Children (STAIC)—State Version (42), there was a non- significant decline in reported levels of anxiety over the course of treatment. In two related studies, Lin and colleagues investigated the benefits of acupuncture for children and adolescents with chronic pain (43) and chronic fatigue (44). Fifty- three children and adolescents, aged 2–18 years, with a variety of painful conditions, reported significant reduc- tions in visual analog scale (VAS) ratings of pain between pre- and post-acupuncture measurements. The average duration of the ‘acupuncture effect’, however, was 3.0 days. In addition, the method of determining effect length was unclear, and seemed to suggest only temporary benefits associated with acupuncture as well as the need for continual treatment for long-term improvement. Eight adolescents, aged 11–18 years, with chronic fatigue syndrome reported similar reductions in average pain ratings, as well as temporary reductions in fatigue and an increase in energy after each treatment; however, the authors do not note whether these improvements are statistically significant. A more thorough presentation of the methods and statistical analysis is needed to draw accurate conclusions. Hand acupuncture has been studied among a sample of 106 children, aged 3–20 years, who presented to a general pediatric practice with a variety of acute and chronic conditions (45). Participants were encouraged to continue standard of care medical treatments (e.g. antibiotics, steroids) in addition to acupuncture therapy. Based on child- and parent-reports and clinical observations, 96% of participants experienced improvement in their symptoms, defined as complete resolution of pain or a 50% reduction in pain magnitude. Approximately 70% of children noted improvements in <3 days, however most chronic symp- toms improved within 1–2 weeks. As the author does not clearly define outcome measurement procedures or statis- tical findings, this study is difficult to interpret. Pediatric Migraine Although several studies have examined the effectiveness of acupuncture as treatment for adult headaches and migraines, as well as a recent review suggesting ‘pro- mising results’ (46,47), there has only been one examina- tion within a pediatric population. Twenty-two children, aged 7–15 years, with migraines were randomized to receive either acupuncture or placebo acupuncture (48). In the acupuncture group, needles were inserted sub- dermally, in accordance with Traditional Chinese Medicine. The placebo group received needle insertions within the stratum corneum, a more superficial skin layer. Weekly frequency-intensity questionnaires revealed a significant decrease in migraine frequency and intensity among participants in the acupuncture group, however, no such decline was observed within the placebo group. Findings from this investigation are particularly limited eCAM 2009;6(4) 431 due to the exclusion of participants who used daily medications, a highly prevalent practice among this population. Procedural Stress Within the pediatric literature, one randomized, con- trolled study was conducted among a premature infant population to examine the potential stress-reducing effects of acupuncture during an ophthalmologic exam- ination for retinopathy of prematurity (ROP) (49). Twenty-two infants were randomized to an acupuncture group, which was administered a single session of electro- acupuncture during the ROP examination, or a control group. Saliva samples were taken prior to electrode placement and 15 min after the ROP was completed to examine cortisol concentration, a marker of stress. Findings revealed that salivary cortisol levels increased among both the treatment and control groups, however, only the increase in the control group was statistically significant. Electrical stimulation was administered at a low frequency and intensity in order to avoid potential adverse events; therefore, the results are limited to low frequency and intensity stimulation. No conclusions can be drawn regarding use of a greater frequency or intensity of stimulation. Enuresis Early studies within the acupuncture literature reveal success rates as high as 98.2% among enuretic populations; however, these studies poorly define outcome variables and lack methodological empiricism (50–53). More recently, Bower and colleagues (54) performed a review assessing the use of acupuncture for nocturnal enuresis within the pediatric literature. Of the 206 articles examined, only 11 studies met criteria for inclusion. Nevertheless, they found that combined heterogeneous forms of acupuncture, as well as acupuncture combined with Chinese herbal remedies, might reduce the number of wet nights to a greater extent than a single treatment modality. Notably, they did not find a significant difference between acupuncture and antidiuretic medication trials. Perhaps the most empirically sound study cited in the aforementioned review was a randomized trial investigat- ing laser acupuncture as compared with desmopressin, a commonly used antidiuretic drug (55). The standard treatment group consisted of 20 children, aged 5–16 years, who received intranasal doses of desmopressin for 3 months. Twenty children, aged 5–14 years, were randomized to receive 10–15 acupuncture sessions in which pre-specified regions were targeted with a low- power laser. Post-treatment assessments at 6 months revealed that 75% of participants in the desmopressin group were complete responders (at least 90% reduction of wet nights) and 10% were partial responders (at least 50%