Adults have found relief in acupuncture for over two thousand years, but American practitioners have traditionally been adverse to actively seek out and treat children, as evidenced by the small niche that pediatric acupuncture occupies. However, treating children with acupuncture, using appropriate techniques, is safe and effective. Additionally, more and more adults are realizing the benefits of acupuncture for themselves, so it is logical that they might also use acupuncture to treat their children. In the last decade I’ve witnessed tremendous growth in the pediatrics specialty brought about by greater demand by parents and a growing number of acupuncturists seeking training.

When I first became licensed in 2003, I never imagined that I’d end up becoming a pediatric acupuncture specialist. My journey to this specialty started simply from the desire to help my infant son heal from a severe case of eczema that wasn’t responding to Western medical treatments. Only after I began treating him with acupuncture, herbal medicine, and dietary changes did his eczema begin to resolve. As I shared my son’s story with my patients, I found that many of their children suffered from conditions that could be treated with acupuncture such as colic, constipation, cough, and ear infections to name a few. Inspired by my son’s story, my patients began to bring their kids in for treatment, too. As word spread about how acupuncture helped these kids, I began seeing even more children and this is how my family practice was born. Today, my practice is comprised of approximately 30 percent babies, children, and teens.

The most surprising thing I found about pediatric acupuncture is that, contrary to what many adults think, kids actually like getting acupuncture. I’ve had babies use sign language to sign for “more” and children that aren’t feeling well ask their moms to schedule a visit with me. Children like acupuncture when they know it helps them feel better. I really enjoy treating kids because the treatments are more playful and spontaneous. They are gratifying to treat because they respond so well and quickly to acupuncture. Recently, I treated a little boy with pneumonia and persistent wet cough. His mother called the next day to tell me that after his session he finally stopped coughing and was able to sleep through the night. Parents are so grateful to me for helping heal their kids by augmenting Western medical treatments.

The key to helping kids learn to like acupuncture is how you approach and honor each child and their receptivity to needles. In this article, I will share some of my practical pearls of wisdom for explaining acupuncture to kids, approaching them with needles, and my painless needling technique. Pediatric acupuncture takes an entirely different approach than when you’re working with adults. When treating an adult there’s an order and routine to the treatment, the needles stay in much longer and they can tell you if something you’re doing is uncomfortable or isn’t working for them. However, working with kids can be challenging because they are often unaware of their physical needs and how to verbally express their symptoms. Sometimes, they are unsure about the process of acupuncture and why it will help them. It’s very important to bring positive energy to each treatment—kids can tell if you’re not feeling connected or are uncomfortable.

Through trial and error I have learned how to treat kids with acupuncture successfully. Just about every child I work with tries acupuncture because of the systematic way I introduce it to them and their parents. From my experience I have developed a philosophy about pediatric acupuncture that I know helps my patients find success with the course of treatment. There are four cornerstones to my philosophy:

1) Trust
2) Respect
3) Flexibility
4) Connection/Play

1) Trust

Building trust with kids is the most important thing you can do. If kids trust you they will be more willing to try something you ask, even if they’re a little afraid. Tricking a child or using distraction to needle them without their permission is not recommended. You can trick them once, but they probably won’t want to come back again. Be patient and eventually they will try acupuncture needles. In the mean time, you can use other non-needle techniques to stimulate the acupuncture points such as microcurrent, laser, shonishen, or tuina massage.

2) Respect

You’re treating a human being in a child’s body, and you should treat her with the same respect for her body and emotions as you would an adult. Many children have been hurt or traumatized by medical providers. Even if it was necessary in the course of treatment, it is still traumatic. That’s why it’s important to make sure you have permission before you touch or treat them with acupuncture. Be gentle and firm and always start by asking them to try acupuncture first before giving other options. If they’re absolutely adamant about not getting acupuncture, respect their decision.

3) Flexibility

With adults there is not much variation in treatment flow, but with kids it’s totally different. To be successful in delivering pediatric treatments, let go of rigid ideas of how you think a pediatric visit should be and go with the child’s flow. If what you’re doing is not working, then do it differently—change it up!

You can change it up by:

  • Changing the point you’re working on
  • Moving location of treatment—mom’s lap, on the table, standing up, or on their belly.
  • Switching to a different modality— massage, microcurrent, shonishen, or laser.

As you do the treatment, communicate with the parents but also talk to the kids about their own bodies. You’re interaction should be guided by the child. In other words, meet the child where they’re at. Are they shy? Outgoing? Fearful? Curious? Ready? Need mom close by? Need distraction? Pay attention to what they need even if they’re not able to verbalize it.

4) Connection and Play

In TCM, we use the Five Elements to understand the unique way of being each child has that shapes his behavior, temperament, and how he interacts with his environment. The Five Elements are Wood, Fire, Earth, Metal, and Water. Each Element represents an archetype that corresponds to a certain way of being in the world. Once you determine a child’s Five Element type, you can use this knowledge as a guide for connecting with treating him in a way that honors his true nature. For example, you may want to challenge a Wood child, bring singing and playfulness into your treatment for a Fire child, talk about friends or pets with an Earth child, explain what you’re doing step-by-step with the Metal child, and allow the Water child to read a book instead of chatting with you. Each Element requires a different approach and this increases your chances of successful treatment.

