In the hands of trained practitioners, acupuncture is a safe medical treatment, even for children. But a new study finds when acupuncture is performed by untrained providers, it can pose a serious risk to young patients.

Millions of people around the world use the ancient Chinese medical practice which involves inserting fine needles into the skin at specific sites around the body to treat illness or to provide anesthesia.

In most cases, concludes a study by Canadian researchers published in Pediatrics, acupuncture is safe enough to perform on children, including infants.

Anita Vohra, of the University of Alberta in Edmonton, says people use acupuncture for a variety of conditions, including promotion of wellness and to reduce chronic pain or nausea.

"There are some children who also have chronic pain. There are also children who have nausea and vomiting. Those conditions are not exclusive to adults."

In a study of the outcomes of more than 14,000 pediatric patients over several decades, Vohra and her colleagues found just 253 reports of minor adverse events. These included cases of pain, bruising and bleeding among infants and children after undergoing acupuncture.

But, in their review of 37 studies, including nine controlled trials, investigators discovered 25 reports of serious events in children treated with acupuncture needles.

The most common serious side effect included thumb deformities caused by the repeated insertion of needles over a year or more. Much less common, but more severe complications, included one case of HIV infection, a cardiac rupture in a boy found at autopsy to have needle marks in his diaphragm, lung collapse in a girl treated for an asthma attack, and severe nerve damage in a boy who had 70 needles imbedded throughout his body.

Vohra says most of the complications occurred when procedures were performed by inexperienced or untrained acupuncturists, but adds such malpractice is highly unusual.

"In most places, providing needle acupuncture is a regulated act. That is, the health care provider has to have special knowledge, training, and certification in order to actually do that act," says Vohra. "And so under modern day standards, we think that those kinds of harms that we found in the serious harms category are extremely unlikely to happen. But that's not to say they didn't occur. Of course they did. Which is why we think it's very important for children, for anyone receiving acupuncture, to make sure that they are in the hands of someone who has appropriate training."