Pediatric Complementary and Alternative Medicine

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Energy Therapies

Energy Therapies are a type of complementary and alternative medicine (CAM) that deal with measurable and non-measurable energy fields.  These therapies are based on the belief that an imbalance in the body’s energy field (an electrical field that is generated by the activities of the cells and tissues and can be detected on the skin’s surface) will result in illness and that health can be restored if the energy field is rebalanced. ¹  There are two types of energy fields, veritable and putative.  

Veritable energies can be measured and include mechanical vibrations such as sound and electromagnetic forces such as light, magnetism, and radiation. There are many established uses for measurable energy fields in the diagnosis and treatment of diseases in children.  Some examples include electromagnetic fields in magnetic resonance imaging, cardiac pacemakers, and radiation therapy. 

Sound therapy is another type of veritable energy.  It is believed that certain sound frequencies resonate with specific body organs to promote healing. 

Music Therapy

Music therapy is the most studied sound therapy.  The main goal of music therapy is to encourage positive nonmusical changes in the body.¹ 

Examples of Use

Music therapy can promote relaxation and help a hospitalized child cope in an unfamiliar environment.  Music therapy can also help children cope with pain, anxiety, and fears.  Music therapy has been used as a complementary therapy when children are receiving palliative care.²  While there is an increasing amount of anecdotal evidence that music therapy provides children with an outlet for emotional expression of feelings such as grief, depression, and hopelessness, and it reduces stress and increases immune system responses, few research studies have been done validating these results.  More studies are needed to support its future use.³ 

Putative energies are those that can not be measured and are based on the concept that humans are infused with a subtle form of energy that flows throughout the body.  The practice of putative energy medicine dates back thousands of years to the ancient Chinese. This subtle form of energy is known by different names in different cultures, such as qi (pronounced "chee") in traditional Chinese medicine and ki (pronounced "ky", rhymes with "my") in Japanese medicine.

Disturbances in energy can lead to illness.  Energy therapists believe  they can work with a person’s energy to effect body changes and promote health.   Examples of putative energy medicine practices include acupuncture/acupressure, Reiki, Qi gong, healing touch, and intercessory prayer (a person intercedes through prayer on behalf of another).¹  Several of these putative energy therapies will be discussed in more detail below.

Acupuncture

Acupuncture has been practiced in China and other parts of Asia for thousands of years.  It is one of the main components of traditional Chinese medicine.⁴  The practice of acupuncture is governed by the concept of achieving balance and harmony of the yin and yang; the positive and negative forces that make up the body’s energy.⁵ 

Acupuncture aims to restore health by stimulating certain points on the body.  Sterile, solid, single use, extremely thin hair-like needles are inserted into specific points throughout the body in an attempt to modify the flow of qi and restore balance to the yin and yang.  When a person is in good health, the yin and yang are in balance and the qi flows without difficulty.  When a person is ill or in pain, the yin and yang are out of balance and the qi is blocked.  Qi travels along 12 defined channels or meridians in the body.  The 12 channels correspond to the body’s major functions such as the stomach, bowel, and bladder.  ^{5, 6, 7}

It is difficult to completely understand how acupuncture works using a western medical frame of reference and the exact mechanisms of action are still under investigation.  Some actions that are understood include how acupuncture relieves pain: 

1.                        The nerve fibers that carry the pain to the brain are the same fibers that are stimulated by the acupuncture needles at specific points on the body.  When the acupuncture stimulation reaches the brain first, this affects the brain’s ability to see additional pain signals and the result is that the brain interprets there is less pain.

2.                        Once the acupuncture signals reach the cortex of the brain, they prompt the release of endorphins and dynorphins, the body’s natural opioid-like pain killers.