Using play is a great way to make treatments fun. Just be sure not to bring too much excitement or you may lose control of the session. Singing, jokes, toys, and drawing are examples of how you can use play in your treatments. Do whatever feels natural to you to connect with kids.

What are kids commonly treated for?

In my practice, I typically see babies and children for chronic rhinitis, upper respiratory tract infections, acute and chronic otitis media, allergies, asthma, eczema, and digestive disorders. For teens, I also treat acne, anxiety, depression, and pain conditions. Overall, I treat kids for the many of the same conditions as adults. For a complete list of the most commonly treated pediatric conditions see Table 1.

How do you explain acupuncture to kids?

The biggest obstacle to treating kids is the word needle. It conjures up images of shots, blood draws, being poked, and memories of being hurt. Acupuncture needles are nothing like hypodermic needles, but once the word needle is out there you can’t take it back. You may lose a patient that you could otherwise treat if they become fearful you’ll hurt them. To avoid the fear and apprehension that is commonly associated with the word needle I coined the term “tap” to refer to acupuncture needles. Children don’t have a frame of reference for “taps” and the term sounds harmless. Who’s afraid of a little tap? I started using this term because I rub and tap the acupuncture point before insertion and I tap the needle in. If children ask if it’s a needle I will tell them the truth, but I’ll make sure to differentiate between a hypodermic needle and an acupuncture needle.

Explaining Acupuncture to Children

Before I show a child “taps” I make sure they understand that I won’t do anything to their body unless I have their permission. I make it clear that I won’t trick them or treat them against their will. I also give them permission to tell me if they’re scared or if something I’m doing is uncomfortable. Since building trust is my primary goal, it allows me to go at the child’s pace so we can continue the treatments long-term if necessary. Many kids visibly relax once they know they won’t be forced to do something they don’t want to do, making them more receptive to trying acupuncture.

As I show kids a “tap”, I open up an acupuncture needle and take it out of the package. I hold it up in the air and I talk about how tiny it is and how it’s barely visible in the tube. I tell them about the hundreds of other kids that were a little scared of “taps” until they tried them and realized how easy and painless they were. Then I explain how “taps” help the body heal itself when I place them at special points on the body.

I make sure to show the child how the taps are placed. I pretend my massage table is a child and I show them how I rub and tap the point and then tap it in. Then I ask the child if they want to try it. Many children will say “yes” at this point. If the child is still a little apprehensive, then I’ll demonstrate the “taps” on their mother or father, so the parents can reassure their child how easy and painless it really is. If the child still refuses, acts afraid, or cries then, at this point, I switch to other non-needle techniques.

What are the guidelines for pediatric needle technique?

First, I use extremely small gauge needles for pediatric acupuncture, which allows for a virtually painless experience. The small gauge allows me to insert needles even at sensitive points such as Bitang or LR 3. In babies and toddlers, I most often use 46 gauge half-inch needles. In small children, I use 44 gauge half-inch needles and for teens, I’ll use 42 gauge half-inch or one-inch needles. In my experience smaller gauge needles are just as effective as larger gauge needles in children.

Second, I always apply pressure, rub, or tap the acupuncture point with my finger before inserting the needle. This “warms up” or desensitizes the point before the needle is inserted. I also use this time to engage with child, check in with their body language and make sure they’re ready. If they are cringing, tensing or pulling away, then I stop and see what’s going on and reassure them that it will be okay. Distractions, such as having the child wiggle their toes or eyebrows, can help them relax if they’re feeling a little nervous. Needling when the child is scared or tense may increase needle sensation during insertion. Once I know the child is absolutely ready, I press my finger down next to the tube to provide added pressure as I tap the needle in. This also helps desensitize the point and provides a virtually pain-free experience.

For babies, I use an in/out needle technique, which means the needle is inserted and immediately removed. In my experience, I have found that this works for babies and kids up to approximately age eight. After age four, I encourage kids to retain the needles for anywhere from 10 seconds to several minutes. Most kids ages eight and up can retain that needles anywhere from one to 15 minutes depending on their age and comfort level.

What is the recommended treatment frequency?

How often I treat a child depends on the nature and severity of their health condition. For example, if I’m treating a baby for painful acute otitis media, I may recommend treatment three treatments in the same week to help reduce the pain and treat the infection. For a case of asthma that is exacerbated and has required several recent emergency room visits, I would start with twice weekly for two weeks, then weekly for twelve weeks. Once symptoms improve the frequency is reduced to twice monthly depending on how the illness is resolving, but total treatment time for chronic asthma may be six months to one year. On average, I recommend a course of six to twelve treatments and then reevaluate the child’s progress. Many mild cases resolve within one course of treatment, although chronic cases may need treatment at varying frequencies for up to a year.

Children enjoy acupuncture and it’s a viable treatment options for many kids with conditions such as ear infections, digestive problems, pain, allergies, and asthma. It can augment or support Western medical treatments and improve clinical outcomes. To help kids learn to like acupuncture, be sure to build trust, be flexible, go with the child’s flow, and use play to connect with them. Explain and demonstrate acupuncture in a way that allays their fears. Use the term “tap” instead of “needle” for kids that are apprehensive about getting treatment. When properly introduced to acupuncture, kids are open and receptive and can benefit from acupuncture treatments throughout childhood.