By Soma Glick
When I went through my academic training in Oriental medicine, pediatric acupuncture was neither mentioned nor offered as part of the curriculum, even as an elective. I discovered it quite by chance in the mid-1990s. I needed to get some extra CEUs for my license and saw a workshop offered by Jake Fratkin on pediatric formulas. I had never treated children before, but I thought about it and decided to enroll. Quite unexpectedly, the seminar pricked my interest in the matter and led to my attending a series of other seminars dealing with pediatrics. Miki Shima's presentation of shoni-shin was a major revelation to me as an alternative way to work with the qi of children in a gentle and non-intrusive way. I was also greatly inspired by the work of Julian Scott and the approach of Alex Tiberi.
I am grateful to all of these great teachers for their invaluable contribution to Oriental medicine, and in a personal way for opening my doors to the specialty of pediatric acupuncture. Treating children has become a big part of my practice and a constant source of joy.
I have been treating children for five years, and teaching a pediatric acupuncture class for three. The following is a brief sharing of some very special experiences.
The first thing that amazed me when I started treating children was how simple it is. One of my first patients was a three week-old baby who came down with a cough after a long flight across the globe. The baby's parents had first tried homeopathy without results, and were about to take their baby girl to a medical doctor when they heard about me. I really hadn't had any experience, but I didn't see any harm in trying. I gave the little girl a shoni-shin session emphasizing the lung channel and booked another two appointments for the same week. It only took five minutes to perform the treatment on such a tiny baby. When the parents came back for the next session, they had noticed a marked improvement in the baby's cough. After the second session, the cough was completely gone. We did two more follow-ups and I assume there was no recurrence of the cough, since the parents did not come back to see me and referred many other parents with sick babies to me.
This could have been beginner's luck, but it did show me how fast and how well children can respond to that kind of treatment. It also gave me the chance to see many more children, and a lot more challenges with each case. Each challenge was also an opportunity for further digging and research in the field of pediatrics.
Through treating little ones, I became aware that most of the patterns we carry into our adult lives actually start at a very early age. Psychologists already have written volumes on the impact of emotional traumas in childhood, especially sexual abuse and violence. What they have not emphasized is that simply living in an atmosphere of constant neglect, stress, tension or conflicts can create traumatic experiences. These experiences affect the child emotionally, and each emotional pattern will in time affect the child physically. I've seen children as young as one year old suffer from major emotional imbalances.
These imbalances turn into the defense mechanisms we all develop in order to get what we want (or simply to cope with life). In terms of health, these defense mechanisms often lock us into reactionary patters such as "me against the world," which do not serve our well-being. These reinforce our sense of separation from the universe and tend to create tension, contraction and struggles. The attitude we adopt toward pain and illness is often a major contributor to the progression of an illness. When we feel at peace and at home within and without, we can relax and drop our guards. The qi then naturally flows smoothly and easily. By age three, a child's constitutional tendencies and personality are already in place, along with the type of physical ailments they will be prone to. Strengthening the child's own healing abilities in these weaker areas can make an invaluable contribution to their future health. Recognizing their strengths and respecting their limitations can offer both parent and child an opportunity for empowerment and self-discovery in their own natural state of health.
Treating children continuously renews my sense of wonder at this ancient art of acupuncture and how its principles are applied in practice. Of all people, children reflect most closely the theory of the five phases and its correspondences. Children are amazing examples of the dynamic balance of the law of yin & yang and its interrelationships. During the first two years of life, children's emotions are pure and uninhibited; hence, their qi flows freely and is readily accessible. In pathology, the symptoms they exhibit are always a clear reflection of what's going on inside. Of course, it's up to the practitioner to read those symptoms correctly. Small children cannot and do not need to tell us what's wrong. The brightness of shen in their eyes; the color on their face and body; the texture and temperature of their skin; and many other signs speak loudly for them. Feedback I've often received from students in my pediatric class or clinic is that they really get to see how acupuncture works because children respond so fast to treatment. Sometimes during treatment, or when the child comes back for a second visit, the changes are obvious and visible. If nothing has happened, I know that we didn't get the initial diagnosis right.
There are several different methods within Oriental medicine for treating children, such as TCM, shoni-shin or tuina. These modalities have one common denominator: they all speak about the differences between children and adults, especially in the first seven years of life. Understanding these differences is a must in successfully treating children. Children are not small versions of adults. Their energetics are totally unique due to the fact that their systems are still developing and in a constant process of growth. By age seven or eight, the child's meridian system is finally developed, and his/her personality is crystallized. Some classics say that only then can acupuncture needles that penetrate the skin be used on children without fear, although tuina or shoni-shin can still be very effective. In the teenage years, especially at the onset of puberty, one can no longer apply the principles unique to children.
In addition to the energetic differences between children and adults, another major difference that arises is the need to involve and educate the parents. You are treating through a third party. If the parent is your ally, the success rate of your treatments will be much higher. For example, making sure a child takes his/her herbs regularly is wholly dependent on the parent's willingness to administer them, even if it means forcing the child at times. Diet and lifestyle are often direct contributors to ill health. Making changes in these areas can be very challenging and might be at odds with the family's beliefs. Unless the parents see that what you're doing is creating a radical improvement in the child's health, they may not be willing to follow up with the many sessions it will take to truly bring a child back to health, especially in the case of chronic diseases.
Educating the parent and creating a good rapport with the child is indeed the first step. Next, you must decide on the modality to use.
Tuina, a form of Chinese bodywork, is a great healing tool for children who need to be touched. It is effective and nurturing in the management of many chronic disorders. The drawback is that it takes longer to administer treatment, and many children tend to be restless and impatient. Also, tuina's scope of practice is limited and not the treatment of choice for febrile or acute illnesses.