In addition to pain relief, the stimulation of acupuncture points can produce activation or suppression of specific areas of the brain.  This can reduce nausea and/or trigger activation of areas such as the hypothalamus or pituitary gland which in turn release substances that may effect temperature, stress, and immune system response.^{6, 7, 8, 9}  

Examples of Use

There is a limited amount of evidence-based research to support the use of acupuncture in children.  This may be partially due to the assumption that children will not readily accept a therapy that uses needles.  However,  studies showed that children (only children over age 5 were included in these studies) can be receptive to acupuncture if they are provided education and demonstration prior to beginning therapy.^{10, 11, 12}   If children remain wary of acupuncture needles, acupuncturists can use other less invasive treatments such as lasers, low-level electrical stimulation, magnets, press balls, indirect moxabustion (heat stimulation of an acupuncture point caused by the burning of a specific herb at the site ¹³) and warming skin salve to stimulate acupuncture points without penetrating the skin.¹⁴ 

There are a number of pediatric pain centers throughout the country who offer acupuncture as part of their pain control program.  A small number of studies have been done to support the benefits of acupuncture as a therapy for children experiencing chronic pain such as chronic abdominal pain, back pain, lower extremity pain, and headaches/migraines.⁶  Additional pediatric conditions where acupuncture has been tried but further study is needed to confirm efficacy include enuresis, allergies, and post-operative vomiting. ¹⁴ 

Risks

Serious adverse effects from acupuncture are very rare.  Although there are case reports of acupuncture associated pneumothoraces, cardiac tamponade, and serious infections, the risk of these serious adverse events is about 2.4 times in 10,000 cases.  More commonly experienced side effects include bleeding or mild discomfort at the site where the needle is inserted. ^{6, 11}

Further research is needed for the use of acupuncture in children.  However, based on the limited risk and possible benefits, it may be a reasonable option to consider for children (over age 5) with chronic pain.

Reiki

Reiki is an energy therapy that originated in Japan in the 1800s.  It is believed Reiki may have been used even prior to this time in ancient Tibet.  The name Reiki means universal life energy.  In Reiki, the therapist places their hands on or near the person receiving the treatment in an attempt to transmit their life energy force, ki, to that person. Reiki therapists believe that a disturbance or imbalance in ki causes the body to malfunction and illness results.  During treatment, the Reiki therapist’s hands remain in place for 2-5 minutes until they feel the transmission of their ki has slowed or stopped.  Persons receiving Reiki typically report feeling refreshed and relaxed after a treatment.  Reiki is considered to be generally safe and no serious side effects have been reported.  Persons may report feeling heat, coolness, pulsations, stomach rumblings, or muscle movements during treatment. Reiki is used to treat a variety of health-related issues such as chronic pain, stress, side effects from the use of chemotherapy and radiation cancer treatments, and recovery from surgery and anesthesia. ¹⁵

Little is known about how Reiki works.  Studies currently in the literature consist of a limited number of case reports, descriptive studies, and randomized control trials with small numbers of patients.  Future research is needed to support its use. ¹⁵

Examples of Use

Although not supported by research, Reiki is being used in pediatrics.  It is being tried as a therapy for a variety of pediatric conditions such as cancer, autism, pain, and stress/anxiety.  Reiki should not be used as a substitute for the standard of care but may be helpful as an adjunct therapy for children. ¹⁵    

Therapeutic Touch

Therapeutic touch was developed in the 1970s by Dr. Dolores Krieger and Dora Kunz.  During therapeutic touch, the practitioner assesses the person’s energy field, searching for areas of energy congestion, imbalance, deficit, excess, or disturbance.  The practitioner then attempts to re-balance and restore the person’s energy field and may even transfer some of their own energy to the person if needed so they can then heal their own body.  This is all done with the practitioner’s hands being close to but not touching the person they are treating.  Therapeutic touch has been used to promote relaxation, reduce anxiety and pain, and promote healing. ^{16, 17}

Scientists are not certain how therapeutic touch works.  No scientific studies have been able to detect the human energy field.  Therapeutic touch seems to affect the autonomic nervous system, increasing parasympathetic activation and decreasing sympathetic activation.  Treatments are generally perceived as pleasant and are considered extremely safe when they are done by trained practitioners. ¹⁶ 

