By Melanie Katin, MSTOM, LAc
Pediatrics as a specialty is one of the oldest topics discovered in the Chinese medical literature. Sabine Wilms discusses that as early as the Han Dynasty (206 BC-220 AD), there is mention of pediatric treatments in at least 19 volumes within the Imperial Library, (Venerating the Root, Part 1, 2013). Sun Simiao was a notable author in the early Tang Dynasty (618-907 AD) who emphasized the treatment of children and women above any other medical issue. Qian Yi (1032-1113, Song Dyn.), who is credited as the “Sage of Pediatrics,” recognized that there are unique characteristics of children that distinguish them not as small adults, but as having distinct physiology and pathophysiology that require modified treatments. The earliest documentation of using acumoxa therapy on children was described by Dr. Wan Quan (1495-1585) in the Ming dynasty. He discussed the reality that children can be difficult to needle, making pediatric massage more sufficient to rectify their diseases.
From these early moments in history forward, the movement towards non-needling children was recognized as beneficial, resulting in the creation of new techniques.. The method of shonishin (sho=little, ni=children, shin=needle) started in Japan in the 1700s, and has been popularized by Western practitioners. Shonishin involves gentle scraping and tapping with small copper, brass or stainless steel instruments along the acupuncture channels of the limbs, abdomen, and back of young patients. The act of tapping and sraping ensures a healthy directional flow of qi in a child. Since their body systems are immature, and they are in the most yang phase of life, a rapidly moving, superficial technique is extremely useful. In modern Japan, it is common for TCM hospitals to raise brightly colored flags with animals on them during each month on the emergence of the full moon. The flag raising signals to local parents that it is time to bring their children in for shonishin treatments. This practice acclimates children to treatment when they are healthy, so that when they do fall ill, they are already familiar with the protocol, and are comfortable with the procedure.
The actual practice of treating children in a pediatric clinic is rewarding yet challenging,. The job requires the herculean ability of juggling parental input and opinion, apprehension about their child’s illness, the child’s initial fear, distrust, and curiosity about the novel methods of treatment, and of course, accurate diagnosis. Don’t forget somehow managing to successfully treat a wiggling, small person. Choosing the necessary instruments for treatment is unique to each situation. In my clinic, various techniques are used for treatment in addition to or in lieu of needling, including tui na massage, tuning forks, Manaka hammers, magnets, and shonishin. Most kids are delighted by the variety of tools, and have a great time exploring them while trying to treat their parents during their treatments. However, it’s been recognized that children with the condition of Sensory Processing Disorder (SPD, also called Sensory Integration Disorder-SID), do not always respond favorably to the shonishin specifically, which can be a useful tool for helping determine both the TCM pattern, and also the type of SPD.
SPD/SID is a comorbid condition that may present with any of the autism spectrum disorders. In 2009, a study by Ben-Hasson, Carter, & Briggs-Gowan suggested that possible risk factors for developing SPD were premature gestational age (less than 36 weeks), low birth weight, maternal stress, illness or medication use during pregnancy, lower socioeconomic status, and living with a single parent. The general presentation of SPD deals with external sensory input. The input is overwhelming and disorganized to the child, who is unable to clarify what information is essential for their attention and response, and what is irrelevant background information or noise. For example, when you are listening to a teacher lecture, the normal response is to ignore the sound from the air vents above and listen to her voice. A child with SPD cannot isolate the imperative input; the result of this internal chaos can manifest as adversity to touch, sounds, smells, tastes, textures, and vigilance to maintaining an orderly space around her/himself, all of which are reflective of hyperactive response. The opposite, or hypoactive response presents with craving strong, stimulatory sensations, textures, and movement. Additionally, it has been found that children with SPD have a range of mental-emotional concerns, from anxiety (hyperactive, or hyper-sensitive to everything) to aggression (hypoactive, because they are trying to elicit strong reactions from those around them).
This disorder also falls under the categorization of ADD/ADHD, although this is a slight misrepresentation according to Carol Kranowitz, in her seminal book, “The Out of Sync Child,” (2006). There are overlapping elements of the two conditions that are suggestive of either SPD/SID or ADD/ADHD, but there is too much reductionist interpretation of these coinciding signs and symptoms to make an accurate diagnosis. This lack of accuracy results in medicating the child for ADD/ADHD, perhaps in lieu of receiving appropriate therapy for SPD.
