This is written by a practitioner who feels passionate about treating children, and which is very much from the perspective of personal experience. She encourages the use of acupuncture, acupressure, tui na, herbs, moxa, cupping and other adjunctive therapies. Examples of three case studies show how these techniques can be used in practice, as well as how to involve parents in the use of simple techniques at home to help their children maintain their health.
I have long wanted to write something to encourage people who may have been wondering about treating children, but with my own children, my practice and other commitments, it has never seemed like the right time. However, I have a passion for the subject and hope that this will come through. This will not be an academic paper but one based on what I have observed over the past 30 years – from living with children and working with them, as a childcare worker, nanny, youth club worker, mother and, in the past ten years, as a professional acupuncturist.
The main points I want to make in this article are: • Children need traditional Chinese medicine, possibly now more than ever. • We need competent and confident practitioners for children. • We need a recognised training that gives people that confidence and competence. • We need to promote TCM passionately as a valued option for parents who may not be aware of its potential for their children. • Whether we treat children or not we need to understand the issues facing parents these days; many of our patients will be parents or carers and may want to talk about these issues.
The tradition of treating children with tui na goes back a very long way indeed (581 - 1644 AD). In recent times there has been a lot of dedicated work on the subject of treating children with acupuncture, particularly by Julian Scott, Teresa Barlow, Bob Flaws and Stephen Birch, among others. There are many more healthy young adults around because of their work.
Childhood has always been a precarious time, and in ancient times survival depended on strong qi in order to fight off external pathogens. These days we have different sorts of challenges facing our children, but no less dangerous.
Acupuncture, acupressure, tui na, herbs, moxa, cupping, and many other adjunctive therapies can help children to face the 21st century. We also need to support parents to do their best for their children in these increasingly complex times, so those of us who are able to do so can share our knowledge of the techniques which can be easily applied in the home to help treatments be more effective.
CASE ONE B; date of birth: 12 October 1994. B first came to me on 24 January 2001 after his adoptive parents had met an acupuncturist at a conference, who suggested they contact me for help with B’s developmental problems.
He had been born six weeks prematurely, and was kept in a special care baby unit for six weeks and was progressing well. At 11 weeks his birth mother took him to the doctor because he was limp. It was ascertained that he had suffered brain damage due to severe hitting and shaking by his birth mother. He had a twin brother who had suffered three broken ribs, but B had received 13 fractures to various parts of his body, mostly on the left side on his skull, collar bone, shoulder and ribs.
When his adoptive parents first fostered him he was 11 months old, and was in hospital. They were experienced in fostering children with learning disabilities and/or developmental problems and wanted to help B from the moment they met him.
B had been predicted to die before he reached 18 months, and had been kept in hospital with a minimum of attention and stimulation because it was believed he was deaf, blind and epileptic. He was diagnosed as having cerebral palsy and was on a wide variety of medications. The adoptive parents proceeded to try many and various ways of reaching B and helping him function more normally: homeopathic injections, eurythmy exercises, remedial massage, hands-on healing, light therapy, plus their own unlimited supply of love and attention. Up to the time of seeing me, after five years of hard work, they had managed to take B off all the medication. He was obviously able to hear and see some things, and clearly loved them as they loved him. He was not suffering fits any more, but was still having muscle spasms which were affecting his bone formation, to the extent that he had a very protruded pigeon chest and problems with the adductor muscles in his legs, which had been subjected to surgery. In order to relax the tension the muscles were cut; however, as they usually knit back together it was expected that he would need more operations. He had also been receiving botulinum injections, which were found to help relax muscles. I do not know whether there is any scientific evidence for this is, but the medical view was that it was worth trying in order to prevent B's hips from being pulled out of joint. However, the osteopath's view was that it would not really make any difference. I was of the opinion that the over-tight muscles needed to be relaxed, using acupuncture, massage and moxa, and the looser muscles strengthened. This would give B the best chance of keeping his hip joints in place.(1)
B had also had all the recommended vaccinations, and we did not discuss this topic in any more detail. He was not due receive any more injections. The main problems I was asked to help with were:
Digestion: B was very constipated, only passing stools every 10-14 days, with great difficulty and discomfort. He was regularly bringing up clear liquid at night, which was occasionally brown. There was an ulcer found in his oesophagus last October and he had been on antacid tablets, after which he had been making frequent snorting noises. The sphincter at the base of his oesophagus was thought to be too loose, allowing acid to regurgitate and burn the oesophagus.
Thirst: B had a lack of interest in drinking, and had copious dribbling and lack of control of the tongue, throat and neck muscles. His head was almost constantly turned to the right, believing it to be forward, which was said to be due to the brain damage and orientation problems.
