In an analysis of 37 studies or case reports, Canadian researchers found that in over 1,400 children treated with acupuncture, just 168 experienced a mild adverse reaction, such as crying or pain. The investigators found 25 reports of serious adverse events.
"In trained hands, acupuncture seems safe in children," said the study's senior author, Dr. Sunita Vohra, a professor in the department of pediatrics at the University of Alberta in Canada.
Results of the study are published online and in the December issue of Pediatrics.
Acupuncture is a treatment that is said to have originated in China thousands of years ago. In Eastern medicine, acupuncture is believed to open the channels where a person's Qi (pronounced chee), or life force, is blocked. In Western medicine, it's more commonly believed that acupuncture works by stimulating the release of the body's natural painkillers, according to the U.S. National Center for Complementary and Alternative Medicine.
Stimulation of certain areas to release the blocked Qi (called acupoints) can be done through the insertion of very thin needles or with heat, pressure or a laser, the study authors pointed out in background information in the article.
Acupuncture is used for a variety of problems, such as pain, nausea, vomiting, anxiety and muscle spasm, according to Vohra and Dr. Raymond Pitetti, the associate medical director of the emergency department at Children's Hospital of Pittsburgh. Jeannie Kang, president of the American Association of Acupuncture and Oriental Medicine, added that acupuncture is also used for sprains, allergies, asthma, and menstrual cramps and irregularities.
Risks of acupuncture are important because evidence of efficacy is "still being developed" in pediatrics, as the group pointed out.
Vohra and colleagues reviewed 37 studies, among which nine randomized controlled trials accounted for roughly half of the adverse events reported. Most of the rest were case reports or case series.
Mild adverse events included pain, bruising, bleeding, and worsening of symptoms and had an overall incidence of 11.8% (168 events in 1,422 patients).
The majority of the 25 serious events reported in children treated with needle acupuncture were thumb deformity, usually after at least a year of acupuncture. All 12 cases of fibrotic changes in the thumb or fibrosis of the thumb adduction muscle were treated with corrective surgery.
Five serious infections reported consisted of one case of HIV, one septic sacroiliitis, one septic arthritis of a lumbar facet joint, a pyogenic spondylitis, and a case of subperiosteal abscess and osteomyelitis of the frontal bone.
These adverse events might have reflected "inadequate sterilization, either of the site or needles," the researchers pointed out.
One case of cardiac rupture was reported in a boy found on autopsy to have needle holes in the diaphragm, pericardium, and right ventricular wall, for whom the cause of death was deemed puncture of the heart.
One case of pneumothorax, with signs of lung scarring at the needling location, occurred in a girl getting acupuncture for an acute asthma attack.
These two cases likely resulted from improper technique or poor knowledge of anatomy, Vohra's group suggested.
"The case of cardiac rupture is particularly disturbing because of the numerous errors that were made, by modern standards, including the insertion of needles through clothing," they wrote in the paper.
"Current acupuncture regulations precisely detail protocols intended to maximize the safety of acupuncture practice, including procedures for sterilization and needling in the area of organs," the researchers added, "but it is unknown what regulations were in place at the times and places of these adverse events."
Another serious adverse event was a case of nerve impairment in a boy found to have more than 70 needles embedded throughout his body, including in the cervical spinal canal.
This case "might have been a result of a practice that was common in Japanese acupuncture and included deliberately breaking needles and permanently embedding them in the body," Vohra's group noted.
Other serious adverse events reported included:
One case of subarachnoid hemorrhage after acupuncture that included insertion of a needle to a depth of about 2 inches near the thyroid cartilage, which was suspected to have damaged meningeal or cephalic blood vessels
One case of intestinal obstruction with an egg-sized hematoma after acupuncture administered for diarrhea
One case of coughing up blood that resolved after a needle was found embedded in the boy's lower right thorax
One case of reversible coma in a boy with posterior cerebral hypoperfusion, with the coma thought to have been from lying on his right side during the acupressure rather than the treatment itself
The researchers cautioned that their review was limited to conventional, English-language reports, therefore perhaps missing other reports in other languages from Japan, China, and elsewhere.
The small number of participants included in the reviewed studies limited ability to draw conclusions about the overall safety of pediatric acupuncture, they acknowledged.
Vohra and colleagues concluded that large prospective studies are needed to produce the kind of convincing risk estimates determined for adult acupuncture.
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