Exploring the Role of Paediatric Acupuncture and Tui Na in Treating Colic and Gastrointestinal Disorders: A Comprehensive Review

Journal of Complementary Therapies in Health ISSN 2975-9323 |eISSN 2975-9552 Journal of Complementary Therapies in Health 2025:3(3). doi:10.5281/zenodo.17290058 institutoptc.com/journal-complementary-therapies Review Exploring the Role of Paediatric Acupuncture and Tui Na in Treating Colic and Gastrointestinal Disorders: A Comprehensive Review. Daniel Sebastião1, Cátia Relvas1*, Jorge André Matos1, Marina Silva1. 1 ABS – Health Level, Atlântico Business School, Vila Nova de Gaia, Porto, Portugal. * Correspondence: catiarelvas[email protected] Abstract Paediatric acupuncture is increasingly investigated as a complementary treatment for infantile colic and other gastrointestinal disorders. Tui Na massage is cited as a beneficial intervention when combined with acupuncture. This study aims to evaluate the efficacy and safety of paediatric acupuncture in the treatment of colic and gastrointestinal disorders, highlighting the role of Tui Na massage as a complementary therapy to acupuncture. Studies suggest that acupuncture can reduce colic symptoms and improve intestinal motility; however, it should be used with caution, as it may cause pain, particularly in younger infants. Tui Na massage has also shown positive results in reducing pain and promoting digestive well-being in children, making it a valuable complementary therapy to acupuncture. While paediatric acupuncture shows therapeutic potential, safety concerns warrant further investigation. Additionally, Tui Na massage may serve as an effective complementary therapy. Keywords: Paediatric Acupuncture; Tui Na massage; Cramp; Colic; Gastrointestinal Disorders. 1. Introduction Infantile colic is a common clinical problem that usually resolves on its own around 4 to 5 months of age. Although this isn´t considered a pathology, children who have had severe colic may be more likely to develop recurrent abdominal pain, allergic problems (such as rhinitis, conjunctivitis, asthmatic bronchitis, pollinosis, atopic eczema and food intolerances) and psychological problems (including sleep disorders, agitation and aggression) during childhood 1. Infantile colic is also a distressing and poorly understood condition 2. According to Meyer et al. 3, functional constipation is a common problem among children and is associated with abdominal discomfort, elimination of faeces, lack of appetite, stool retention, and overflow incontinence, negatively impacting the child's quality of life. Therefore, rapid diagnosis through a complete history and physical examination is crucial to enable an appropriate treatment plan 3. Additionally, functional constipation is a prevalent gastrointestinal condition that causes numerous negative effects on children's daily lives 4. Comprehensive treatment of functional constipation begins with clearance, if necessary, followed by maintenance therapy. However, functional constipation usually requires prolonged maintenance therapy, which includes pharmacological intervention, behavioural changes, and dietary adjustments 3. Citation: Sebastião D., Relvas C., Matos JA., Silva M. Exploring the Role of Paediatric Acupuncture and Tui Na in Treating Colic and Gastrointestinal Disorders: A Comprehensive Review. Journal of Complementary Therapies in Health. 2025;3(3) 10.5281/zenodo.17290058 Academic Editor: Jorge Rodrigues Received: 15 September 2025 Reviewed: 20 September 2025 Revised: 23 September 2025 Revised: 5 October 2025 Accepted: 6 October 2025 Published: 7 October 2025 Publisher’s Note: IPTC stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Copyright: ©2025 by the authors. Submitted for open access publication under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Journal of Complementary Therapies in Health 2025: 3(3). 