Acupuncture Treatment for Nocturnal Crying in Pediatric Patients: A Systematic Review of Clinical Studies

Acupuncture for procedural pain in newborn infants

RATIONALE

Procedural pain management in newborns, particularly those in neonatal intensive care units (NICUs), presents challenges due to limited safe and effective options. Acupuncture, a Traditional Chinese Medicine practice, has emerged as a potential alternative for pain relief in this population.

OBJECTIVES

To assess the benefits and harms of acupuncture in newborn infants undergoing painful procedures.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, and clinical trial registries up to August 2023. We checked the references of included studies and related systematic reviews.

ELIGIBILITY CRITERIA

We included parallel and cross-over randomized controlled trials (RCTs) comparing acupuncture with no treatment or sham treatment; any non-pharmacological treatment; any pharmacological treatment; or one type of acupuncture compared to another type of acupuncture.

OUTCOMES

Our outcomes were: pain scores; harms; parental, family, and caregiver satisfaction with the intervention; use of additional pharmacological intervention for pain relief; episodes of bradycardia/apnea/desaturation; neonatal mortality; mortality during initial hospitalization; intraventricular hemorrhage; late-onset sepsis; duration of hospital stay; major neurodevelopmental disability.

RISK OF BIAS

We used Cochrane's RoB 1 tool for RCTs.

SYNTHESIS METHODS

We conducted meta-analyses using fixed-effect models to calculate risk ratios (RR) and risk differences (RD) with 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) or standardized mean difference (SMD, when combining different pain scales) and standard deviation for continuous outcomes. We summarized the certainty of evidence according to the GRADE approach.

INCLUDED STUDIES

We included 11 RCTs enrolling 852 infants. Five studies compared acupuncture to no treatment or sham treatment; four studies to non-pharmacological treatment (oral sucrose or glucose); and two studies compared acupuncture to other types of Traditional Chinese Medicine treatments, which we refer to as 'type B acupuncture,' such as foot massage or reflexology. No studies compared acupuncture to any pharmacological treatment. We identified four ongoing studies.

SYNTHESIS OF RESULTS

We have listed outcomes reported in at least one study. Acupuncture compared to no treatment or sham treatment Acupuncture may reduce pain assessed during the procedure with any validated scale compared to no intervention (SMD -0.56, 95% CI -0.75 to -0.37; 7 studies, 471 infants; low-certainty evidence). It may result in little to no difference in any harms compared to no intervention (RR 0.35, 95% CI 0.01 to 8.31; 2 studies, 138 infants; low-certainty evidence). Acupuncture compared to any non-pharmacological treatment The evidence is very uncertain about the effect of acupuncture on pain assessed with a validated scale during the procedure compared to non-pharmacological intervention (SMD 0.29, 95% CI 0.04 to 0.54; 4 studies, 267 infants; very low-certainty evidence). Acupuncture may result in little to no difference in any harms compared to non-pharmacological treatment (RR not estimable, RD 0.00, 95% CI -0.03 to 0.03; 3 studies, 247 infants; low-certainty evidence). Acupuncture type A (e.g. penetration of the skin with a needle) compared to acupuncture type B (e.g. foot massage or reflexology) The evidence is very uncertain about the effect of acupressure on pain assessed with any validated scale during the procedure compared to foot massage (SMD 0.05, 95% CI -0.26 to 0.36; 2 studies, 163 infants; very low-certainty evidence).

AUTHORS' CONCLUSIONS

Acupuncture may reduce pain assessed with different scales during the procedure, with little to no difference in any harms, when compared to no intervention. The evidence is very uncertain about the effect of acupuncture on pain assessed with different scales during the procedure when compared to any non-pharmacological treatment; acupuncture may result in little to no difference in any harms. The evidence is very uncertain about the effect of acupressure on pain assessed during the procedure when compared to foot massage or reflexology.

FUNDING

This Cochrane review had no dedicated funding.

REGISTRATION

Protocol (2023): doi.org/10.1002/14651858.CD015894.

Acupuncture in Pediatrics: A Scoping Review

Background: The use of acupuncture for common pediatric conditions continues to grow in the United States. Six previous reviews have summarized the research; however, approximately 8 years have accumulated adding to this growing body of literature. Objectives: The aim of this article is to provide a scoping review of acupuncture research in pediatric conditions and a summary of the effectiveness of acupuncture in the pediatric population. Methods: A systematic search was performed to identify clinical trials and reviews published between August 2015 and October 2023. Trials and reviews were excluded if they were not: (1) acupuncture specific, (2) data limited to pediatric patients, and (3) published in English. The literature was assessed and synthesized into a scoping review and commentary. Results: Seventy-one publications were identified (42 clinical trials and 29 reviews) that represented 17 conditions and 10 countries; the top 2 were China and the United States. The top five areas of new research (based on numbers of clinical trials) are pain, cerebral palsy (CP), attention-deficit hyperactivity disorder, autism spectrum disorder, and nausea and vomiting. Conclusions: Clinical trials in pediatric acupuncture represent a small but important subset of acupuncture literature. Data are positive for postoperative nausea and vomiting and promising for CP, nocturnal enuresis, perioperative pain, procedural pain, and tic disorders. Several factors preclude additional firm conclusions from being drawn, including a limited number of trials, small sample size (n < 100) of the majority of randomized controlled trials (78.6%), and heterogeneity of treatment approaches. Continued research on the use of acupuncture for pediatric conditions is warranted, particularly in conditions demonstrating recent promising evidence.

Review of Integrative Interventions in Pediatric Sleep

Ensuring good sleep is crucial for the overall well-being of children, as it impacts their development, mental health, and physical wellness. Children with sleep disorders, especially those with comorbid health conditions, may experience insufficient or low-quality sleep. Given that sleep disorders typically have multifactorial contributors, the holistic approach of integrative medicine is well suited to address sleep health concerns comprehensively. This article will provide insignia into evidence-based integrative interventions for common pediatric sleep disorders. These interventions encompass foundational sleep hygiene principles, mind-body interventions, behavioral therapies, dietary supplements, and other nonpharmacologic methods. [Pediatr Ann. 2025;54(3):e88-e93.].

An Uncommon Cause of Nocturnal Crying and Discomfort: A Case of a 15-month-old Girl With Spondylodiscitis

Nocturnal crying in toddlers has a broad spectrum of causes, including psychosocial and somatic causes, whereby the majority are self-limiting and do not need referral to specialist medical care. Although uncommon, atypical presentations of nocturnal crying-such as spondylodiscitis-require referral to specialist medical care, especially when combined with discomfort. In this case report, we present a case of a 15-month-old girl with an atypical presentation of nocturnal crying in combination with back pain.