Needling

11 Needling

Once the root treatment has been administered, in most cases one then adds some light stimulation to target relief of the symptoms of the child. What is done, where, and with what level of dose varies considerably depending on age, sensitivity, symptoms, and overall health of the child. Some of the shonishin tools and treatment techniques can be applied to start addressing symptoms. The most common technique is the use of tapping at specific acupoints or over specific regions of the body; the next being the application of gentle pressure to specific acupoints. Most regular adult acupuncture methods can also be used on children, provided they are modified and made suitable for the child. This includes the use of needling, moxa, cupping, bleeding, retention of press-spheres, intra-dermal needles, or press-tack needles. This section will cover the tools and methods of applying them on babies and children. The book Japanese Acupuncture: A Clinical Guide (Birch and Ida 1998) covers each of these techniques in detail in individual chapters. What is described below should be complemented by reading the relevant chapters of that book. The accompanying DVD also describes the techniques of needling, moxa, and use of the press-sphere, press-tack needle, and intra-dermal needle. Please watch the relevant sections of the DVD for further details of these techniques.

In general when inserting needles into a baby or child we have two simple approaches:

The “in and out” method: the needle is inserted, manipulated slightly for a short while and then withdrawn

The “retained needle” method: the needle is inserted and retained for a while, a technique called “chishin” in Japanese

For the in and out method, after insertion the needles are usually manipulated slightly with an up and down movement of the needle for a few seconds and then withdrawn. For the retained needle method, after insertion the needles are left for as long as 2 minutes or more, the time depending on the condition of the child, sensitivity of the child, and whether he or she stays still or not. The techniques of insertion are illustrated in the accompanying DVD. In order to understand how to use these techniques on babies and children it is necessary to consider a number of important issues. It is usually the insertion of needles and the fearful reactions of the child that have made use of acupuncture on babies and children something to avoid for many acupuncture practitioners.

In Chapter 2 I discussed the development of shonishin and the likely influences that gave rise to it. One of these is that inserting needles can be difficult on babies and children because they find it painful or distressing. This is not only stressful for the child and his or her parents, but also for the practitioner. Further, one of our primary goals in treatment is not to trigger unnecessary emotional expressions and outbursts since we are, as practitioners of traditionally based acupuncture, interested in helping regulate the qi of the patient, not cause it further disturbance. Therefore, we have to think about how we are to needle a child, where the reactions can be quite unpredictable. Before discussing the actual techniques of treatment in detail, I first discuss the handling of the child and parents, and choice of needles and other instruments.

Needle Types

In order to needle a child and minimize emotional reactions to what you do, you must use the right kind of needle. It is desirable that the child does not feel your needle or at least does not feel it as a threatening, uncomfortable, or painful thing. Thus, we use only high-quality thin needles. The needles should be the thinnest available, 0.12 mm or 0.14 mm gauge (Japanese number 00 or number 0, respectively). We also need to use needles that have the smoothest possible surface. Anyone who has looked at needles under a microscope will have noticed that despite the unmagnified visual appearance of being smooth, needles are actually not smooth. Their surfaces have small bumps and depressions in them. This is a normal part of needle production. These bumps and depressions cause surfaces that can be felt more on insertion. In order to counter this problem, manufacturers of syringe needles developed a technology whereby the surface of the needle is exposed to materials that give a super thin coating on the surface of the needle, so that they become very smooth, and when looked at under a microscope they appear completely smooth. This minimizes the sensations of being needled, making them easier to use. Since at least the 1980s the Seirin needle company has been manufacturing needles using the same technology, giving their needles a very smooth surface, which reduces discomfort or pain on insertion (Fig. 11.1a, b). It is ideal to use 0.12-mm or 0.14-mm Seirin needles (Fig. 11.2). This does not mean that you cannot try using other brands of needles, but with less smooth surfaces the chances are that the child may feel them more easily.

When the child feels the needle being inserted it could be experienced as pain, which can provoke crying, anger, and fear reactions, or they can experience sensations that draw their attention to the needle. Either way, the retained needle method can become difficult if not impossible. The child will do whatever he or she can to remove the needle. If the needling is experienced as painful or uncomfortable the child will often move around a lot, making it difficult for you to do any small manipulations of the needle if you are not going to retain it. Further, if the child pulls away suddenly after a needle has been inserted it could cause more discomfort or a small scratch, which are also undesirable. In order to ensure these problems do not occur, or to minimize the risk of them occurring there are, of course, a number of other things you must pay attention to.