Cupping Therapy Practiced on Children: Maltreatment or Alternative Therapeutic Procedure?

After attending this presentation, attendees will have increased knowledge of cupping as one of the possible differential diagnoses of bruises in the child victim of suspected maltreatment. This presentation will impact the forensic science community by providing information concerning the clinical presentation of skin injuries caused by Cupping Therapy (CT). Two unusual cases, managed in the multidisciplinary unit dedicated to the evaluation of suspected abused children (“Bambi”) of the Ospedale Infantile Regina Margherita in Turin, Italy, are presented as illustrations. Case 1: Two Algerian brothers, three and five years old, were accompanied by their father to the hospital. The parents were separated and the children had previously been with their mother. Upon their return, the father noticed injuries on their backs. The medical examination found the presence of painful, round, and excoriated bruising, approximately 3cm in diameter, on the backs of both children. The patients reported that the mother had produced lesions in order to drive out bad spirits. Case 2: A 2-month-old Chinese girl was taken to the “Bambi” unit by social workers who had noticed the presence of skin lesions. The little girl actually had a series of round- and oval-shaped reddish bruises, one on the neck, three on the chest, three on the abdomen, and one on the right forearm. The largest measured 3cm in diameter, the others measured 1cm, on average. The parents, who were both very young, did not know the Italian language and were in no way socially integrated. The lesions observed in these three children were all roundish or oval-shaped bruises and were all produced at the same time as they were of the same color. They were attributable to the domestic practice of CT, one of the oldest traditional procedures in folk medicine around the world. A common element in all cultures that practice CT is the extraction of toxic substances from the body by creating negative pressure in a cup by means of heat or a special suction apparatus. Traditional Chinese medicine and the Arab world both include their own form of CT.1 It is used to treat many diseases, including painful conditions, nausea and vomiting, urinary tract infections, and respiratory and rheumatic illnesses.2 After a period of decline, CT has regained popularity over the past six decades by means of its promotion by holistic health care practitioners in China, and also in the Western world. CT was even used during the 2016 Olympic Games in Rio de Janeiro by an extraordinary swimmer who broke the world record.3 Some side effects have been reported, especially when practiced at home by inexperienced people; anemia, factitial panniculitis, and herpes viral infections are the most frequent adverse events as well as abscesses, post-inflammatory skin hyperpigmentation, and keloids.2 It is essential to be aware of this form of traditional practice and of the characteristics the lesions can leave on the skin in order to avoid the misdiagnosis of traumatic bruises due to a compressive mechanism. Moreover, in similar situations, it is necessary to thoroughly investigate the familiar, psychological, and social context of the child. While CT is configurable as an alternative therapeutic practice when used on an adult subject, it is placed at the limit of maltreatment when performed on a child who cannot consciously express consent. Reference(s): 1. Chirali Ilkay Zihni. The cupping procedure. In: Traditional Chinese medicine cupping therapy. (London: Churchill Livingstone, 1999), 3. 2. Naseem Akhtar Qureshi, Gazzaffi Ibrahim Ali, Tamer Shaban Abushanab, Ahmed Tawfik El-Olemy, et al. History of cupping (Hijama): A narrative review of literature. Journal of Integrative Medicine. 2017;15(3):172–181, doi: 10.1016/S2095-4964(17)60339-X. 3. Kate Lyons. Interest in cupping therapy spikes after Michael Phelps gold win. The Guardian. August 8, 2016, https://www.theguardian.com/sport/2016/aug/08/cupping-therapyinterest-spikes-michael-phelps-rio-olympics.