Chinese herbal medicine is very effective for infants and small children, yet many acupuncture/TCM practitioners remain wary of treating children. This is in contrast to naturopaths, who enter the healing arts confident and optimistic about treating all members of the family. In China, pediatrics is a TCM specialty, attracting many of the best and the brightest. Some concentrate on pediatric tuina massage for infants; others specialize in herbal medicine. I would like to see more American TCM practitioners train in treatments for infants and children, and in fact such training is available through the Holistic Pediatric Association, which offers a good TCM concentration. (See www.hpakids.org [2]). Treating children is particularly rewarding – they recover quickly and predictably, especially in contrast to geriatric patients. The abundant qi and yang of children helps their recovery, and the practitioners develop confidence and optimism in their practice. It is very rewarding.
In the main, formulas used for children are the same as those used for adults. That is to say, children do not require special formulas for common conditions. What is important is determining the correct syndrome differentiation. There are certain points one considers in giving herbs to infants and toddlers. Avoid very strong herbs – herbs too pungent or bitter, too warming or cooling, or too moving. A gentler approach is usually successful. Also, it is recommended that in acute conditions with infants and toddlers, as soon as improvement is noticed, one can discontinue the treatment. Momentum should take the child to complete recovery.
Dosing Considerations. Dosing can be done by age. Whether giving powder, liquid, or pills, the Chinese texts make these recommendations:
- Newborns: 1/6 adult dosage
- Babies: 1/3 – 1/2 adult dosage
- Young children (age 2-5): 1/2 - 2/3 adult dosage
- School children: same as adults
Normally, I take a prepared patent medicine (or two), and grind it in an electric coffee grinder. I then return the powder to the original bottle or a zip-lock bag. Or, one can use a Taiwan style extracted granule-powder. These are the instructions I give parents:
"Take one-half to one teaspoon of powder. Add a small amount of boiling water, enough to make a dark liquid: not too watery, not thick or pasty. Strain through a metal mesh strainer. From this liquid use a pediatric syringe and give the following dose:
- Infants: 1-2 ml/cc
- 1 to 2 years: 2-3 ml/cc
- 2 to 3 years: 3-4 ml/cc
- 3 to 5 years: 4-5 ml/cc
- Above 5 years: 6 ml/cc or one teaspoon."
Once children are able to swallow pills, somewhere between ages 7 and 12, I prefer this method or the use of tinctures. Normally I give 1/2 to 2/3 the adult dosage.
Common Clinical Illnesses. For many practitioners, treatment of infants, toddlers, and children revolve around acute conditions. The most common for infants are colic, fever, cough, and vomiting. As children get older, one treats common cold, fever, cough, headache, and stomachache. Chronic conditions where parents seek out alternative practitioners include eczema, asthma, insomnia, constipation, and behavioral problems such as ADHD (attention deficit hyperactivity disorder).
By the time a child is six or seven, standard TCM differentiations may be applied, and we use pulse, tongue and the same as seen in adults. (Children at this age will have slightly faster pulses.) For diagnosis of younger children, we rely on symptoms and history described by the parents, although tongue and palpation are helpful.
Pathophysiology Considerations. In children, three systems that are most commonly affected are digestion (spleen-stomach), lungs, and the immune system.
The digestive systems of infants are immature and delicate. They are easily injured by overeating, or by food that is too cold or too rich (spicy, fatty, sugary). Cow’s milk would be considered too rich and fatty, and often leads to food stagnation. Food retention caused by over-feeding is responsible for vomiting, colic, diarrhea, malnutrition, and anorexia (poor appetite). In these cases, effective formulas include Bao He Wan (Preserve Harmony Pill). Occasionally, wind-cold can lead to food retention, and an effective formula is Huo Xiang Zheng Qi San (Agastache Powder to Rectify the Qi). In cases of constipation with fever in infants, saline enemas, purchased in drug stores, are quite effective. Acute constipation in older children can be treated with formulas that contain Da Huang (Radix et Rhizoma Rhei). In acute situations of food poisoning or stomach flu in toddlers and young children, again, Huo Xiang Zheng Qi San (Agastache Powder to Rectify the Qi) would be the medicine of choice.
Infants and toddlers are susceptible to exogenous pathogenic factors (wind, cold, dryness, heat, summer-heat, and damp). Appropriate formulas for wind-cold and wind-heat can be used. The ones I use most frequently are Xiao Qing Long Tang (Minor Bluegreen Dragon Decoction) for wind-cold, and Yin Qiao San (Honeysuckle and Forsythia Powder) for wind-heat. For older children I frequently use the patent medicine Gan Mao Ling. For wind-heat-dryness, showing dry cough, I like to use Sang Ju Yin (Mulberry Leaf and Chrysanthemum Decoction).