2 of 12 Sebastião D., Relvas C., Matos JA., Silva M. Exploring the Role of Paediatric Acupuncture and Tui Na in Treating Colic and Gastrointestinal Disorders: A Comprehensive Review. doi:10.5281/zenodo.17290058 Santucci et al. 5 presents a review of current pharmacological options and discusses possible future therapeutic approaches for children with functional gastrointestinal disorders and suffering from functional abdominal pain disorders. Pharmacological approaches include anti-inflammatory drugs, protein regulators, analgesics, and serotonin antagonists, which play a therapeutic role in the treatment of irritable bowel syndrome. On the other hand, non-pharmacological approaches include stimulation of the peripheral electrical nerve field to the external ear, gastric electrical stimulation, and dietary modifications such as low-fructose and high-fibre diets, probiotics, prebiotics, and synbiotics. As well, complementary treatments such as acupuncture, moxibustion, yoga and spinal manipulation are also becoming more popular in the treatment of bowel disorders. In this sense, physical and manipulative therapies, such as abdominal massage, reflexology, acupuncture, and transcutaneous nerve stimulation, show promise in the treatment of paediatric gastrointestinal disorders 6. Furthermore, the World Health Organization 7 recognizes acupuncture as beneficial in the treatment of various diseases. In 2002, a report listed 28 diseases with demonstrated efficacy and a further 63 with possible advantages. In total, there are 91 clinical disorders where acupuncture may be seen as a treatment choice, primarily as an adjunct to standard medical practices. For example, acupuncture is often evaluated for its effectiveness in relieving chronic pain and improving symptoms of gastrointestinal disorders 7. Moreover, according to Shen et al. 8, Traditional Chinese Medicine (TCM) treatments, including acupuncture and abdominal massage, have shown efficacy in improving bowel movement regularity, managing the digestive system, and relieving discomfort in paediatric age. However, these treatments must be done by qualified professionals, following strict safety protocols. Acupuncture may act on specific points of the body where Qi (vital energy) flows through defined meridians and influences physiological functions. These points are associated with nerve endings, muscle fibres, and vascular structures, and stimulation can modulate neural pathways, inflammatory processes, and neurotransmitter release. This therapeutic practice can be classified as manual or needle acupuncture, electroacupuncture (which involves electrical stimulation through acupuncture needles), transcutaneous electrical acustimulation (which replaces needles with surface electrodes) or laser stimulation 9. According to Landgren et al. 10, qualitative data indicated that caregivers of newborns undergoing acupuncture more frequently reported an improvement in colic and noted favourable changes in symptoms beyond frequency. On the other hand, in the study by Lu et al. 11, in children between 0 and 6 years old with acute diarrhoea, paediatric Tui Na massage demonstrated significant effects in reducing the frequency of diarrhoea episodes. Therefore, this research aims to evaluate the efficacy and safety of paediatric acupuncture in the treatment of colic and gastrointestinal problems in children, observing its use both independently and in conjunction with Tui Na massage. The effects of these therapies on pain relief, improved intestinal function, and caregiver satisfaction will be analysed. 2. Methodology 2.1. Search strategy for identification of studies We systematically searched PubMed, SciELO, ScienceDirect and Google Scholar using the keywords: “Paediatric”, “acupuncture”, “Tui Na massage”, “colic”, “gastrointestinal disorders”, “pain”, and “needling”. Boolean operators (AND, OR) were employed to refine the search queries. For example (“Paediatric Acupuncture” AND “Colic”) OR (“Paediatric Acupuncture” AND “Gastrointestinal Disorders”) OR (“Tui Na Massage” AND “Colic”). While the initial period covered the years 2020 to 2025, it was later expanded to include earlier studies of high scientific relevance due to the limited number of eligible publications meeting the inclusion criteria. Journal of Complementary Therapies in Health 2025: 3(3). 3 of 12 Sebastião D., Relvas C., Matos JA., Silva M. Exploring the Role of Paediatric Acupuncture and Tui Na in Treating Colic and Gastrointestinal Disorders: A Comprehensive Review. doi:10.5281/zenodo.17290058 Furthermore, efforts were made to ensure methodological transparency by including articles written in Portuguese, English, or Chinese, with searches cross-referenced using controlled vocabulary. 2.2. Inclusion and Exclusion Criteria In this narrative review, studies were included if they were published in Portuguese, English, or Chinese and involved paediatric populations aged 0 to 6 years. Eligible studies specifically addressed the efficacy, safety, or clinical application of acupuncture and/or Tui Na massage in the treatment of infantile colic or gastrointestinal disorders in children. A broad spectrum of scientific literature was considered, including original research articles, systematic reviews, meta-analyses, clinical trials, and observational studies. Studies were excluded if the full text was not accessible, if the population studied did not fall within the specified paediatric age range, or if the intervention focused exclusively on adults. 