Pediatric Acupuncture Safety: A Scoping Review

Abstract

Background

Previous research studies have indicated that acupuncture may be a promising treatment for several pediatric conditions, but the frequency and severity of associated adverse effects remain unclear.

Objective

We conducted a scoping review to identify the most recent evidence on the safety of pediatric acupuncture and to identify priorities for further research.

Method

Using MESH headings, we searched the MEDLINE database for articles published between July 1^st, 2015, and June 30^th, 2025. Articles identified with the search were analyzed using Covidence, a systematic review management system. We included publications with data pertaining to the safety of acupuncture for children. We restricted our search to studies reporting use of the most common type of acupuncture needles (filiform) for patients under age 21. Studies of acupuncture in combination with another intervention were excluded.

Results

330 potentially relevant abstracts were identified, 71 of which appeared to meet our criteria. After full text screening, 14 studies met our inclusion criteria: 5 randomized controlled trials, 3 case reports, 2 cohort studies, 2 feasibility studies, 1 systematic review, and 1 retrospective review. No serious adverse effects were reported in any of the publications reviewed.

Limitations

Search limited to MEDLINE and filiform needling.

Conclusions

Our scoping review of research published in the past decade failed to identify any reports of serious adverse effects of acupuncture in pediatric populations, confirming the findings of previous reviews. However, studies have failed to capture complete and comprehensive data on the adverse effects of pediatric acupuncture. Future research that rigorously evaluates both the effectiveness and the safety of commonly used acupuncture treatments for specific pediatric conditions will help clinicians and families make more fully informed decisions about the appropriate role of acupuncture in pediatric care.

Keywords

acupuncture pediatrics traditional Chinese medicine

Introduction

The percentage of adults in the U.S. reporting use of acupuncture has increased from 1.0% to 2.2% in the last 20 years.¹ Acupuncture for children is now offered in prominent children’s hospitals including John’s Hopkins All Children’s Hospital,² Boston Children’s Hospital,³ and Children’s Hospital of Philadelphia.⁴

Although preliminary evidence suggests acupuncture is a promising treatment for some childhood conditions,⁵ the frequency and severity of adverse effects of acupuncture for pediatric conditions remains unclear. In 2008, 2 reviews concluded that pediatric acupuncture is generally considered safe when conducted by appropriately trained practitioners but noted that the quality of the evidence was poor.^6,7

A 2011 systematic review reported a few serious adverse effects of pediatric acupuncture including infections and organ penetration, but most adverse effects were deemed mild (eg, pain, bruising, and worsening symptoms). As with previous reviews, this study concluded that acupuncture is safe when performed by appropriately trained practitioners.⁸ Finally, a large 2015 review of the efficacy and safety of acupuncture for children identified 24 systematic reviews that included 142 randomized controlled trials (RCTs) with over 12 000 participants.⁵ Based on the results of the 6 of these 24 reviews that reported on safety, the authors were unable to reach a conclusion. Given the limitations of previous research on the safety of pediatric acupuncture, we conducted a scoping review of studies published in the last decade to lay the groundwork for future research that will provide a clearer answer to this question. Scoping reviews have been described as “exploratory in nature, seeking to identify the nature and extent of research on a particular topic, and can be used to identify gaps in the literature.”⁹

Methods

Overview

Our review focused exclusively on filiform needle acupuncture, the most widely used style associated with acupuncture practice in Western countries.¹⁰ Other needle types, such as press needles that barely penetrate the epidermis and are less likely to cause discomfort or pain, were excluded. We also excluded studies combining acupuncture with other treatment modalities to ensure any adverse effects could be confidently attributed to acupuncture alone. This review was conducted and reported in accordance with PRISMA scoping review guidelines.¹¹

Search Strategy

Using MeSH-based keywords (See Appendix) to capture studies related to acupuncture, children, and safety, we searched MEDLINE to identify potentially relevant studies. Articles published between July 1^st, 2015 and June 30^th, 2025 were included.

Study specifications based on the PICO criteria¹² were: (1) study participants were restricted to pediatric populations aged 21 years or younger, (2) interventions were restricted to treatments using only the insertion of filiform acupuncture needles into the skin, including electroacupuncture, (3) no restrictions were applied to the types of comparison groups because we were only interested in the safety of acupuncture treatments, and (4) all data pertaining to adverse effects of pediatric acupuncture were collected and analyzed. Furthermore, only publications mentioning “safety” or “adverse effects” in the Methods and/or Results sections and those with full-text articles in English were included.

Review Process

This review was conducted by 2 licensed acupuncturists (AB and BL) who are Teaching Associates at the University Washington (UW) Osher Center for Integrative Health in Seattle. The Director of Research at UW Osher Center (DC), an experienced researcher and clinical trialist, provided guidance and insights throughout the review process.

