Acupuncture, which is the most commonly used method among traditional and complementary medicine methods, has recently begun to be used also in pediatric cases. In the present review, acupuncture procedures performed by acupuncture needle in pediatric cases were evaluated. Studies have revealed that there are fields in which acupuncture is beneficial and not recommended for pediatric diseases. The use of acupuncture is recommended for the treatment of nocturnal enuresis, pain, nausea-vomiting and allergic diseases in children. Acupuncture and acupressure studies in neonates have also been initiated. Further studies are needed on the applicability of acupuncture in pediatric patients. How important is the benefit brought by acupuncture to children, it is also important who would perform acupuncture and which method would be used.
Among complementary medicine methods, acupuncture is a therapeutic method being used for a long time. Acupuncture is known to be effective for the treatment of numerous diseases and has been used in Asia for thousands of years. Acupuncture is the most commonly used method among Traditional Chinese Medicine. The effectiveness of acupuncture is explained in terms of concepts such as Qi, Yin, and Yang in Traditional Chinese Medicine. Acupuncture is performed by stimulating the certain acupuncture points identified on the body surface by needle, laser, heating or pressure. Acupuncture is becoming a more popular method day by day all over the world. While 2 million adults received acupuncture in 2002 in the USA, it reached to 3 million in 2007. It has been determined that 4% of the individuals in the USA have acupuncture procedure in anytime of their lives. The use of acupuncture has become widespread with the consensus of the National Institutes of Health (NIH) in 1997, in which effectiveness and usability of acupuncture for postoperative and chemotherapy-related nausea- vomiting and tooth pain are decided unanimously [
Acupuncture has recently become a therapeutic method preferred also in pediatric patients. The demand for complementary and alternative medicine for pediatric patients ranges at a rate between 2% and 20% - 30%. It has been observed that parents using any complementary medicine for themselves prefer a complementary medicine technique also for their children. According to a research conducted in 2007, acupuncture has been preferred for 0.2% (150,000) of children in the USA [
In the world, many algology centers have acupuncture units. It has been stated that one third of pediatric pain clinics in the USA have acupuncture units. Among the complementary medicine methods used in the pediatric pain centers in the USA, acupuncture ranks second with a rate of 32% [
Along with the use of acupuncture procedures in pediatric patients, safety has been the most emphasized issue. In a study on acupuncture safety conducted in 2009 in 229,230 subjects with a mean age of 46 years, adverse events were reported by 8.6%, the most common adverse events were bleeding (6.1%) and pain (1.7%), and it was suggested that ecchymosis and pain that would occur in children led to more concern than those that would occur in adults [
In the literature, there is a limited number of safety studies conducted on acupuncture in pediatric cases. Presence of well-planned application protocols and implementation of these protocols by experienced physicians are important to be protected from serious adverse events [
It is more difficult to perform acupuncture in children than in adults. Fear of needle in children definitely enhances this difficulty. Children should be approached with love and a safe environment including objects they would enjoy, such as toys and dolls, should be prepared before the acupuncture procedure. Performing acupressure prior to acupuncture may facilitate compliance in some children [
Acupuncture is performed by inserting acupuncture needle into an acupuncture point on the skin. Receptors such as nociceptive receptors, Meissner’s corpuscle receptors, Krause’s end-bulb receptors and Golgi tendon organ receptors are found intensely in the acupuncture points [
Acupuncture performed on the Back-Shu, Front-Mu and HuaTuo Jiaji points is effective in the treatment of visceral organs. Effect of acupuncture can be explained by viscerocutaneous, cutaneovisceral, and visceromuscular reflexes. Localization of Back-Shu, Front-Mu and HuaTuoJiaji points are associated with segmental distribution of sympathetic and parasympathetic systems. Changes in visceral organs due to acupuncture procedure can be explained by sympathetic and parasympathetic system modulation [
Acupuncture has been usually performed in children for nocturnal enuresis, diseases with pain, diseases with nausea and vomiting, and gastrointestinal, neurological, and allergic system diseases.
