Acupuncture: A Viable Option for Children
from Clinical Update, Spring 2003

Abstract: For children suffering from cancer-related nausea and chronic pain, acupuncture may deliver relief. A staple of Chinese medicine, acupuncture is finding increasing acceptance in the U.S. as studies confirm its validity.

Kathi Kemper, M.D., a pediatrician at Brenner Children’s Hospital, says using acupuncture may relieve some side effects of medical treatment and make pediatric patients more comfortable, according to a study published in Contemporary Pediatrics (Dec. ’02).

“I recommend acupuncture be used as an adjunctive therapy for children who experience chronic, recurrent or severe pain such as migraine, severe chronic abdominal pain and pain associated with cancer and nausea,” Kemper said. “Several studies have shown that acupuncture is effective in the treatment of headaches in pediatric patients. Acupuncture is safe and effective. For patients who have no interest in taking additional medications or who are already receiving maximal medical treatment and want help with symptoms, acupuncture is a viable alternative.”

Kemper says that patients can gain relief from nausea as well.

“In our clinical experience, pediatric oncology patients often report great relief from a combination of professionally administered acupuncture and over-the-counter acupuncture wrist bands,” she said.

Kemper says some patients prefer acupuncture because its side effects include an enhanced sense of well-being and alertness and reduced pain.

Acupuncture is the most familiar of the several therapies that make up traditional Chinese medicine. The practice of and research on acupuncture have flourished in the United States over the past 30 years. The Food and Drug Administration, which regulates acupuncture needles as disposable medical devices, estimates that in the 1990s Americans made 9 million to 12 million annual visits to acupuncturists and spent approximately $500 million each year on acupuncture services.

Despite this growth, access to acupuncture services for most children remains limited because few acupuncturists treat children and few insurance companies provide full coverage for services, Kemper said. “Many pediatricians rarely think of acupuncture as a therapeutic option due in part to the lack of training in and familiarity with acupuncture,” Kemper said.

Another key factor is that pediatricians subscribe to conventional wisdom that children are afraid of needles, Kemper said.

“Our studies have shown that children suffering from severe, chronic pain may be willing to try this alternative,” Kemper said. “Many patients who receive acupuncture treatment remark on how much less painful it is than conventional needles and many acupuncturists use a variety of non-needle techniques to stimulate acupuncture points.”

Many children’s hospitals — including Brenner Children’s Hospital — do not currently offer acupuncture services. Kemper says she hopes that as more acupuncturists become available in more mainstream clinical settings and as insurance plans are encouraged to cover the treatment, pediatric access will grow.

For more information, visit the Brenner Children’s Hospital website at www.brennerchildrens.org.

How to Find and Work with an Acupuncturist

Pediatricians working with acupuncturists should be familiar with local providers, World Wide Web resources and with the basic procedures, expected outcomes and side effects of acupuncture treatment. Acupuncturists welcome referrals from physicians and are usually more than happy to develop a working relationship, including regular communication. Before referring patients, physicians should speak with any practitioner, visit the office and consider having a treatment so they can better inform patients about what to expect. If there is an acupuncture school in your area, call for the names of graduates. Ask your patients which practitioners they have seen and what their experience has been.

Before referring, it is useful to get answers to the following questions:
• What are your state's requirements for acupuncture practice?
• Has the acupuncturist graduated from an accredited school? (Find accredited schools at www.acaom.org)
• Has the acupuncturist passed the National Commission for Certification of Acupuncture and Oriental Medicine exam or its equivalent? (NCCAOM information is available at www.nccaom.org.)
• Does the acupuncturist have special training in pediatric acupuncture? If yes, ask the practitioner to describe that training.
• How long has the acupuncturist practiced, and how many pediatric patients are seen weekly? (At least 12 months of experience with at least three weekly pediatrics visits is recommended.)
• What style of acupuncture is practiced and are non-needle techniques used? (Japanese acupuncture, for example, is often gentler than Chinese acupuncture.)
• What are the typical fees? Is insurance accepted, and which types? Is there a sliding fee scale?
• Does the practitioner carry malpractice insurance? Has he or she ever been sued for malpractice, lost privileges or been forced to leave a practice or group?
• How many continuing education credits has the acupuncturist earned in the past three years?
• Does he or she belong to any local, state or national professional groups?
• Are herbs or other products recommended or sold through the acupuncturist’s office? If so, how certain is he or she of the purity and lack of contamination of these products?
• What are the referral patterns? Does the practitioner refer to other acupuncturists, specific chiropractors, massage therapists, psychologists, naturopaths or other healthcare providers? Does she work with clergy, schools, coaches, tai chi schools or other professionals or institutions?
• How many patients are seen per hour? How long is an initial office visit? (More than three patients per hour raises questions about thoroughness and attention to detail and the unique needs of children; initial visits less than 45 minutes raise similar questions.)
• How often is a new patient typically seen? What is the end point for that patient? (Most acupuncturists see new patients two or three times a week to treat an acute problem, and expect to see some improvement within five treatments.)
• What are the most common side effects of treatment? (If he or she says no patients report side effects, including bleeding or bruising at a needle site, the acupuncturist may not be a keen observer or a complete reporter.)

It is important for physicians to communicate their specific goals and objectives for their patients, as well as how often and under what circumstances they want to get status reports.