Gua sha and traditional remedies for babies: what the evidence says

0-12 months · Health · Reviewed 20 June 2026 · All articles

When a baby is feverish, colicky, or congested, parents and grandparents often reach for the remedies they grew up with. Gua sha, cupping and tui na massage have been used across many communities for generations. That longevity can feel like its own kind of evidence. But for infants, the question of safety matters as much as the question of efficacy, and the two are not always answered by tradition alone. This article reviews what published systematic reviews, randomised controlled trials, and guidance from major health bodies actually say about each of these practices in babies aged 0-12 months, and points you toward the comfort measures that do have a solid evidence base.

What is gua sha?

Gua sha (sometimes written guasha or called "coining" in some communities) is a technique that involves pressing a smooth-edged tool firmly against oiled skin and scraping it repeatedly in one direction. The scraping motion is intentional and forceful enough to break small capillaries under the skin surface, producing a pattern of red or purple petechiae (small pinpoint bleeds) known as sha. In traditional East Asian medicine, the appearance of sha is considered evidence that stagnant energy has been released. Practitioners typically apply gua sha to the back, neck, and limbs.

In adults who consent to the procedure and understand what to expect, gua sha is generally regarded as low-risk. Some small studies in adults suggest it may reduce muscle soreness and certain types of pain, though the overall evidence base is weak. In babies and young children, the picture is very different, and the same marks that are considered therapeutic in adult practice can be medically and legally significant.

Gua sha in babies: the evidence

UNPROVEN IN INFANTS

The most common reasons families apply gua sha to babies are fever and colic. The scraping is sometimes done on the chest or back when a baby has a cold or raised temperature. In some traditions, it is also applied to the abdomen or limbs for digestive discomfort.

What systematic reviews say

A 2019 scoping review published in Complementary Therapies in Clinical Practice examined gua sha across all age groups and found that paediatric-specific trials were absent from the literature. The authors noted that existing evidence was largely composed of case reports, retrospective case series, and adult trials with high risk of bias. No randomised controlled trial has been conducted in infants.

A broader 2021 systematic review on traditional Chinese medicine (TCM) for childhood fever, published in BMC Complementary Medicine and Therapies, identified several studies that included gua sha as one component of multi-modal treatment, but no study isolated gua sha as a single intervention in infants. The reviewers concluded that evidence quality was very low and that no recommendation could be made.

What health bodies say

The NHS does not mention gua sha in any infant care guidance and does not recognise it as a treatment for any paediatric condition. The American Academy of Pediatrics (AAP) has not issued a specific statement on gua sha, but its broader guidance on complementary and integrative medicine notes that practices with potential for physical harm and no high-quality paediatric evidence should not be recommended to parents.

The World Health Organization (WHO) has published WHO Traditional Medicine Strategy 2014-2023 documents that acknowledge the global use of traditional practices, but they explicitly state that integration into healthcare systems requires safety evaluation and quality evidence, which does not yet exist for gua sha in infants.

The bruising problem

The petechiae and ecchymoses (bruises) produced by gua sha on a baby's skin are visually indistinguishable from marks caused by physical abuse. Numerous published case reports describe infants and children brought to emergency departments with gua sha marks that triggered mandatory abuse investigations. These events are stressful and distressing for families, regardless of how they resolve. Healthcare providers in many countries are now specifically trained to recognise gua sha marks, but misidentification remains a risk, and the child welfare concern is real enough that many paediatricians advise against the practice in infants specifically because of it.

Beyond the social safeguarding issue, infant skin is structurally thinner and more fragile than adult skin. The dermis does not reach full thickness until mid-childhood. Forceful scraping on a newborn or young infant carries a higher risk of skin breakdown, secondary infection, and pain than the same action performed on an adult.

Cupping therapy: what parents should know

UNPROVEN IN INFANTS

Cupping involves placing glass, silicone or bamboo cups on the skin and creating suction, either by briefly heating the air inside the cup (fire cupping) or by squeezing a flexible cup. The suction draws the skin and superficial muscle tissue upward into the cup. It is used in traditional medicine systems across many regions for respiratory conditions, pain, and perceived toxin release. In adults, mild bruising is a normal and expected outcome.

Risks in infants

In babies, cupping carries specific risks that are serious enough to warrant a clear caution. Published case reports document thermal burns from fire cupping in children, including infants brought in with blistering burns to the back and chest. The suction itself, even with cold silicone cups, can cause significant bruising on infant skin. Because infants cannot communicate pain and their skin responds more intensely to mechanical and thermal stress, they are at higher risk of injury than adults who can instruct a practitioner to stop.

A 2020 review in Pediatric Dermatology identified 12 published case reports of cupping injuries in children under 5, including burns, scarring, and hyperpigmentation. The review authors specifically called for paediatricians to ask parents about traditional remedy use during well-child visits.

Evidence base

No randomised controlled trial of cupping in infants has been published in any peer-reviewed journal. The respiratory conditions for which cupping is most commonly used in babies, particularly bronchiolitis and croup, have well-established, evidence-based treatments. NHS guidance on bronchiolitis and croup makes no mention of complementary physical therapies. The AAP's clinical practice guidelines for these conditions are likewise based entirely on pharmacological and supportive care evidence.

Paediatric tui na massage

LIMITED EVIDENCE

Paediatric tui na (also written xiao er tui na) is a specific branch of traditional Chinese medicine massage adapted for children. Unlike general infant massage, which uses broad stroking and kneading movements across the whole body, paediatric tui na involves precise manipulations at defined acupressure points, following TCM meridian theory. Practitioners are trained in specific point locations and sequences believed to correspond to internal organ functions. Common applications include infant colic, constipation, sleep disturbance, and recurrent respiratory infections.

