When East Meets West: Integrating Traditional East Asian Medicine into Neonatal Care
By Ke-Ni N. Tien, DNP RN APRN.CNP NNP-BC
Neonatal care has advanced significantly in improving survival outcomes for both preterm and medically complex infants over the past few decades. However, in daily neonatal practice, clinicians continue to encounter challenges in the neonatal intensive care unit (NICU) that extend beyond survival. During critical periods of neurodevelopment, these neonates often are exposed to repeated painful procedures, such as heel lances for blood draws and peripheral intravenous catheter placements for medications or nutrition needs, as well as environmental stressors including noise, bright light, and prolonged hospitalization. Despite the use of established nonpharmacologic strategies—such as sucrose, facilitated positioning, skin-to-skin care, and pharmacologic interventions when indicated—optimizing comfort, physiologic stability, and long-term neurodevelopmental outcomes remain ongoing priorities in neonatal practice. Neonates are particularly vulnerable due to immature regulatory systems and heightened sensitivity to environmental and procedural stressors.
Concerns regarding the impact of sedatives and opioids on the developing brain have directed increasing attention toward minimizing medication exposure in this vulnerable population. This has led to growing interest in integrative, nonpharmacologic approaches that may support autonomic regulation, reduce stress responses, and enhance developmental care. Neonatal nurses have been at the forefront of adopting holistic, family-centered strategies that prioritize both physiologic and behavioral stability.
Traditional East Asian medicine (TEAM), also known as traditional Chinese medicine (TCM), is a system of health care developed over thousands of years and includes practices such as acupuncture, acupressure, and therapeutic massage (Tui Na). Instead of focusing solely on disease processes, TEAM emphasizes the body’s ability to maintain balance and regulate function.
Key concepts within TEAM include Qi, Yin and Yang, and the five phases (Marshall, 2020; Matos et al., 2021; Maciocia, 2015; Wiseman & Ellis, 1995):
- Qi is often described as the body’s functional energy, representing the integrated activity of physiologic processes.
- Yin and Yang describe complementary and interdependent forces that work together to maintain dynamic equilibrium.
- The five-phase theory describes patterns of transformation and interaction through five functional groupings—wood, fire, earth, metal, and water—which help organize relationships between physiologic systems.
Within TEAM, these frameworks have guided the understanding of normal function, disease processes, and therapeutic strategies.
Rooted in a long history of clinical observation, TEAM focuses on supporting the body’s capacity for regulation and adaptation. In modern clinical settings, TEAM is gaining attention as an adjunctive approach to symptom management and physiologic support, particularly within pediatric and integrative care models.
When applied in neonatal populations, these therapies are adapted to prioritize safety and gentleness, often using non-invasive techniques such as light touch, acupressure, or low-level stimulation rather than needle-based interventions and are performed by appropriately trained practitioners within established clinical guidelines.
Although the conceptual framework of TEAM may be unfamiliar to neonatal clinicians, many of its principles can be translated into modern physiologic terms. From a physiologic standpoint, current evidence suggests that stimulation of specific points on the body may influence autonomic nervous system activity, enhance circulation and metabolic function, promote parasympathetic activity, and reduce sympathetic overactivation (Cui et al., 2021; Johnson Rolfes et al., 2020; Scott & Barlow, 1999). In addition, acupuncture has been associated with modulation of endogenous opioid release, which may contribute to analgesic effects, as well as regulation of inflammatory pathways and neuroendocrine signaling (Cui et al., 2021; Gao et al., 2015).
TEAM mechanisms closely align with key priorities in neonatal care, including pain management, physiologic stability, and stress regulation. Though research in neonatal populations remains limited, early studies and clinical observations suggest potential benefits in areas such as procedural pain, feeding tolerance, and neonatal abstinence syndrome (NAS; Raith et al., 2013; Tou et al., 2023; Urlesberger et al., 2025). Importantly, these approaches appear to support overall physiologic regulation rather than targeting a single disease process.
Nonpharmacologic interventions are already a cornerstone of neonatal care. Beyond clinical outcomes, the successful integration of any new therapy in the NICU depends on acceptance by both healthcare providers and families. Early work exploring the incorporation of TEAM into neonatal settings suggests openness to such approaches when they are presented as complementary, non-invasive, and aligned with patient-centered care principles (Johnson Rolfes et al., 2020).
In the neonatal care setting, where small physiologic shifts can significantly impact outcomes, approaches like TEAM that support regulation rather than add burden may be particularly valuable. As interest in integrative neonatal care grows, early evidence suggests potential benefits of incorporating TEAM into NICU practice. For example, a recent study found a decreased incidence of feeding intolerance in neonates after one week of Tui Na intervention (Li et al., 2023). Emerging findings like these and initial efforts to introduce TEAM approaches into neonatal settings highlight the importance of close collaboration between neonatal clinicians and trained TCM practitioners. They also emphasize the need for thoughtful implementation, including clear protocols, attention to safety, and alignment with standards of neonatal care.
Neonatal clinicians who learn the principles, safety considerations, and potential applications of TEAM have additional tools to support this highly vulnerable population.
It is important to note that TEAM is not intended to replace standard medical care but rather to complement existing practices within a multidisciplinary framework. As with any emerging therapy, careful consideration of safety, training, and clinical context remains essential.
An NNP in the Department of Neonatology at Cleveland Clinic, Ke-Ni N. Tien also is a student pursuing her Doctor of Acupuncture and Chinese Medicine degree at Pacific College of Health and Science in Chicago, IL.
References
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