2.3. Assessment of Study Quality and Risk of Bias Although the present study follows a narrative review format, an informal quality assessment was conducted to provide context and enhance the scientific rigour of the synthesis. The included studies were evaluated based on study design (e.g., Randomized controlled trials, observational studies, or literature reviews), clarity of outcome measures, transparency of methods and reporting. Limitations and potential biases identified within individual studies were highlighted during the synthesis and discussed to ensure a balanced interpretation of the findings. 3. Results The initial search yielded a total of 65 articles (PubMed: 15; SciELO: 8; ScienceDirect: 12; Google Scholar: 30). A two-stage screening process was then applied: first, titles and abstracts were reviewed for relevance, resulting in 41 studies being selected for full-text analysis (PubMed: 24; SciELO: 6; ScienceDirect: 8; Google Scholar: 3). Following this, a detailed full-text review led to the inclusion of 35 studies that fully met all predefined inclusion criteria (PubMed: 22; SciELO: 5; ScienceDirect: 6; Google Scholar: 2). The main reasons for exclusion at each stage included lack of access to the full text, focus on non-paediatric populations, absence of acupuncture or Tui Na as a therapeutic intervention, insufficient clinical relevance, or failure to address gastrointestinal conditions. This structured and rigorous selection process ensured that only clinically meaningful evidence was synthesized in the final analysis, thus reinforcing the validity and applicability of the findings within the context of Traditional Chinese Medicine. 3.1. Paediatric Acupuncture in the Treatment of Colic and Gastrointestinal Disorders According to the study by Oflu et al. 12, complementary medicine practices and nonconventional therapies are used at a significant rate for the treatment of infantile colic. Most parents perceive complementary medicine practices and NCTs as safe. Therefore, as these practices are commonly used to treat infant colic and other health problems, healthcare professionals should be aware of their potential negative effects. Jindal et al. 13 reinforce that acupuncture appears to be reasonably tolerated in children, as the rate of side effects is low and generally negligible. However, parents should be advised to seek out professionals who are properly licensed and have experience working with children. Diagnostic assessment involves identifying the type of disharmony according to TCM, such as Qi deficiency, internal heat, or jingluo (meridian) obstruction, and determining an appropriate therapeutic strategy. The selection of acupuncture points must consider factors such as the child's age, tolerance, and anatomical safety. Frequently used points include Hegu (LI4), Zusanli (ST36), and Sanyinjiao (SP6). The depth and angle of needle insertion are adjusted according to age and body constitution: for children under Journal of Complementary Therapies in Health 2025: 3(3). 4 of 12 Sebastião D., Relvas C., Matos JA., Silva M. Exploring the Role of Paediatric Acupuncture and Tui Na in Treating Colic and Gastrointestinal Disorders: A Comprehensive Review. doi:10.5281/zenodo.17290058 3 years of age, superficial insertion (0.3 to 0.5 cm) without retention is generally applied; for those aged 7 to 14, needle depth may range from 1 to 2 cm, with retention times of 10 to 15 minutes. Throughout the procedure, continuous monitoring of the child’s response is essential, with a strong emphasis on comfort and safety. Auxiliary techniques such as gentle manipulation (including rotation or mild stimulation) should be brief and delicate. In specific cases, complementary techniques may be employed, such as indirect moxibustion (using moxa sticks or small cones) or acupressure with beads or specialized instruments. The standard also specifies the types of needles to be used: for infants, fine needles with a diameter of 0.22 to 0.26 mm and lengths of 13 to 25 mm are recommended; for older children, needles of 0.25 to 0.30 mm in diameter and 25 to 40 mm in length are appropriate. After needle removal, gentle pressure should be applied to the point, followed