430 Pediatric acupuncture Prior to the advent of modern medicine, acupuncture evolved as a primary health care modality for treatment of diverse conditions involving orthopedics, gastroenter- ology, obstetrics/gynecology and cardiology (17–21). Originating in China, acupuncture has been practiced as a form of bioenergetic healing (i.e. relating to the flow and transformation of energy in and between living organisms and between living organisms and their environment) for over 2000 years (22). Although there are several variations in its practice, acupuncture is based upon the notion of energy or ‘Qi’ (pronounced ‘Chee’), which is distributed throughout the body via a complex network of channels, or ‘meridians’ (23). Specific acupoints, which serve as target points in order to restore altered or obstructed Qi, can be found at precise positions along each meridian and are accessed using a variety of methods, the most common of which is dry needles (23,24). In response to the widespread use of acupuncture throughout history, recent research has sought to critically examine the efficacy of acupuncture as a treatment for diverse conditions. In adult populations, research suggests beneficial effects for conditions includ- ing fibromyalgia (25,26), dyspnea (27), nausea and vomiting (28,29), tinnitus (30), stroke rehabilitation (31), angina (31), menopausal symptoms (31), dysmenor- rhea (31), anxiety (32–34) and pain management (35). As the adult literature continues to determine the efficacy of acupuncture, the utilization and awareness of acupunc- ture in the treatment of pediatric conditions is also gaining increased attention. An examination of 43 pain clinics in North American children’s hospitals revealed that approximately one-third offered acupuncture services (36). Most research, which has focused on prevalence rates and acceptability, suggests that a large number of children are being referred for acupuncture, that the notion of receiving this type of alternative treatment is generally acceptable to their parents and that they are happy with the experience overall (37). This appears to contradict the mainstream notion that children are afraid of needles and that parents may not want to subject them to additional stress and pain (37,38). Despite the high prevalence of CAM usage in children, few empirically-based studies have examined the effec- tiveness of most CAM therapies in a pediatric popula- tion. A literature review of the web-based search engines PubMed, PsychInfo and Medline was conducted using the following search terminology: pediatric acupuncture, acupuncture and children, acupuncture and adolescents, pediatric CAM, CAM and children, and CAM and adolescents. All available studies addressing pediatric acupuncture were chosen for inclusion, with the exception of studies with poor methodological quality (e.g. poorly defined outcomes, sample size <10, etc.). This review will examine pediatric acupuncture across specific disease states, followed by a global assessment of design and methodological limitations commonly noted within this literature base. Contraindications associated with acu- puncture and potential future directions will also be discussed. Studies Assessing Acupuncture for Pediatric Populations Chronic Pain Kemper and colleagues (37) conducted a retrospective qualitative examination of 47 children and adolescents, aged 5–20 years, referred for acupuncture for a variety of chronic pain conditions. Treatment strategies included needles (98% of children), moxibustion or heat (85%), cupping (26%) and magnets (26%). Results revealed that 67% of patients and 60% of parents described the acupuncture experiences as positive or pleasant. In addi- tion, 70% of patients and 59% of parents reported that treatment was helpful in alleviating pain. Despite metho- dological limitations, this study revealed a high degree of acceptability among patients and parents, as well as pain- reducing benefits associated with acupuncture. A more recent study by Zeltzer and colleagues (39) examined the acceptability and feasibility of a CAM intervention among a pediatric sample with chronic pain. Thirty-three children, aged 6–18 years, were referred for a combined treatment of acupuncture and hypnosis. The acupuncture portion of treatment included six weekly sessions involving 6–15 needles placed at individually- determined acupoints, based on traditionally recognized methods. Participants also underwent progressive muscle relaxation and guided imagery exercises for 20 min. Findings revealed that 29% and 16% of participants had prior experience with acupuncture and hypnosis, respectively. Although parents with previous experience anticipated lower effectiveness, experience and anticipated effectiveness ratings were not associated with treatment outcome. Anticipatory anxiety and pain ratings taken during each session revealed that both variables signifi- cantly declined as treatment sessions progressed. In addition, both parent and child reported current pain ratings decreased from baseline to post-treatment on the Varni-Thompson Pediatric Pain Questionnaire (40). Almost half the participants experienced a 50% reduction in current pain ratings after the intervention. There was also a significant increase in functioning according to both child and parents reports, such that there was less pain-related interference in various arenas, including physical activity and activities with friends. Depression scores on the Children’s Depression Inventory (41) did not significantly change over the course of treatment, however, over 90% of the sample did not endorse clinically significant depression prior to the intervention. According to the State-Trait Anxiety Inventory for