Circulation: He had very cold feet and legs.
Sleep: He needed more peaceful sleep as he had been waking at night, sometimes with great upset.
Respiration: His lungs needed to be strengthened in order to prevent further chest infections, to which he had been prone, due to chest constriction, general damp and lack of exercise.
Muscle tone: His legs needed to be strengthened (they were extremely thin and generally flaccid apart from the spasms in the adductors) and energy brought to all the limbs.
Tongue and pulse: His tongue at first sight seemed to be pink and shiny with a thick white coat and his pulse was virtually absent on the left, and thready on the right. His capillary vein was short and purple.
B’s first teeth had been eroded by medication. He had a large split in his lower lip, which became worse when he was extremely constipated, and it would bleed. My interpretation of this was that he needed a lot of yin tonification, that some of the need arose directly from an absence of early nurturing. However, he also needed damp and toxin removal, with corresponding changes to his diet. The tonification of the spleen was a priority in order to increase the digestive capacity and the circulation of blood. There was also a need for some channel stimulation in order to bring the qi to the arms and legs and thus facilitate independent movement. There was spasm in both of the big toes, which caused him to lift his toes almost permanently.
At the first visit I treated him with massage and laser to St 36 and along the channel to the ankle, Liv 3, Lu 9, Ren 12, Ren 15, GB 20 and Du 16. I suggested that the parents could massage B at home with the mix of oils we used at the clinic (a general warming and tonifying oil), on the legs and around his tummy. We also discussed damp producing foods and damp removing foods which they conscientiously followed. When some foods slipped through the net, there were recurrences of the symptoms of damp, which indicated to the parents that they were on the right track.
At the second visit, B was already bringing up less fluid and it was no longer brown. However, he was still not moving his bowels. The coating had begun to recede and his tongue was showing the characteristic red dots which seem to correspond to accumulated toxins in the system (which were interestingly not visible at the first treatment) and the coating was becoming patchy. This could be interpreted as a sign of Candida. This would be a possibility as B was terribly damp and had received many medications, including numerous antibiotics. I had given the parents some work to do to help the treatment be more effective, as I was only able to see B once a month: tummy massage following the direction of the colon and massaging down the stomach channel from St 36 to the ankle and along the outer thigh muscles, where the fascia lata are related to the large intestine (as in kinesiology theory). At this stage I was reluctant to use moxa even though his feet were incredibly cold.
By the third visit I had decided to try moxa, as it seemed possible it could be of help. The pulse was very deep on both sides and I hoped to bring it up, which happened with the right hand pulse but not the left (yet). The great success was that B began to loosen his bowels a little, unaided by the usual drugs or enemas, for the first time after the fourth visit, when the parents began to implement the treatment plan of massage homework for 10 days followed by five days off. I also prescribed some Bach Flower Remedies to help B overcome some of his earlier traumas.
When I applied some stress release (also from kinesiology) over the chakras (solar plexus, heart and throat) B had quite a few small spasms during the treatment, but later seemed to progress as a result. I oiled and cupped his tummy in order to stimulate the circulation of qi and blood in the abdomen. The tongue coating seemed to be clearing more by the fourth visit and the red dots were beginning to fade. He also began to loosen his bowels more frequently. The unfortunate thing was that he also developed a ‘chest infection,’ for which he was prescribed antibiotics. He was prescribed nystatin for thrush as well as something to clear his sinuses. Fortunately, the parents managed not give him any of these medications and he recovered. His feet started to get warmer around this time.
B continued to open his bowels more frequently and the school were very impressed. The family went on holiday, where he developed a tummy bug, vomited a lot (with lots of phlegm!). He slept a lot. The parents used aloe vera, which helped B but I warned against overuse as it could be too cold for his system long-term. When he showed signs of getting colder they stopped using it, by which time his tummy was settling. The doctor prescribed more antibiotics when they returned home, which gave him diarrhoea so they stopped administering them and returned to the aloe vera. He was much better. The other exciting thing which happened at the same time was that he was beginning to turn his head to the left more and was observed to be tracking things and people with his eyes. He had not been doing this before. It was assumed he was blind, but the parents were not convinced. I had definitely witnessed him looking at things and people as though he could see them.
In June 2001 B started seeing a local osteopath on a weekly basis and that augmented my treatments enormously. He is now moving his limbs more and has put weight back on which he lost while he was ill in May. He is laughing a lot more, waking less in the night, and is not having the nightmares he used to experience. His front teeth have come out and the adult teeth are growing, hopefully less damaged by the medication he took. To date (August 2001) B has had 10 treatments but there have been some very positive changes. The parents can contact a homeopath should he develop a chest infection in the colder weather, as there is no children’s acupuncturist in their neighbourhood. We have not determined a cut-off point for the treatments as the parents are keen to see just how much B can progress.