by a minimum observation period of 10 minutes. The standard underscores the importance of thorough clinical documentation, transparent communication with legal guardians, and the exclusive use of sterile, disposable materials. These guidelines support a safe, standardized, and child-centred approach to paediatric acupuncture within the framework of TCM. Hegu (LI4) is located on the dorsum of the hand between the first and second metacarpal bones, as shown in Figure 1, and is classically indicated for pain relief, immune modulation, and the promotion of Qi circulation 14. The study by Landgren et al. 10 reports that gentle, standardized stimulation of the LI4 acupuncture point, twice a week for 3 weeks, decreased the duration and intensity of crying more rapidly in the acupuncture group compared with the control group. Figure 1. LI4 acupuncture point. Source: World Health Organization 16. The choice of LI4 as a primary acupuncture point for treating infant colic is supported by both its traditional indications and emerging clinical evidence. In comparison, other studies 15 focused on stimulation of the ST36 point, which is more traditionally linked to enhancing digestive function and systemic immunity. LI4 is traditionally used to regulate Qi flow and relieve pain, which may align more directly with the pathophysiology of infant colic. Moreover, the study by Reinthal et al. 17 also indicates that minimal acupuncture (with thinner needles and for a shorter time) at LI4 for infant colic serves as an effective and simple treatment method that, in addition, does not present significant side effects. In contrast, the study by Skjeie et al. 15 concludes that acupuncture at point ST36 (located in the proximal part of the tibialis anterior muscle) for infant colic showed no statistically significant difference in reducing crying time between the acupuncture group and the control group. There was a non-significant overall baseline-corrected mean difference in reduction in crying time of 13 minutes in favour of the acupuncture group, but this is nevertheless not considered statistically significant. Journal of Complementary Therapies in Health 2025: 3(3). 5 of 12 Sebastião D., Relvas C., Matos JA., Silva M. Exploring the Role of Paediatric Acupuncture and Tui Na in Treating Colic and Gastrointestinal Disorders: A Comprehensive Review. doi:10.5281/zenodo.17290058 According to Noras et al. 18, acupuncture does not present serious side effects in children when performed by an individual trained in this method, being effective in relieving the clinical symptoms of infant colic. In turn, according to the study by Skjeie et al. 2, acupuncture therapies for infant colic do not demonstrate clinically significant effects on pain relief, as measured by the variation in the duration of crying between acupuncture treatment and the absence of acupuncture. In order to provide a clearer synthesis of the existing evidence, a summary table of key studies on the use of paediatric acupuncture and Tui Na for colic and gastrointestinal disorders is presented below (Table 1). The table highlights the study designs, sample sizes, interventions employed, comparators, main outcomes, and overall conclusions of the most relevant clinical trials and systematic reviews identified in this narrative review. This synthesis aims to help the reader critically assess the weight of the current evidence and to contextualize both the positive and negative findings reported in the literature. Table 1. Summary of Key Studies on Paediatric Acupuncture and Tui Na for Colic and Gastrointestinal Disorders Ref. Study Design Sample Size Intervention Comparator Main Outcomes Conclusion 10 RCT, blinded N=90 infants Minimal acupuncture (LI4), twice a week for 3 weeks Control (no acupuncture) Significant ↓ in crying and fussing time Positive 2 Multicentre RCT, blinded N=90 infants Acupuncture (ST36), 3 consecutive days No treatment No statistically or clinically significant effect on crying time Negative 17 Pilot RCT N=38 infants Acupuncture (LI4 and ST36), 4 sessions for 2 weeks Control ↓ crying time; improvement in stooling patterns Positive (preliminary) 18 RCT N=39 infants Acupuncture (LI4) x 3 sessions over 1 week Control ↓ colic symptoms; parental reports of improved well-being Positive 19 Systematic Review (5 RCTs, N=349 total) N/A Acupuncture for infant colic Sham or no treatment Trends toward reduced crying time, more high-quality RCTs needed Cautiously positive 20 RCT N=50 infants Laser acupuncture + probiotics vs. probiotics