Examples of Use

Although most of the studies on therapeutic touch have been done on adults, several small studies have been done in children.  One study found hospitalized preterm infants seemed more relaxed after therapeutic touch.¹⁸ A small study of hospitalized, adolescent psychiatric patients reported that therapeutic touch improved their communication with the hospital staff .¹⁸  Another small study of HIV infected 6-12 year olds showed they had reduced anxiety after they received therapeutic touch. ¹⁹  Further study is needed to support the use of therapeutic touch in pediatrics.  Currently, with the extremely low risk of side effects, this may be a treatment option to consider for children with stress and anxiety.  

References

1. http://nccam.nih.gov/health/backgrounds/energymed.htm, accessed 4/29/08.
2. Hilliard, R. (2003).  Music therapy in pediatric palliative care:  Complementing the interdisciplinary approach.  Journal of Palliative Care, 19(2), 127-132.
3. Avers, L., Mathur, A. & Kamat, D. (2007).  Music therapy in pediatrics.  Clinical Pediatrics, 46(7), 575-579.
4. http://www.medicalacupuncture.org/index.html, accessed 5/12/08.
5. http://nccam.nih.gov/health/acupuncture/, accessed 4/29/08.
6. Kundu, A. & Berman, B. (2007).  Acupuncture for pediatric pain and symptom management.  Pediatric Clinics of North America, 54, 885-899.
7. Breuner, C. (2002).  Complementary medicine in pediatrics:  A review of acupuncture, homeopathy, massage, and chiropractic therapies.  Current Problems in Pediatric and Adolescent Health Care, 32, 353-384.
8. Kundu, A. Personal email communication, 5/8/08.
9. Wang, S., Kain, Z. & White, P.  (2008).  Acupuncture analgesia:  1.  The scientific basis.  Anesthesia & Analgesia, 106(2), 602-610.
10. Lin, Y. & Ly, H.  (2003). Acupuncture and needlephobia:  The pediatric patient’s perspective.  Medical Acupuncture, 14(3), 15-16.
11. Kemper, K., Sarah, R., Silver-Highfield, E., Xiarhos, E., Barnes, L., & Berde, C.  (2000). On pins and needles?  Pediatric pain patients’ experience with acupuncture.  Pediatrics, 105(4), 941-947.
12. Zeltzer, L., Tsao, J., Stelling, C., Powers, M., Levy, S., & Waterhouse, M. (2002). A phase I study on the feasibility and acceptability of an acupuncture/hypnosis intervention for chronic pediatric pain. Journal of Pain and Symptom Management, 24(4), 437-446.
13. Beal, M. (2000).  Acupuncture and oriental body work:  Traditional and biomedical concepts in holistic care:  History and basic concepts.  Holistic Nursing Practice, 14(3), 69-78.
14. Gold, J., Nicolaou, C., Belmont, K., Katz, A., Benaron, D., & Yu, W. (2008).  Pediatric Acupuncture:  A review of the clinical research.  eCAM, doi:10.1093/ecam/nem181, 1-11.
15. Miles, P. & True, G.  (2003). Reiki – Review of a biofield therapy.  History, theory, practice, and research.  Alternative Therapies in Health and Medicine, 9(2), 62-73.
16. Kemper, K. & Kelly, E.  (2004). Treating children with therapeutic and healing touch.  Pediatric Annals, 33(4), 248-255.
17. Gronowicz, G., Jhaveri, A., Clarke, L., Aronow, M., Smith, T. (2008).  Therapeutic touch stimulates the proliferation of human cells in culture.  The Journal of Alternative and Complementary Medicine, 14(3), 233-239.
18.  Ireland, M. & Olson, M.  (2000). Massage therapy and therapeutic touch in children:  State of the science.  Alternative Therapies in Health and Medicine, 6(5), 54-63.
19.  Ireland, M. (1998).  Therapeutic touch with HIV infected children:  A pilot study.  Journal of the Association of Nurses in AIDS Care, 9(4), 68-77.