CASE TWO O; date of birth: 10 April 1996. O was born eight weeks prematurely by caesarian section. He had atrial septal defect which cleared up by itself. O was diagnosed with ‘developmental delay’ and was fed through a stoma (a tube directly into stomach), although he also ate regular food. He was very reluctant to engage with others earlier in his life but is now wanting more contact.
O had received naturopathy, osteopathy, homeopathy and then in June 200 came to me for acupuncture. O's mother wanted a combined approach which our clinic could offer. O also visited a therapist in who did Body Brushing, which seemed to have a very positive effect. O's main problems were:
Digestion: O's bowels were sluggish and the need to help move them was a high priority as he had so much discomfort and pain when they did eventually move. Using suppositories was very upsetting to both him and his parents. He had a very strong will, although he appeared very slight in build. O was very rarely ill, with only occasional snuffles, although he did have bronchiolitis at nine months, when he was prescribed and given steroids. He had a sensitivity/allergy to cow’s milk.
Sleep: He slept well.
Hearing: Although his ears were quite waxy, his hearing was acute, and certain sounds like a vacuum cleaner or hair dryer really troubled him.
Immunisations: O has had the three DPT vaccinations, but his parents have decided he will receive no more for the present as they have sufficient back-up with homeopathy and acupuncture.
Muscle tone: His ankles and leg coordination needed improvement.
Tongue and pulse: His tongue had red dots all over it and his pulse was slippery in the middle position, on both sides, and a little low on the third right side.
Treatment: I saw O for six treatments from June - August of 2000. Since then treatments have been farther apart due to his mother’s work commitments. He was also seeing a therapist for Body Brushing, which really seemed to help with the body’s reflexes.
Treatment was mainly focused on massaging the stomach channel and the fascia lata; also tonifying the kidneys with Ki 3. At first the bowels responded very well but became stuck again when the gaps between treatments became wider. I then gave his mother some ‘homework’ which helped.
O began standing more after the first few visits and now has more control over his ankles. However, he still needs his support boots. He has had some ups and downs over the past year, and has come through them quite well. He had a ‘tummy bug’ which may have been a virus but it may have been his own system clearing itself out. His button for feeding through the stomach wall came out recently and his mother saw it as a blessing in disguise because she had to put it back herself.
The red dots on O’s tongue began to fade to pink by the eighth visit and he was beginning to chat and play more. We have continued with similar points, the main focus being on strengthening him and tonifying the kidney and spleen yang, while also clearing out the toxins from previous medications. On the twelfth visit he cried inconsolably during treatment (which we agreed was obviously not the cause of the upset). I used a stress release technique from kinesiology and he settled down eventually and was much calmer for the rest of the treatment. In the days following this visit, O's bowel movements were much easier. His mother was also following my advice and massaging St 36 and down the leg for 10 days consecutively, followed by five days off. He is now walking almost unaided and communicating much more. The surgeon keeps a check on his button, which was put in to replace the stoma recently. If he can be seen to be gaining some more weight, then they may consider taking it out. He is not gaining weight as quickly as they would like him to, although he is growing in height.
Again, this is a long term commitment on my part and that of the parents, as we are not sure of the outcome. We hoped to achieve great things, and so far we have been rewarded. O’s teachers have been very impressed with him on his return to school this autumn. They have documented that they have seen a huge change in his behaviour since last term, particularly his happy demeanor and increased interest in the other children.
CASE THREE L; date of birth: 26 July 1997. L was diagnosed early in life with cerebral palsy which was later queried at eight months old. A small hole was found in his heart at six weeks, which they said would probably close. Developmental delay was also diagnosed. He was getting spasms in his hands and legs, for which he received botulinum injections. He also suffered from some stiffness in his arms, which made movement difficult.
L was obviously a very bright boy who showed a keen interest in trying to do many things, but had very limited muscular control. He had a very wise facial expression, and did not suffer fools gladly. He slept well, 10-12 hours a night with a nap of one or two hours in the day. His hearing was good despite having had one ear infection.
Birth: L’s birth was very long (30 hours) and badly managed, according to his mother. He was in a posterior position and she was prescribed a lot of drugs. He had defied the morning-after pill and his mother felt a sense of destiny with him. He was a good size at birth (7lb 11oz) but was quite small for his age now.