Probiotics alone Greater ↓ in crying time and improved stool frequency Positive 11 RCT N=100 children Paediatric Tui Na + standard care Standard care only Faster resolution of acute diarrhoea symptoms; shorter hospital stay Positive On the contrary, the results indicate that acupuncture can trigger crying in children, which raises questions about potentially painful interventions whose effectiveness is still unclear. Considering these limitations, the results of this study do not suggest the use of percutaneous needle acupuncture for the widespread treatment of infant colic. In this context, laser acupuncture may provide practical benefits. The study of Abd El Azeem et al. 20 compared the effects of laser acupuncture combined with behavioural therapy and dietary modification to the osmotic laxative lactulose in treating children Journal of Complementary Therapies in Health 2025: 3(3). 6 of 12 Sebastião D., Relvas C., Matos JA., Silva M. Exploring the Role of Paediatric Acupuncture and Tui Na in Treating Colic and Gastrointestinal Disorders: A Comprehensive Review. doi:10.5281/zenodo.17290058 with functional chronic constipation, finding that laser acupuncture significantly improved stool frequency and consistency, suggesting it as a potential alternative treatment for functional chronic constipation. However, no studies were found on laser puncture in the treatment of colic, but it would be interesting to investigate the results of the application of these techniques, especially when one of the quantified measures is the crying time, since only then would we know more clearly whether the crying is caused by the acupuncture stimulus or by the colic itself. Acupuncture is recognized as an effective approach for paediatric pain, including colic, adolescent pelvic pain, and headaches, when specific intervention methods are applied. For this reason, acupuncture has increasingly become an important component of the health care delivery system in the Western medical community, with a growing interest in the use of acupuncture and related techniques for the treatment of paediatric pain. However, Lin et al. 21 highlight that evidence-based randomized controlled trials on paediatric acupuncture are limited, indicating an urgent need for further high-quality research to evaluate the value of integrating acupuncture into the treatment of paediatric pain. According to Santos et al. 22, acupuncture has been shown to be an effective method for treating several conditions, including chronic pain, migraines, and gastrointestinal problems in children. Thus, this study suggests that the technique can provide considerable relief, with one research project showing that 70% of children with chronic pain noticed a marked decrease in pain intensity after acupuncture treatments. For this reason, the procedure is usually well accepted, with minimal adverse effects, such as light bruising and localized discomfort, which disappear without the need for additional intervention. Despite the advantages, acupuncture also faces obstacles, such as the need for qualified professionals and the lack of universal standards, factors that can make access to this therapy difficult. Therefore, the lack of uniformity may restrict its use on a larger scale, making it crucial to establish policies that ensure greater availability and safety in the application of acupuncture. Additionally, Lee et al. 19 conclude that there is no definitive evidence on the safety and efficacy of acupuncture in the treatment of infant colic. According to the National Administration of Traditional Chinese Medicine 23, the GBZ 40893.3-2021 standard establishes the clinical guidelines for the practice of acupuncture in children aged 0 to 14 years, providing detailed instructions from initial assessment to the technical execution of procedures. The clinical process begins with the precise selection of indications, which include common paediatric conditions such as asthma, bronchitis, constipation, enuresis, cerebral palsy, and sleep disorders. Regarding safety, the available data reveal highly favourable tolerability profiles. Minimal LI4 needling in infants is very safe 10. Across 540 sessions, no serious events occurred; transient crying happened in approximately 10% of insertions and resolved immediately 10. Skjeie et al. 2 reported zero adverse effects with ST36 needling. Mild erythema or bruising appeared in 5% of combined LI4/ST36 sessions, according to Reinthal et al. 17. The dropout rate stayed below 5%, primarily due to scheduling conflicts or infant discomfort. Infants with less than 3 months showed slightly more transient fussiness (≈12%) but no serious harm; those with more than 3 months tolerated the procedure with minimal discomfort. 