Dr. Jean Ayres, an occupational therapist, first discussed SPD about 40 years ago. Within the treatment paradigm of OT, the strategy is to always offer sensory information that is steady, consistent, and firm, depending on whether the child’s tendencies are hyperactive or hypoactive. In the hyperactive case, the child is overwhelmed with sensory information, indicating that treatment needs to be done with firm pressure, in a darker room, and small space. These conditions reduce the amount of concurrent sensory distraction, allowing the neurological system an opportunity to quiet and calm down. The specific types of treatment in the TCM clinic would include firm tui na techniques, Manaka hammer on specific acupoints that correspond to diagnosis (as long as the sound is not distressing), and use of tuning forks on acupoints. In contrast, the hyporesponsive child needs much more sensory input, so quick, rapid and lighter techniques would be appropriate, along with movement of both patient and practitioner around the treatment room (i.e. sitting on the floor during treatment). In the hypoactive case, shonishin would be a well tolerated technique to add, but since it is performed with gentle, surface techniques on the skin, it is tremendously uncomfortable for the hyperactive presentation, as these children are almost uniformly averse to light pressure and touch.
In most cases, the family is not aware of which type of SPD their child has, but the practitioner will discern fairly quickly what is distressing, and ideally will stop that activity during the treatment. You can use this shonishin information to your benefit when trying to identify the TCM pattern.
While the action of treating children is fairly easy, determining the pattern is often elusive. Solely focusing on the sense organ most affected, the pattern of element out of harmony or organ system imbalance will be nearly impossible to distinguish. The types of sensitivities are as varied as the senses: visual, auditory, taste, texture, proprioceptive, and olfactory. Children exhibit varying degrees of sensitivity to one or all of these sensory cues. Additionally, there may be inconsistency in their sensitivity, for instance, a child with proprioceptive imbalance who always bumps or trips over objects may be quite adept and coordinated when engaging in focused sporting activities. Closely observe the reaction to shonishin, since this a clear objective collection of data, and this information will yield a better clinical perspective.
In this author’s experience, there are a few standard recognizable patterns of symptoms, when identified can indicate the most appropriate and comfortable treatment options.
Hypersensitivity to Touch – Tactile Defensiveness
- Dislikes light touching or cuddling
- Distressed with clothing seams or tags, textures, turtlenecks
- Avoids or averse to messy playthings, such as sand, playdoh, silly putty, etc.
- Distressed by brushing teeth, cutting finger/toe nails, brushing hair, having face washed
- Refuses to walk barefoot on certain surfaces, such as grass, and may only walk on toes
- Very ticklish
- Prefers to be hugged with strong pressure
- Tends to be anxious about new experiences, people
- Underlying TCM Pattern(s): Blood vacuity, Qi vacuity, or Wei Qi vacuity
Hyposensitivity to Touch – Under-responsive
- Craves touch
- Touches everything around himself, including people
- Unaware of bumping into objects unless very forceful
- May be self-abusive: biting, hitting body against objects
- Puts a lot of objects into mouth
- Seeks out surfaces and textures that have tactile interest
- Craves vibrating or strong sensory information
- May have aggressive tendencies or tantrums
TCM Pattern(s): Heart & Liver Fire, Phlegm-fire harassing the Shen
The internal heat in these children is evident in their outward behavior, but usually will also present with long, red, pointy tongues, with or without thick coat.
Poor Tactile Perception & Discrimination
- Difficulty with tasks such as zipping, buttoning
- May be fearful of the dark
- Disheveled appearance: unties shoes, untucked shirt, pant leg tucked into sock, etc.
- Difficulty using crayons, scissors, feeding himself with utensils
- Difficulty determining physical characteristics of objects, such as their shape, weight, temperature, etc.
- Difficulty with identifying objects by their touch only; needs vision to assist recognition
TCM Pattern(s): Lung vacuity, Kidney vacuity
There can be more fear-based living in these children, which clearly points to Kidney/Heart vacuity, but the lack of coordination and “bodily structure” suggests that the Metal element can be weak.
Melanie Katin, MSTOM, LAc has been on the faculty of Pacific College of Oriental Medicine (PCOM) NY since 2006, and has a private practice in NYC, where she focuses on pediatrics and auto-immune cases.