He has had many problems since birth; at 10 months old he had a urine infection (when the doctors did not hear the mother’s concerns early enough and it became much worse). He apparently had a congenitally small ureter and had reconstructive surgery to correct it. His parents separated after this. L also has a chromosomal deletion (22nd). He had all the usual vaccinations, including meningitis C, in 2000. This happened immediately after his having encephalitis, following a viral infection. He had not had any of the usual childhood infections. L is currently taking long-term antibiotics for ‘protection’ of his kidneys and thyroxin due to loss of thyroid function during the encephalitis. His chest is fine, but he gets feverish when ill and gets colds and infections easily. He was very colicky as a baby.
Digestion: L had chronic constipation. He had soft teeth and regurgitated a little, though not vomiting. He ate a lot of dairy products, chocolate, pasta, soup and eggs. He was not very thirsty, but drank a little milk or blackcurrant when he did drink.
Appearance: He had a very pale face which was translucent.
Tongue: His tongue was covered in red dots with a thick white coat towards the back and middle.
Treatment: His mother wrote copious notes after his first visit, which detailed a quite dramatic response in some respects. The treatment I gave was light massage on St 36 and along the channel, which was very tender for him, Sp. 6 (also on his mother), laser on St 25, Ren 12, Ren 6 and Du 16. Throughout the week he had less tension in his legs, his hands were more active, he was not as cold, he produced more saliva and his head was warmer. He was quiet and chatty alternately (he does not yet speak but can make conversation with sounds). He had a lot of wind in the first two days followed by two big bowel movements. The following day he was quite grumpy and tired. He had a lot of nasal mucus and his legs had more spasticity. His mother massaged his legs. The sixth day after treatment he was much brighter and more active at school, he was in a good mood and had a small bowel movement.
He later threw up phlegm from his stomach (the day before his next visit). A similar treatment was given, which also included St 34 (one leg jumped during treatment). I suggested some cranial work would be beneficial and gave L and his mother some Bach Flower remedies.
L did not come for another few weeks because he developed chicken pox, which he recovered from very well, despite his ear flaring up a little. His tongue was much less coated and the red dots were fading. The laser was used on the scars remaining after his intravenous treatment last year. This has helped them to fade very well. I also applied SJ 5 for the ear, GB 40, Bl 60, Ki 3, as well as the usual St 36, Sp 6 and St 25. I massaged his legs with our clinic's healing oil. He continues to have good bowel movements.
L's mother has followed my dietary advice quite carefully and by the 4th visit he had really improved in several areas; hand-eye co-ordination was better and his extremeties were warmer. His bowel movements began to decrease again so I suggested his mother massage him for 10 days, followed by five days off. This seemed to really help him.
When he became constipated L's mucus levels increased. This tended to happen after the 10 days of massage by his mother. His parents became more able to spot his illness patterns as they occurred.
After the sixth visit, L was gaining weight and was moving arms and legs more. He was also drinking more. At this visit, L cried and his crying seemed to really come from the heart (again we were reassured that this was not as a result of the treatment he received). He was allowed to cry until he decided to stop and he was administered rescue remedy. After this, he seemed to take some leaps forward in his development.(2)
At his most recent visit, he was reported to be having bowel movements six days out of seven.
Training As the above cases demonstrate, acupuncture practitioners can apply other forms of treatment even in the most desperate of situations. It is vitally important that acupuncturists are further trained in paediatrics to ensure that there are experienced and confident practitioners throughout the country available for children who need treatment.
I believe it is also very important to educate parents and carers about the philosophy of Chinese medicine and provide them with some simple techniques to use at home to help their children maintain their health (and minimise the need for long and tiring journeys to visit the ‘experts’). We cannot at this time offer the support to those in need in order to fully benefit from Chinese medicine, such as home visits, weekend availability, evening availability, local clinics, etc. People must often travel long distances to consult a practitioner, which can be detrimental to the well-being of their children. We need to address accredited training in paediatric acupuncture when we are considering CPD. There are several very experienced practitioners, already mentioned in this article, who could share their knowledge with others.
I hope these cases are helpful for people, especially for those who may be considering whether or not to treat children. There are so many children who can benefit from the careful and timely application of acupuncture / acupressure / touch therapy. I am hopeful we can have a wide reaching network of practitioners with the experience and confidence to tackle even the most seemingly intractable cases.
Notes 1. The spasms were mostly in his back and I have yet to start tackling the muscle, having been working energetically so far. 2. Acupuncturists should be encouraged to take on further training in order to be prepared for this kind of reaction to treatment and to not be shocked or surprised when it happens.
June Tranmer June Tranmer has been running an acupuncture practice in York, UK, since 1991. She also runs a busy complementary health clinic, and teaches several health-related classes for the public. She also teaches children's acupuncture courses for practitioners.