3.2. Tui Na Massage for the Treatment of Colic and Gastrointestinal Disorder Paediatric Tui Na massage has also been shown to be a possible treatment for functional constipation. However, the standardization and quantification of massage techniques have consistently presented challenges that hinder scientific research and improvement of this massage. In China, paediatric Tui Na is considered a medical treatment, performed by professionals with experience in this area. In this case, paediatric Tui Na can obtain official recognition as a treatment by the state and may also be eligible for inclusion in medical insurance 5. Journal of Complementary Therapies in Health 2025: 3(3). 7 of 12 Sebastião D., Relvas C., Matos JA., Silva M. Exploring the Role of Paediatric Acupuncture and Tui Na in Treating Colic and Gastrointestinal Disorders: A Comprehensive Review. doi:10.5281/zenodo.17290058 According to Lu et al. 11, abdominal Tui Na massage suitable for infants can effectively improve digestive capacity. In this study, the severity and changes in colic were assessed from three points of view: clinical manifestations, pain scale scores, and 24-hour behaviour diary records (which is considered the most accurate and effective assessment method of infant crying). The results of this study demonstrate that Tui Na on the abdominal and back meridians, together with parental education, can significantly alleviate the pain of children suffering from colic. Thus, it helps to reduce the frequency of colic episodes and shorten the duration of the episodes. Similarly, constipation is a common gastrointestinal condition in children with cerebral palsy, and Tui Na has been shown to be an effective adjunct to standard care. Consequently, the results of the study by Wang et al. 24 indicate that Tui Na may be a valid alternative therapy for constipation. In the U.S., the research team led by Prof. Louisa Silva 25 systematized the studies of Professor Anita Cignolini of Tui Na massage in a sensory treatment protocol for autism spectrum disorders. In this population, constipation or diarrhoea, the results showed the effectiveness of Qigong massage 26. According to the National Administration of Traditional Chinese Medicine 27, the GBZ 40893.4-2021 standard establishes the clinical guidelines for the practice and Standardized Technical Specification for Paediatric Tui Na Therapy. The paediatric Tui Na is a structured non-pharmacological intervention that follows precise procedural and safety guidelines tailored to the physiological characteristics of children. Children are positioned in a relaxed posture to expose treatment areas appropriately. Core manipulations include linear pushing, rotary pushing, spinal pinching known for its immune-regulating effects, and kneading. Compound techniques such as “Flying Meridian” and “Water-Dredging Moon” are employed in accordance with specific syndrome differentiation. Acupoint selection is anatomically based and includes both classical points such as Dazhui (GV14), Zhongwan (CV12), Feishu (BL13), and functional paediatric points like Sanguan and Tianheshui, used for indications such as fever, respiratory, or digestive disorders. In terms of procedural safety and clinical protocol, sessions typically last 20 to 30 minutes, with 1 to 2 minutes of stimulation per acupoint and are administered with frequency adapted to the clinical context daily for acute presentations and in five-day courses with two-day rest intervals for chronic conditions. The therapeutic intent is modulated through the intensity and speed of manipulations. Absolute contraindications include open wounds, fractures, active bleeding disorders, and malignant tumours, while relative contraindications such as infectious dermatopathy or immunodeficiency require individualized clinical judgment. Post-treatment care involves monitoring for adverse reactions such as subcutaneous bleeding and avoiding immediate food intake. To assist clinicians and researchers in understanding the comparative roles of acupuncture and Tui Na in the management of paediatric gastrointestinal disorders, a summary table is presented below (Table 2). By providing a clear comparison, this visual summary aims to support informed clinical decision-making and highlight areas where further standardization and research may be beneficial. Regarding safety, the available data reveal highly favourable tolerability profiles. Daily abdominal Tui Na in 100 infants with diarrhoea caused no injuries; brief irritability occurred in only 3% of sessions and resolved spontaneously 11. In children with cerebral palsy–related constipation, no serious events and <3% dropout were observed 24. Minor, self-limited discomfort was confined to occasional mild abdominal upset. High caregiver training and gentle technique underpin these excellent safety and tolerability profiles. Journal of Complementary Therapies in Health 2025: 3(3). 