type of therapy requires patients to develop and deepen their awareness of internal bodily sensations (interoception), which could potentially trigger re-traumatization. Proper assessment and referral are important to ensure the patient receives appropriate care and to avoid negative outcomes. For those with PTSD who have a strong support system and coping strategies, biofeedback may be a safe and effective treatment.

For More Information

• Visit the Biofeedback Refer a Patient page to learn more about referring patient
• Watch the Seattle Children’s Biofeedback program’s informational video
• Watch a video on Avery’s experience with biofeedback therapy at Seattle Children’s
• Review patient and family resources