Acupuncture treatment appears to be safe for those who are under 18, with very little risk involved when qualified practitioners are wielding the needles, although there may be minor side effects in a small number of cases, a study said.

Acupuncture is used as an alternative therapy for a range of conditions, including pain, headaches and constipation, but few large, long-term studies until now have examined either its effectiveness or its safety in youngsters.

“Based on the available evidence, in trained hands, acupuncture is safe for children,” said Sunita Vohra, from the University of Alberta in Edmonton, who worked on the study.

Serious side effects were rare and likely to be caused by substandard practice, researchers wrote in a report in Pediatrics.

The study reviewed 37 other studies, ranging from randomized trials that compared side effects with acupuncture and other treatments, to single reports of acupuncture illness and injury.

“We calculated a mild adverse incidence per patient of 168 in 1,422 patients, or 11.8 percent,” the researchers wrote.

“Mild” side effects included things such as pain, bruising, bleeding, or worsening of symptoms.

“Of the adverse events associated with pediatric needle acupuncture, a majority of them were mild in severity. Many of the serious adverse events might have been caused by substandard practice,” the researchers wrote.

Among them was a case of a 17-year-old French boy who was diagnosed with HIV after acupuncture treatment for tendonitis, and 12 thumb deformities at one Chinese center in the 1980s.

“There’s some pretty unusual circumstances. Those sorts of things don’t really seem to happen now under modern-day circumstances,” Vohra said.

Others agreed, noting that there are ways to make sure children are getting safe, appropriate treatment.

Parents should get a recommendation from their child’s pediatrician, then should talk with the acupuncturist about the medical condition prior to any appointments, said Adeline Ge, senior Chinese medical consultant with the U.S. National Institutes of Health in Bethesda, Maryland.

Parents should also go to the appointment with their child, make sure the needles being used are clean, and be wary of acupuncturists who offer inexpensive treatment, she added.

Acupuncture is not recommended for children under two.

“In general, acupuncture is a very safe therapy. It should be good for kids. But consider their age, and we do need to be very careful and recommend that the parents are always involved,” Ge said.

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