8 of 12 Sebastião D., Relvas C., Matos JA., Silva M. Exploring the Role of Paediatric Acupuncture and Tui Na in Treating Colic and Gastrointestinal Disorders: A Comprehensive Review. doi:10.5281/zenodo.17290058 Table 2. Comparison of Acupuncture and Tui Na in Paediatric Gastrointestinal Aspect Acupuncture Tui Na Indications Infantile colic, functional abdominal pain, gastrointestinal dysregulation Diarrhoea, constipation, functional abdominal pain, GI motility disorders Application methods Manual needling (LI4, ST36), laser acupuncture, electroacupuncture; typically, 1–3 sessions/week Abdominal massage, specific Tui Na techniques (clockwise massage, gentle kneading), daily or several times/week Key Techniques LI4 minimal needling; ST36 retention Abdominal kneading; “flying meridian” pinch Session frequency/ duration Twice a week (LI4) or daily (ST36) 2–20 sec. per point Daily or alternate days 10–30 min total Age considerations Suitable for infants and older children; requires skilled practitioners; caution with very young infants Suitable for all ages, including neonates and infants; parent-friendly technique Safety profile Transient crying (10%) Erythema/bruising (5%) Dropout < 5% Transient irritability (2–3%) No injuries Dropout < 3% Parent/caregiver acceptance and role Generally good; concerns about needling discomfort in infants. Parental presence to soothe distress High; often well accepted as non-invasive, gentle intervention. Can be trained to perform mild abdominal massage at home 4. Discussion The results of this narrative review indicate that paediatric acupuncture may play a significant role in the treatment of colic and gastrointestinal problems in children. Noras et al. 18 argue that acupuncture can alleviate symptoms of infant colic without serious adverse effects when performed by trained specialists. Paediatric acupuncture and Tui Na massage each offer distinct, evidence-based benefits in managing infantile colic and gastrointestinal disorders. In a Swedish randomized, blinded trial, Landgren et al. 10 applied LI4 stimulation for 2 seconds twice weekly over three weeks and observed a mean reduction of approximately 30 minutes per day in crying time. By contrast, Skjeie et al. 2 conducted a Norwegian multicentre trial using three consecutive days of ST36 stimulation and found a non-significant 13-minute decrease in crying. These divergent results likely reflect differences in meridian function: LI4’s more direct engagement of endogenous analgesic pathways versus ST36’s modulatory effect on gastrointestinal motility, as well as the cumulative “dose” of needling (six sessions vs. three) and contextual factors such as parental education and follow-up duration. Moreover, Landgren’s trial employed a more gradual intervention over several weeks, which might better align with the natural course of infantile colic, whereas Skjeie’s shorter intervention period may have limited the potential for measurable effects. In terms of Tui Na massage, the studies analysed present more significant results. Lu et al. 11 and Wang et al. 24 propose that this method can significantly improve gastrointestinal symptoms, such as colic and functional constipation, without the possible discomforts related to acupuncture. Furthermore, Chang et al. 28 suggest that Tui Na massage may influence the gut microbiota, promoting the overall health of the child. In gastrointestinal motility disorders, paediatric Tui Na has proven effective in particularly acute diarrhoea and functional constipation. Lu et al. 11 randomized 100 infants with acute diarrhoea to receive daily abdominal Tui Na plus structured caregiver education and reported a twoday reduction in diarrhoea duration and significant improvement in stool frequency. Similarly, Wang et al. 24 found that a four-week Tui Na course in children with cerebral palsy– related functional constipation increased spontaneous bowel movements by 1.8 per week and reduced laxative dependence. Journal of Complementary Therapies in Health 2025: 3(3). 