The rate of monosymptomatic nocturnal enuresis is encountered in 15% - 20% of children aged about 5 years and this rate decreases as the child grows up and is approximately 5% in adulthood. The treatment of monosymptomatic nocturnal enuresis includes drugs, behavioral therapies and some other conventional methods. In a review, in which complementary and alternative medicine methods performed for nocturnal enuresis was scrutinized, it was determined that 1283 of 2334 children with nocturnal enuresis were using one of the complementary medicine methods [
Björkström et al. [
In a recent study, patients with a mean age of 15.7 years who had monosymptomatic nocturnal enuresis were divided into three groups and the first group underwent laser acupuncture alone, the second group received desmopressin alone, and the third group both underwent laser acupuncture and received desmopressin [
Acupuncture is most commonly used in the treatment of pain in adults and mostly its analgesic effect has been investigated. Similar studies have also been conducted in children. In a retrospective study evaluating 47 pediatric and adolescent patients aged 5 - 20 years who had chronic pain and underwent acupuncture procedure, children-reported decrease in pain was 67% and parent-reported decrease in pain was 60% [
Although there are many studies on acupuncture procedure for the treatment of headache and migraine in adult patients, this subject has not been studied adequately in children.
In their review, Gold et al. [
In a study, acupuncture and hypnosis were performed in the same session in 33 children aged 6 - 18 years and having chronic pain. It was stated that there was a significant decrease in anxiety symptoms and complaint of pain after treatment [
In a study, acupuncture was performed two times for 10 - 15 minutes with 24-hour interval in children aged between 7 months and 18 years, who were postoperatively hospitalized at a tertiary referral pediatric intensive care unit [
The efficacy of acupuncture in adult and pediatric patients was studied mostly on nausea. Many studies have demonstrated that the use of acupuncture point PC6 decreases nausea and vomiting. This efficacy has also mentioned in classical textbooks. Bolton et al. [
Butkovic et al. [
In a study performed to reduce the adverse events of chemotherapy in adult patients with cancer, a significant improvement was observed in nausea and vomiting [
It has been expressed that in addition to anesthesia-related nausea and vomiting, complementary medicine might also be effective in reducing anxiety of children [
Constipation is a common condition also in children. Behavioral therapy and massage techniques are used in the treatment of constipation in children. Despite numerous acupuncture points that might be effective on the gastrointestinal system, the relation between acupuncture and constipation has not been studied enough in pediatric patients. In China, a success rate of 81% was achieved with acupuncture in the treatment of adult patients with constipation. In a study, LI11 point was stimulated for three successive days without giving laxatives in 10 patients having hospital-induced constipation and spontaneous defecation was observed 2 hours after treatment [
Acupuncture has been tried as a therapeutic option for the treatment also for pediatric cases with refractory seizure. In a study from China, in which acupuncture + Chinese herbal medicine or Chinese herbal medicine alone or carbamazepine alone was given to 64 boys (1 - 17 years of age) with seizures, decreases in the number of seizures were reported in all groups without statistically significant difference among the three groups in terms of success of the therapeutic method [
In China, acupuncture is performed in many children with neurological sequelae. In a study, tongue acupuncture was performed for more than 30 days in 10 patients with drooling problems and it was reported that the method was beneficial [
In the 2008 Cochrane review [
Cerebral imaging studies have been conducted by performing acupuncture in children with cerebral palsy and in normal children. Differences have been determined between the images obtained during acupuncture therapy. It has been emphasized that studies on the use of acupuncture for the treatment of cerebral palsy should continue [
In a randomized controlled study published in 2013, acupuncture was performed in half of 56 preschool children with asthma and the other half was included as the control group [
In Egypt, laser acupuncture was performed 3 sessions per week in 50 children followed for asthma and it was stated that an improvement in respiratory function tests were observed, beta-mimetic drugs were discontinued, and the dose of inhaled corticosteroids was reduced after the 1-month treatment period [
In a randomized controlled study conducted in Hong Kong in 72 children aged 6 - 20 years, who had allergic rhinitis and underwent acupuncture procedure, a significant reduction was reported in the symptoms of allergic rhinitis at the end of 3 months [
In a survey conducted by Landgren [
Ecevit et al. [
Benefit and efficacy of acupuncture in the treatment of hypoxic-ischemic encephalopathy, which is an important problem in neonates, were investigated; however, no noteworthy study could be found [
Raith et al. [
There is a need for randomized controlled studies on the pediatric use of acupuncture, which is a widespread complementary method of treatment. It is obvious that acupuncture, which is associated with has low rates of serious adverse events when performed by experienced acupuncturist physicians, and would contribute to healing in pediatric diseases. We are in the opinion that development of guidelines for acupuncture procedures in pediatric patients will be beneficial for acupuncture to be performed safely in children.
Demet Tas,Mehmet Tugrul Cabioglu, (2016) Acupuncture in Pediatric Diseases. Open Access Library Journal,03,1-9. doi: 10.4236/oalib.1102611