Earlier this year, researchers who reviewed reports of acupuncture in kids concluded that treatments were safe for the under-18 crowd.
Knowing how to treat a child with TCM is the easy part. It's simple to select the points and herbs that will help begin the healing process. Delivering the TCM treatment is an entirely different matter and I hope to share some ideas on how to manage pediatric treatments to make them smooth and painless for everyone.
Preparation
To start the process off smoothly, make sure to educate parents on how to prepare and support their child during acupuncture treatments, especially the first visit. Parents need to know that you will not force the child to get acupuncture if they don't want it and that you offer alternative treatments such as shonishin, cold-laser or microcurrent. I tell the parents to avoid the words "poke," "pokey," "pins" and "needles" because if the child has had vaccination shots this will make acupuncture seem scary and painful, which it is not. In my clinic I prefer to call pediatric acupuncture "taps" because there's lot of tapping involved as I prepare the acupuncture point for in-out acupuncture.
During the child's initial visit there will be a considerable amount of time discussing the child's healthy history and while we have toys in the office I suggest parents bring something special to help entertain their child during that part of the office visit, this is especially helpful for children under age 5.
For children who have been chronically ill or have a fear of doctors I suggest that they bring a stuffed animal or blanket to give them comfort or even have them dress up in costume. I'll never forget the first little I girl I saw who came dressed up as a pirate. She told me she dressed up "because pirates are brave and I'm gonna be brave today." That little girl was brave and tried five acupuncture needles. By the third visit she no longer needed her costume and just strolled into the treatment room ready for her "taps." It's amazing how these small tokens of comfort can help them become more at ease with acupuncture.
A Good Introduction
The atmosphere in your office will also set children at ease if you have an environment with soft lighting, relaxing music and toys to entertain them. If you wear a white lab coat normally in your practice, I would take it off before you treat children. Having a different look and feel than a doctor's office will work to your advantage with children who are fearful.
Keep in mind your patient is the child or baby and not the parent. The parents are a very important part of the treatment, but ultimately you serve the healthcare needs of the child with the trust and cooperation of the parents. When you meet your new little patient acknowledge your patient first and as you introduce yourself to the child bend down to their level to say hello if necessary. Then greet the parents and introduce yourself to them as well.
Once everyone is situated in the treatment room, if the child is old enough to understand explain to them that you'll be talking about their health concern with their parents and you may have some questions for them during that process. Meanwhile they can play.
During this time, I make sure to tell every child that I'm here to help them get better and that I'll need their cooperation to do so. I also tell them they we are partners and I won't force them to do anything they don't want to do, but if they'll work with me I can make them feel better.
The Examination
As you start your examination, explain what your going to do step by step and make sure that child is ready. Looking at tongues and feeling pulses is usually straightforward, sometimes a tongue depressor can come in handy either as a distraction or to gently help open the mouth, especially if you need to look at the throat.
The level of examination you can do, beyond pulse and tongue examination, will depend on what is within your scope of practice in your state. If it's within your scope, look into the child's ears, listen to their lungs and do a brief abdominal examination. The reason to do this is so you have a baseline should the child present with an illness, it helps improve your examination and diagnosis skills and it show the parents that you are competent with basic physical exam skills. They just might bring their child to you the next time they start pulling on their ears and be able to avoid an unnecessary round of antibiotics.
Everyone will have different style when they work with kids. Playfulness is one element that has usually helped me during the examination to set the child at ease as well as build rapport. Asking a three-year-old if they have drums in their ears before you check with your otoscope and telling them you're going to gently tug on their ear while you look to see makes the whole process fun and easy.
Treatment
Even if the parents have told me in advance that their child won't do acupuncture, I still explain what "taps" are and how they help the body to heal. I also tell them that even if they don't want to try it today someday they'll be brave enough to. I continue to show them the needles or "taps" and ask if they want to see Mom or Dad try it so they can tell them what it's like. Afterwards, Mom or Dad usually respond with something like "that didn't even hurt" or "I could barely feel it at all" which is very helpful but sometimes not enough. Then I ask if they'd like to try putting a "tap" on my treatment table. Most kids are very excited to get involved and are eager try "tapping" the table. I hold the tube on the table and let them tap it in. This gives them a chance to see how quick the procedure is and gets them involved. If they can do taps on the table it can't be that scary, right? Next, I ask them if they'd like to try a "tap." Sometimes they will and sometimes they won't. If they're unsure I'll often ask them another time in the session if they want to, but I don't pressure them because most kids will eventually try acupuncture in their own time. The most important thing you can do is to build trust and rapport and since there are non-needle modalities you can use it is unnecessary to force the issue.
If the child chooses to try acupuncture, then I give them a choice of where to do the first "tap" and I tap the point with my finger, rub a little and sometimes make a few silly sounds as I do this. Anticipation of pain can be worse than the actual procedure and using distraction is helpful in avoiding it. Sometimes we'll say a special phrase like "blue sky" or I'll ask them about their favorite movie and we'll say something like "Lightening McQueen." For babies and toddlers distraction from the parents is often the most helpful. Other ways to use play are to let kids see the needles with a mirror, calling the points names like "the unicorn point" for yin tang or "bunny ears" for UB 7 or drawing on the table paper.
Getting kids involved in the process of their treatment is beneficial and empowering for them. If a child has even been forced to have a chest x-ray, vaccination shot or other procedure against their will they may be scared of doctors or medical procedures including acupuncture. When children walk into the room on their own, help decide how and where their treatment will be done you'll find them much more compliant and willing to give it a try.
Not all treatments will go as smoothly as described. Helping scared kids, crying babies and parents with an over abundance of questions or fears are some of the problems you may have in pediatrics. In my next article I will cover some strategies to navigate the more difficult aspects of dealing with kids and their parents.