Ethical integrative pediatric care: A new perspective

Gottsegen, David

doi:10.1016/j.eujim.2011.12.006

Cited by 3 publications

(3 citation statements)

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“…When planning new RCTs about the efficacy of percutaneous needle acupuncture for infants, we consider it important to facilitate adequate blinding of outcome assessors, and to validate the quality of any blinding procedures. The risk of causing pain should be evaluated and taken into consideration when assessing the benefits and harms of acupuncture in small children who cannot consent to treatment [ 28 , 37 , 67 ]. Our findings also emphasise the need for more quantitative and also qualitative [ 68 , 69 ] research to explore parents’ experiences and the possible positive impact of acupuncture on outcomes other than reduction in crying time.…”

Section: Discussionmentioning

confidence: 99%

“…It has been suggested that acupuncture might play a role in the treatment of infantile colic [ 5 , 18 , 24 , 28 , 29 ]. Thus, it is proposed that acupuncture can counteract gut dysmotility in infants with colic, possibly by affecting the parasympathetic vagal reflexes and the centrally opioid-mediated pain inhibitory pathway [ 30 , 31 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, controlled trials investigating the efficacy of acupuncture in cases of infantile colic show conflicting results [ 31–34 ]. There are ethical concerns about the use of an intervention that can cause pain [ 32 , 34 , 35 ] in children who cannot consent to treatment [ 28 , 36 , 37 ]. There are no previous systematic reviews or meta-analyses concerning acupuncture treatment for infantile colic.…”

Section: Introductionmentioning

confidence: 99%

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Acupuncture treatments for infantile colic: a systematic review and individual patient data meta-analysis of blinding test validated randomised controlled trials

Skjeie

Skonnord

Brekke

et al. 2018

Scandinavian Journal of Primary Health Care

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ObjectiveNeedle acupuncture in small children has gained some acceptance in Western medicine. It is controversial, as infants and toddlers are unable to consent to treatment. We aimed to assess its efficacy for treating infantile colic.DesignA systematic review and a blinding-test validation based on individual patient data from randomised controlled trials. Primary end-points were crying time at mid-treatment, at the end of treatment and at a 1-month follow-up. A 30-min mean difference (MD) in crying time between acupuncture and control was predefined as a clinically important difference. Pearson’s chi-squared test and the James and Bang indices were used to test the success of blinding of the outcome assessors [parents].Eligibility criteria and data sourcesWe included randomised controlled trials of acupuncture treatments of infantile colic. Systematic searches were conducted in Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL and AMED, and in the Chinese language databases CNKI, VIP, Wang fang, SinoMed and Chinese Clinical Trial Registry.ResultsWe included three randomised controlled trials with data from 307 participants. Only one of the included trials obtained a successful blinding of the outcome assessors in both the acupuncture and control groups. The MD in crying time between acupuncture intervention and no acupuncture control was −24.9 min [95% confidence interval, CI −46.2 to −3.6; three trials] at mid-treatment, −11.4 min [95% CI −31.8 to 9.0; three trials] at the end of treatment and −11.8 min [95% CI −62.9 to 39.2; one trial] at the 4-week follow-up. The corresponding standardised mean differences [SMDs] were −0.23 [95% CI −0.42 to −0.06], −0.10 [95% CI −0.29 to 0.08] and −0.09 [95% CI −0.48 to 0.30]. The heterogeneity was negligible in all analyses. The statistically significant result at mid-treatment was lost when excluding the apparently unblinded study in a sensitivity analysis: MD −13.8 min [95%CI −37.5 to 9.9] and SMD −0.13 [95%CI −0.35 to 0.09]. The registration of crying during treatment suggested more crying during acupuncture [odds ratio 7.7; 95% CI 2.7–20.6; one trial]. GRADE-Moderate quality evidence.ConclusionsPercutaneous needle acupuncture treatments should not be recommended for infantile colic on a general basis.Systematic review registrationPROSPERO 2015:CRD42015023253Key pointsThe role of acupuncture in the treatment of infantile colic is controversial. Available trials are small and present conflicting results.There were no clinically important differences between infants receiving acupuncture and no acupuncture control in this IPD meta-analysis of randomised controlled trials.The data indicate that acupuncture induces some treatment pain in many of the children.The study results indicate that percutaneous needle acupuncture should not be recommended for treatment of infantile colic on a general basis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acupuncture treatments for infantile colic: a systematic review and individual patient data meta-analysis of blinding test validated randomised controlled trials

Skjeie

Skonnord

Brekke

et al. 2018

Scandinavian Journal of Primary Health Care

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Editorial

Kemper¹

2012

European Journal of Integrative Medicine

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‘Big needles, small bodies’—the absence of acupuncture treatment for infants in contemporary Shanghai: a qualitative study

Skjeie

Brekke

2015

BMJ Open

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ObjectiveTo explore contemporary practices and clinical recommendations regarding the use of acupuncture for infants by Traditional Chinese Medicine (TCM) practitioners in Shanghai.DesignA qualitative study consisting of four field visits between February 2014 and March 2015. Data was collected using participant observation, focus group interview, in-depth interview, textbook page analysis and informant validation.Participants14 Shanghainese professionals, including interpreters and TCM practitioners, of which seven were acupuncturists.SettingThe Longhua Hospital (paediatric, acupuncture and Tui na departments) in southern Shanghai and the campus of the Shanghai University of Traditional Chinese Medicine.ResultsThe Longhua Hospital outpatient acupuncture clinic receives 400 consultations on average per day. Children, including patients from the paediatric department, are referred to this clinic. During 3 days of participant observations at this department, we saw two children. No infants. During 3 days at the paediatric department and 1 day at the Tui na department we saw no referrals. Formal interviews and informal conversations with acupuncturists and other TCM professionals revealed that acupuncture was neither routinely practiced nor recommended for infants and small children. Acupuncture was considered potentially painful for this young patient population. Alternative treatment options such as herbal treatments or medical massage were widely available and preferred. Western medical diagnostics and treatment were also used, recommended, and trusted.ConclusionsAcupuncture for infants is not a preferred therapeutic method among TCM practitioners working in contemporary Shanghai. Acupuncture on broad indications in infants appears to be a Western practice with little basis in TCM modern-day practice.

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Ethical integrative pediatric care: A new perspective

Cited by 3 publications

References 42 publications

Acupuncture treatments for infantile colic: a systematic review and individual patient data meta-analysis of blinding test validated randomised controlled trials

Acupuncture treatments for infantile colic: a systematic review and individual patient data meta-analysis of blinding test validated randomised controlled trials

Editorial

‘Big needles, small bodies’—the absence of acupuncture treatment for infants in contemporary Shanghai: a qualitative study

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