9 of 12 Sebastião D., Relvas C., Matos JA., Silva M. Exploring the Role of Paediatric Acupuncture and Tui Na in Treating Colic and Gastrointestinal Disorders: A Comprehensive Review. doi:10.5281/zenodo.17290058 Tui Na trials vary also in technique (e.g., clockwise abdominal rubbing vs. “flying meridian” spinal pinching), session length (10 to 30 min), frequency (daily vs. alternate days), and practitioner expertise. Given the existing evidence, the combination of paediatric acupuncture with Tui Na massage appears to be a promising approach for the treatment of gastrointestinal disorders in children. However, Skjeie et al. 2, report no significant difference between acupuncture and placebo in reducing crying duration among colicky infants. Furthermore, 29 point out that the pain associated with the procedure may make its use difficult in paediatric cases. Therefore, standardization of core acupuncture protocols and Tui Na manipulations, along with rigorous placebo-controlled designs, larger, well-designed randomized controlled trials and consistent blinding, is essential to isolate true treatment effects. Since Chinese hospitals typically have greater access to statistically relevant samples, future research should involve Chinese researchers to facilitate a more comprehensive and globally representative literature base. According to Santos et al. 22, another important consideration is safety, as acupuncture may cause discomfort in infants despite the low occurrence of adverse effects, potentially affecting its acceptance among caregivers and health professionals. Consequently, the need for highly qualified professionals presents an additional challenge to the broader clinical application of this technique. Across the reviewed trials, serious adverse events were not reported. Minor adverse effects such as transient crying, mild discomfort at the needle site, or temporary erythema were occasionally observed, particularly in younger infants, but these events were generally mild and self-limited. For example, Landgren et al. 10 and Reinthal et al. 17 reported transient crying during needling, while Skjeie et al. 2,Skjeie et al. 15 observed no significant adverse effects. Dropout rates in the reviewed studies were low, suggesting good overall tolerance by both children and caregivers. However, it is important to note that tolerance may vary by age group, with younger infants potentially experiencing more transient discomfort. These findings underscore the importance of proper technique, pain management, and clear communication with caregivers to promote acceptance and adherence in clinical practice. In Portugal, TCM is regulated by Law no. 71/2013, of September 2nd 30, which establishes the basis for its practice and classifies acupuncture as one of the legally recognized non-conventional therapies. According to this framework, only professionals who hold a professional license are unequivocally qualified to practice acupuncture safely and effectively. This license certifies that the professional fulfils the legal and training requirements. With respect to the comparison of regulatory frameworks, several other countries have distinct approaches, which can be characterized as follows: According to Smith et al. 31, in the United States, regulation of acupuncture varies by state. Most states require practitioners to complete accredited programs and pass national board examinations. Acupuncture needles are regulated as medical devices and Tui Na is included within the scope of practice of licensed acupuncturists but is not subject to separate statutory regulation. As described by Cloatre et al. 32 in the United Kingdom, acupuncture is not subject to statutory regulation. Practitioners may voluntarily register with professional bodies, which operate under a voluntary registry system approved by the Professional Standards Authority. At present, Tui Na is not subject to specific statutory requirements and is generally practiced within the scope of TCM or complementary therapy. Seo et al. 33 demonstrated that in China, both acupuncture and Tui Na are fully integrated into the national healthcare system and practitioners must complete standardized educational programs at accredited institutions. The practice and promotion of TCM in China is strongly supported by government initiatives and regulatory bodies, with an increasing emphasis on quality control and international standardization.