Covidence,¹³ a validated online platform for managing systematic and scoping reviews, was used to streamline the publication review process, minimize screening bias, and improve transparency of decision making. This software supports key functions such as elimination of duplicate publications, title and abstract screening, full-text review, and data extraction.

The review process involved 4 stages: (1) title and abstract screening, (2) full-text screening, (3) data extraction from selected articles using a standardized form completed independently by 2 reviewers, and (4) consensus review of extracted data. The 2 reviewers (AB and BL) independently assessed each article and assessed eligibility at each stage. When disagreements occurred, the reviewers jointly re-examined the publication to reach consensus. In the few cases when consensus could not be achieved, a third reviewer (DC) made the final determination. The reviewers were provided with agreed upon exclusion criteria to choose from and instructed to annotate the reasoning for their decisions.

Analysis of Screened Publications

After the screening process was completed, publications meeting the criteria were categorized by publication type (eg, systematic review, case study, randomized clinical trial), condition treated (eg, pain, colic), sample size, participant age range, whether or not studying safety was a specific aim of the study (yes/no), adverse effects reported (none, only non-serious, serious), and specific types of adverse effects.

Results

Search Result

The initial search using MeSH terms identified 330 abstracts. Of these, 71 met the preliminary eligibility criteria and underwent full-text screening. Fifty-seven publications were subsequently excluded, primarily because they studied acupuncture in combination with another treatment, included participants older than 21 years old, or failed to report any data on adverse effects. Ultimately, 14 studies met all inclusion criteria (Figure 1).

Figure 1.

Preferred reporting items for systematic reviews and Meta-Analyses (PRISMA) flow diagram

Description of Studies Included in Review

Table 1 describes the 14 studies included in the analysis. These studies included a total of 2432 participants, 1412 of whom received acupuncture. Participants’ age ranged from 4.5 weeks to 21 years. None of the 14 studies were explicitly designed to assess the safety of acupuncture, but 6 studies reported collecting safety-related information in their Methods sections. Randomized clinical trials (RCTs) were the most frequent type of study (n = 5) followed by case reports (n = 3). Only 2 trials included more than 100 participants who received acupuncture.^14,16 Pain of various types was the most frequently studied condition (3 of the 14 studies). Eight studies were published in conventional medical/health care journals, 3 in integrative medicine/health journals, and 3 in acupuncture journals.

Table 1.

Identified Publications

Author - year	Name of journal	Types of Condition (s) treated	Study design	Age range of children	Treatment style^a	Acupuncture (n)	Control (n)	Where safety mentioned	Any AEs^b reported	Any serious AEs reported
Cheng 2024¹⁴	Healthcare	Cerebral palsy	Systematic review/Meta-Analysis	1.6 ± 0.25 years old to 12.4 ± 6.2 years old	MA	869	861	Result	Yes	No
Garlanger 2017¹⁵	American Academy of Physical Medicine and Rehabilitation	Pain	Feasibility study	14-17 years old	MA	15	0	Method; result	Yes	No
Gold 2023¹⁶	Children	No specific symptoms focused	Cohort study	8 to 21 (mean age of 15.9 years old)	MA	230	0	Result	Yes	No
Huang 2021¹⁷	Acupuncture in Medicine	Transverse myelitis	Case report	4 years old	EA & MA	1	0	Result	No	No
Khadour 2025¹⁸	Clinical Rheumatology	Juvenile idiopathic arthritis	RCT	8 and 16 years old	EA	42	41	Method; result	Yes	No
Landgren 2017¹⁹	Acupuncture in Medicine	Infantile colic	RCT	4.5 to 7 weeks old	MA	98	0	Result	Yes	No
Liu 2020²⁰	Evidence-Based Complementary and Alternative Medicine	Other	Cohort study	4.25 to 8.33 years old	MA	19	0	Method; result	Yes	No
Luetmer 2019²¹	American Journal of Physical Medicine & Rehabilitation	Muscle soreness	Feasibility study	13-8 years old	MA	42	0	Method; result	Yes	No
Shang 2018²²	Medicines	Myopia	RCT	6 and 12 years old	MA	22	22	Result	No	No
Tsai 2020²³	Complementary Therapies in Medicine	Pain	Retrospective chart review	Median 17.5 years (range 8 to 21 years old)	MA	24	0	Method; result	No	No
Tsao 2015²⁴	The Laryngoscope	Pain	RCT	3 to 12 years old	EA	30	29	Method	No	No
Wang 2020²⁵	Chinese Journal of Integrative Medicine	Cerebral palsy	RCT	24-60 months old	EA & MA	18	18	Method; result	Yes	No
Yang 2024²⁶	Medicine	Anti-NMDAR encephalitis	Case report	13 years old	MA	1	0	Result	No	No
Zhang 2021²⁷	Acupuncture in Medicine	Henoch-Schönlein purpura	Case report	6 years old	MA	1	0	Result	No	No

^aMA: Manual Acupuncture, EA: Electric Acupuncture.