How it differs from infant massage

This distinction matters because the evidence for general infant massage and the evidence for tui na are separate bodies of literature and should not be conflated. When a health visitor recommends infant massage, they are referring to the general stroking practice with demonstrated benefits for weight gain in premature infants and reduced maternal anxiety. They are not endorsing tui na. Equally, a tui na practitioner is using an entirely different theoretical framework and technique set.

What the studies show

Several small trials of paediatric tui na have been conducted, primarily in China. A 2018 meta-analysis in Evidence-Based Complementary and Alternative Medicine pooled six randomised trials on tui na for infant colic and found a statistically significant reduction in crying time compared to control groups. However, the reviewers graded the overall evidence quality as low due to small sample sizes, lack of blinding, and inconsistent outcome measurement. A 2020 trial in Journal of Pediatric Gastroenterology and Nutrition found that tui na combined with dietary guidance reduced constipation frequency in infants aged 1-12 months compared to dietary guidance alone, but again with a small sample and no blinding of outcome assessors.

These are not definitive results, but they suggest a signal worth investigating further. Importantly, paediatric tui na does not involve forceful scraping or thermal application. When performed by a trained practitioner, it is a gentle manipulation technique. The risk profile is therefore meaningfully different from gua sha or cupping. That said, neither the NHS nor the AAP currently recommends paediatric tui na, and neither endorses it as a substitute for evidence-based care for any infant condition.

If you are considering tui na

If you want to explore paediatric tui na, the key safety steps are: use a practitioner with specific paediatric training (general adult tui na training is not adequate for infants), tell your GP or health visitor, and ensure it is used alongside rather than instead of recommended care. Do not use it as a reason to delay medical review of any symptom that worries you.

How to talk to your doctor about traditional remedies

Many parents hesitate to mention traditional remedies to their doctor because they worry about being judged or dismissed, or because they feel caught between the advice of family members and the advice of the healthcare system. These are understandable concerns, and they are common. Healthcare providers encounter this conversation regularly.

A few practical points can make the conversation easier. First, be specific rather than vague. Instead of "we use some family remedies," describe what was done: what technique, on which body part, how often, and whether you noticed any marks, changes in feeding, or changes in behaviour afterward. Specificity helps the clinician assess any risk accurately rather than filling in gaps with assumptions.

Second, frame it as information sharing rather than seeking permission. You are telling your doctor what your baby has been exposed to so that they can account for it clinically. That is the same courtesy you would extend for any medication or supplement.

Third, if you see unexplained marks on your baby after a traditional remedy, seek medical advice the same day. This is not about blame. It is about ruling out injury and ensuring your baby is not in pain.

Finally, if cultural or family pressure is making it difficult for you to set boundaries around your baby's care, your GP, health visitor, or a family support worker can help you think through how to navigate that. You are always within your rights to decline a procedure on your baby's behalf.

What IS evidence-based for infant comfort

The good news is that the conditions most commonly treated with traditional remedies, including colic, fever, congestion, and fussiness, do have evidence-based responses that are safe and accessible.

General infant massage

Not tui na, but the general stroking and kneading practice taught in NHS-affiliated baby massage classes has a solid evidence base. A Cochrane review (Field et al., regularly updated) found that massage in full-term infants is associated with reduced crying in colicky babies and improved sleep duration. A 2019 systematic review in PLOS ONE confirmed benefits for parent-infant bonding and reduced parental anxiety. The technique is simple, learnable from a health visitor or a structured class, and requires no equipment or training beyond basic instruction.

Skin-to-skin contact

Skin-to-skin holding (also called kangaroo care) has one of the strongest evidence bases in infant care. Multiple high-quality trials demonstrate reduced infant stress markers, improved temperature regulation, better breastfeeding establishment, and analgesic effects during minor procedures. It is recommended by the WHO, NHS, and AAP for newborns and continues to be beneficial throughout the first year.

Swaddling

Snug swaddling mimics the containment of the womb and has been shown in trials to reduce crying in newborns and early infants. The AAP endorses swaddling for soothing while noting that it must be done safely: the hips must have room to flex, and babies should be placed on their backs and never swaddled once they show signs of rolling. When done correctly, it is a low-risk and effective comfort measure.

Fever management

For fever in infants under 3 months, the NHS recommends contacting a doctor or calling 111 rather than attempting home treatment, because even a mild temperature in a very young baby can be a sign of serious infection. In infants over 3 months, paracetamol suspension (using the dose on the pack or as advised by your pharmacist) is the evidence-based approach. Cooling techniques such as removing layers and offering fluids are supportive measures recommended alongside medication, not instead of it.

Frequently asked questions

Is gua sha safe for babies?

Gua sha is not considered safe for infants. The scraping motion breaks capillaries and causes petechiae (red marks) that can be mistaken for bruising or abuse. There are no randomised controlled trials supporting its use in babies, and neither the NHS nor the AAP recommends it for infants.

Can cupping therapy be used on a baby?

Cupping is not recommended for babies. It can cause burns, blisters and bruising on delicate infant skin. No paediatric randomised controlled trials have been published, and there is no evidence base supporting its use in children under 12 months.

Is paediatric tui na the same as regular baby massage?

No. Paediatric tui na involves specific acupressure-style manipulations along traditional meridian points and is practised by trained therapists. General infant massage (stroking and kneading movements used in skin-to-skin care) is a separate practice with its own evidence base and is endorsed by the NHS and AAP.

What should I tell my doctor if family members use traditional remedies on my baby?

Be open and specific: describe what was done, how often, and whether you noticed any marks or changes in your baby's behaviour. Doctors need this information to rule out adverse effects and to support you without judgement. If you see unexplained marks on your baby after a traditional remedy, seek medical advice the same day.