Shoni-shin offers a wonderful alternative. It is my favorite modality and truly works wonders for common respiratory and digestive ailments. Even if it can't help a child with a more complicated picture, it is still beneficial for the nervous system. It can enhance circulation and relaxation, thereby improving health in general. Shoni-shin is a form of bodywork that makes use of small metal tools designed to bring qi to the surface, help it move by "spreading" it along the channels, and stimulate specific acupuncture points. There are about a half-dozen different tools in a shoni-shin kit, none of which penetrate the skin. Children usually love holding the tool for you, or playing with the other tools you are not using, or trying to guess which tool you are using without seeing it. A shoni-shin treatment can be performed in 10 to 20 minutes depending on the age of the child and the severity of the illness. Even a very guarded or frightened child will usually warm up to the idea of shoni-shin, and many actually look forward to it as a kind of game that you, the doctor, are playing with them.
Using acupuncture needles is always a last recourse, but there are situations when it's absolutely necessary. Tuina or shoni-shin are not recommended when treating skin rashes or conditions where the skin is compromised. When the child is overly tired, restless or so hyperactive that he/she cannot sit still through a treatment, it is best to use needles. I try never to use more than two or three points per session, and there is no retention on the points for children under 10. For high fevers, bleeding tends to be the best modality; for cold situations, moxa therapy is a must.
Children are very sensitive to herbal products and supplements. Often, these should be the first choice of action at the onset of viral or bacterial infections, except for severe or emergency situations. One of the most common reasons for children to get started on a course of antibiotics is otitis media or strep throat. Stronger or luckier children will get better after the first course and move on, but many others will start a cycle of course after course of antibiotics because the infection refuses to go away, or more often goes away and then comes back after a few weeks or months. Enough has been written about the harm that frequent or long-term antibiotic use can do to the body. This scenario is present in the majority of cases I see in my practice. If the child has a weak digestive system, he/she also tends to develop all kinds of food or environmental allergies. After just one shoni-shin session, a change of diet and a few days of taking herbs, the change in the child's energy and facial color is often spectacular.
It is important to establish a good relationship with your little patients because you will have to treat them more often than grownups: at least two to three times a week for an acute disorder. Often, two or three treatments are enough to bring children back to health, as they respond quite rapidly to energetic treatments. In fact, if a child in an acute stage of illness has not responded positively within three days to whatever modality I'm using, I infer that he or she needs something else and refer out.
In the case of a more chronic illness, which is definitely the majority of our cases, the child should be treated once or twice week at the very least for two to three months, even if the child seems to be fully recovered after only a few sessions. Although it is somewhat of a hardship for parents to take the time to bring the child in, it should be impressed upon them that even if things change quickly on the outside, it takes time to re-establish the inner balance of the child and to strengthen his/her own ability to stay healthy.
In addition to the need for follow-up treatments, you have to make the parents aware of other factors that may contribute to the child's disorder. Dietary and emotional factors tend to top the list. Bad posture acquired from too many hours spent in front of the TV; video games or some type of electronic stimulation; and a lack of fresh air and exercise, play a major role in ill health. Parents not spending enough quality time with their children because of work constraints is another contributor to illness. Daycare facilities cannot replace the care and attention of a loving family member.
Although science and hygiene have helped us conquer many disorders, our nervous system has become a source of new ills because there is such an overload of sensory stimulation in urban settings and because the pace of living has become so hectic. Children, who are by nature more sensitive and vulnerable, are the most disturbed by the increasing complications of modern life. These and the other factors mentioned earlier have increased the incidence of stress-related pathologies in childhood, including ADD and hyperactivity. Because of the gentle balancing action the ancient art of acupuncture has on the emotional and physical body, this type of treatment can be a way to help children better cope with the many demands put upon their physiology.
Holistic medicine means integrating the spiritual, emotional, mental and physical aspects of our beings. When we treat children with Oriental medicine, we infuse them with the awareness that bodies and minds are connected. The mind drives the body. A peaceful mind allows the body to take the rest it needs when it needs it, allowing the body to regenerate and heal. For too many of us, the mind constantly remains on fast idle, even after we've turned off the engine.
I want to stress that it is not my intention to advocate Oriental medicine over Western medicine in the treatment of children. Both have their places and their limitations. Educating both practitioners and parents can increase discrimination of what form of care should be used and when. Western medicine is best for interventions in a life-or-death situation, emergency care, or very acute and severe disorders. It is the best, and can even be miraculous, when structural disorders or congenital malformations require a surgical procedure. For many common childhood disorders, stress-related pathologies or chronic conditions, however, long-term care with strong drugs or antibiotics tends to complicate the picture and undermine the child's ability to tap into his/her own reservoir of healing energy.
Treating children is not everybody's cup of tea. You need to enjoy being around them and their chaos. You need to be able to take yourself back to that place of innocence and irrationality where the mind hasn't yet learned to discriminate between fantasy and reality. It takes a special affinity to establish a rapport of trust with your little patient. Trust is essential for your treatments to have a lasting effect. When a child is closed, resistant, or simply says no to the treatment, you cannot use force or rationally argue with a child. You can only entice, coax or simply be patient. Children like to be seen and respected as individuals. When a child has already been hurt or their trust has been betrayed, he/she will be fearful and guarded. In this case, I may use the first session just to gather the necessary information from the parent and make contact with the child from a distance. This allows the child to check me out. The next time around, I can move closer into the child's space. However, most children are naturally open, trusting, uncomplicated and receptive. This is why it is such a joy to work with them.
It is my hope that more parents and practitioners will make the right inquiries concerning the treatment of children with Oriental medicine. Our journey starts from day one, and it's never too early to tackle health from a different perspective: a perspective that honors our connection with nature, respects the human spirit, and empowers us to take greater responsibility for our own well-being.