US researchers reviewed the safety and efficacy of acupuncture in children. They located 31 journal articles, including 23 RCTS and eight meta-analyses/systematic reviews. They found evidence of some efficacy and low risk associated with acupuncture in paediatrics. From all the conditions reviewed, the most extensive research looked into acupuncture’s role in managing postoperative and chemotherapy-induced nausea/vomiting. Postoperatively, there is far more evidence of acupuncture’s efficacy for paediatrics than for children treated with chemotherapy. Acupuncture seems to be most effective in preventing postoperative-induced nausea in children. For adults, research shows that acupuncture can inhibit chemotherapy-related acute vomiting, but conclusions about its effects in paediatrics cannot be made on the basis of the available published clinical trials data to date. Besides nausea and vomiting, research conducted in pain has yielded the most convincing results on acupuncture efficacy. Musculoskeletal and cancer-related pain commonly affects children and adults, but unfortunately, mostly adult studies have been conducted thus far. Because the manifestations of pain can be different in children than in adults, data cannot be extrapolated from adult research. Some studies have demonstrated relief for adults treated with acupuncture but the researchers could not find any well-conducted RCTs that looked at paediatrics and acupuncture exclusively. For seasonal allergic rhinitis, they reviewed two studies conducted in children and adults, respectively. Both populations showed some relief of symptoms through acupuncture, but questions remain about treatment logistics. Additionally, there are limited indications that acupuncture may help cure children afflicted with nocturnal enuresis. Systematic reviews show that current published trials have suffered from low trial quality, including small sample sizes. Other areas of paediatric afflictions reviewed that suffer from lack of research include asthma, other neurological conditions, gastrointestinal disorders, and addiction. A review of serious adverse events found the risk of a major complication occurring to have an incidence between 1:10 000 and 1:100 000, which is considered ‘very low’. Another study found that the risk of a serious adverse event occurring from acupuncture therapy is the same as taking penicillin. The safety of acupuncture is a serious concern, particularly in paediatrics. Because acupuncture’s mechanism is not known, the use of needles in children becomes questionable. For example, acupoints on the vertex of infants should not be needled when the fontanel is not closed. It is also advisable to apply few needles or delay treatment to children who have overeaten, are over-fatigued, or are very weak. This review of paediatric adverse events found a 1.55 risk of adverse events occurring in 100 treatments of acupuncture; that coincides with the low risk detailed in the studies mentioned previously. The actual risk to an individual patient is hard to determine because certain patients, such as an immunosuppressed patient, can be predisposed to an increased risk, acupuncturist’s qualifications differ, and practices vary in certain parts of the world.