If untreated or ignored, pathogenic factors will remain in the body. This can manifest in the lungs and sinus as phlegm, in which case formulas such as Qing Qi Hua Tan Wan (Clear the Qi and Transform Phlegm Pill) are effective. If the pathogens settle in the lymph or tonsils, one can combine Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Pu Ji Xiao Du Yin (Universal Benefit Decoction to Eliminate Toxin).
As far as boosting the immune system, I rely on either Yu Ping Feng San (Jade Windscreen Powder) or Astragalus Vials (Huang Qi). This is especially effective during the pollen allergy season.
When To Treat, When To Refer. Treating children takes study, enthusiasm, and some degree of confidence. Many parents are quick to jump to Western medicine, but the experienced practitioner knows when to treat, and when to refer. Referring, in my experience, usually means that the child requires hospitalization. I say this because conventional medicines for non-hospitalization illness in infants and children can be quite damaging. Many pediatricians rely on antibiotics and steroids for treating most pediatric conditions, when herbal medicine or acupuncture offers effective and much safer alternatives. The TCM pediatrician should see him or herself as an alternative to Western pediatricians for the outpatient level of common problems. Hospitalization, when necessary, however, draws on the true power and knowledge of Western medicine in order to save life or limb.
As an example, let us look at an uncommon presentation. True meningitis – a bacterial or viral inflammation of the brain or spinal cord – must be treated in the hospital in order to save a life. Isolated convulsion with high fever may not. If the TCM practitioner is successful in lowering the fever, a non-meningitis convulsion should not repeat itself. Arching of the spine, or continual or repeated convulsions, are dangerous signs, and the experienced practitioner should know that the child needs hospitalization. When we embrace the practice of pediatrics, training should be at the seriousness of this level, that severe illness can attack a young child. We must know when and how to refer, whether to the hospital’s emergency room, or to a conventional pediatrician.
Conclusion. Julian Scott, a great pioneer and advocate for TCM pediatrics in the West, said once, in a lecture, only go into pediatrics if you genuinely love children. Otherwise, when they are irritable or uncomfortable, they will drive you crazy. This love for children makes the clinic light and cheerful. They always make me laugh or smile, and in turn, that makes them relax. Some pediatricians in Oriental Medicine talk about creating a kid-friendly clinic with toys, pictures, gifts, but I think what is truly necessary is a heart-felt connection with the child. When they know that you like them, whether a 3-year-old or a 16-year-old, they enjoy coming in, and they trust the medicine. This does not mean that there are no boundaries, or that the clinic is a playroom. It is not. It is important for the child to be focused on why they are in the clinic. I always look the child in the eye, and say this: "The medicine will not taste very good. Swallow it quickly, and then have something to take the taste out, like water or juice. But if you take the medicine, you will get better quickly." I say this with belief and kindness, and because of that, children take their medicine. More importantly, they come to rely on Chinese medicine when they get sick, and ask for it in spite of the taste. And they grow up knowing something very valuable - that Chinese medicine works.
Recommended Reading.
- Essentials of Traditional Chinese Pediatrics, Cao Jiming, Su Cinming, Cao Junqi. Foreign Language Press, Beijing, 1990.
- Infantile Tuina Therapy, Luan Changye, Foreign Language Press, Beijing, 1989.
- Practical Therapeutics of Chinese Medicine, Wu Yan, Warren Fischer, Edited Jake Fratkin. Paradigm Publications, 1997.
This article originally appeared in Acupuncture Today, September, 2007
About the Author
Following undergraduate degrees in Chinese language and philosophy at the University of Wisconsin, Dr. Fratkin trained in Korean and Japanese acupuncture starting in 1975, in Chicago, and began clinical practice in 1978, in Madison, Wisconsin. In 1980 he began his education in traditional Chinese herbal medicine, which included ten months advanced training in China at several traditional hospitals. Dr. Fratkin has been teaching at various acupuncture colleges since 1982 and was Department Chairman of Herbal Medicine, Southwest Acupuncture College, Santa Fe. He is a practitioner and teacher of taijiquan and qi gong, which he has followed since 1974. He is the author of Chinese Herbal Patent Medicines, The Clinical Desk Reference.
Dr. Fratkin is currently in private practice in Boulder, Colorado, where he combines Chinese herbal medicine, Japanese meridian balancing acupuncture, and nutritional medicine. He specializes in internal disorders, infections, and pediatrics.
To learn more about pediatrics and TCM, click here [3] to view a complete list of courses by Jake Fratkin.