Putting children under the needle for acupuncture appears safe when performed by trained practitioners, researchers concluded in a systematic review.
Only mild adverse effects dominated among those reported with pediatric acupuncture, accounting for 253 of 279 events recorded in the literature over the past 60 years, Sunita Vohra, MD, MSc, of the University of Alberta in Edmonton, and colleagues found.
Of the 25 serious events reported among 1,422 patients treated in the included studies, many appeared to have been caused by "substandard practice," they noted in the December issue ofPediatrics.
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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