^bAEs = Adverse Effects.

Analysis on Adverse Effect

None of the 14 publications reported serious adverse effects, 6 reported no adverse effects, and 8 studies documented only non-serious adverse effects (Table 1). The most frequently reported adverse effects were minor bruising, localized pain or numbness, tingling at the insertion site, and minor bleeding (Table 2).

Table 2.

Adverse Effect Details

Author and year	Author reports of adverse effects
Garlanger 2017¹⁵	Pain or tingling in the treatment area, sensation of cold, numbness, minor bruising, dizziness, nausea, sensation of heat, and lightheadedness,
Landgren 2017¹⁹	Bleeding (a single drop of blood)
Wang 2020²⁵	Mild bleeding during treatment
Luetmer 2019²¹	Numbness and tingling in the treatment area
Liu 2020²⁰	Mild subcutaneous, needling pain
Gold 2023¹⁶	Mild facial redness and swelling resolved on its own
Cheng 2024¹⁴	No description of AE details
Khadour 2025¹⁸	Pain, hematoma, dizziness after session, flares, other discomforts after session

Discussion

The findings of this review of research published between 2015 to 2025 are consistent with those from earlier reviews that concluded that acupuncture is generally safe for pediatric patients.^6-8 None of the included publications reported serious adverse effects. However, because nearly all studies of pediatric acupuncture focused primarily on treatment effectiveness, adverse effects have received minimal attention and inconsistent documentation.

To strengthen the evidence base, future research should adopt validated methods for documenting adverse effects and standardizing terminology.^28,29 This includes using reporting guidelines such as CONSORT (Consolidated Standard of Reporting Trials) for RCTs^13,28 and STRICTA (Standards for Reporting Interventions in Clinical Trials of Acupuncture).³⁰ These tools promote simpler reporting mechanisms, consistent use of terminology and universally accepted standards frameworks.²⁸

To establish confidence in pediatric acupuncture safety in diverse clinical settings, effectiveness studies in real world practice and efficacy studies in controlled conditions should systematically report not only the frequency, severity, and specific types of adverse effects but also information about practitioner qualifications, needle gauge, needling technique (depth, manipulation, needle retention time), and the specific acupuncture approach or style employed. Furthermore, we support Kemper’s assertion that “more complete data about safety in children would require prospectively gathered, population-based studies, which are expensive to conduct.”⁷

The primary strengths of this review are its inclusion of evidence from the most recent decade to update older systematic assessments and to provide a foundation for future studies on the safety of acupuncture for children. Key limitations include restrictions to a single publication database (MEDLINE), English language publications, and studies using the most commonly-used type of acupuncture needles, all of which could introduce selection bias.

Finally, future studies should focus on pre-pubescent children who are physiologically different from adults,³¹ include other literature databases and non-English studies (especially Asian), and expand the exclusive focus of previous research on physical harms to include psychological harms.

Conclusions

The results of this scoping review of recent studies are consistent with earlier studies that did not find evidence that pediatric acupuncture was unsafe. However, no studies have been specifically designed to capture data on the safety of pediatric acupuncture using filiform needles, the most commonly-used type of needle in the West.¹⁰

Future research that rigorously evaluates both the effectiveness and the safety of commonly used acupuncture treatments for specific pediatric conditions will help clinicians and families make well-informed decisions about the appropriate role of acupuncture in pediatric care.

Footnotes

Acknowledgments

We wish to acknowledge Elektra Enslow, Director, Clinical Research and Data Services at the University of Washington Health Sciences Library for assistance.

ORCID iD

Aiko Bailey

Author Contributions

Aiko Bailey, DACM, EAMP conceptualized and designed the study, analyzed the data, drafted the initial manuscript and critically reviewed, and revised the manuscript.

Brenda Loew, DAOM, LAc conceptualized and designed the study, analyzed the data, drafted the initial manuscript and critically reviewed, and revised the manuscript.

Dan Cherkin, PhD conceptualized and designed the study, analyzed the data, drafted the initial manuscript and critically reviewed, and revised the manuscript.

Iman Majd, MD, LAc conceptualized and designed the study, critically reviewed and revised the manuscript.

Rachel Blume, MLIS assisted with the initial database search strategy and reviewed the manuscript.

All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Article Summary

This updated review of research on the safety of pediatric acupuncture clarifies the current state of knowledge and identifies priorities for further research.

Appendix

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