Impact of pediatric Tui Na over three months on children’s growth: A systematic review and meta-analysis of randomized controlled trials

• This systematic review evaluated pediatric Tui Na effects on growth in 0–14-year-olds. • Children grew more with pediatric Tui Na compared to routine care or touch only. • Tui Na for 3 months or longer both show benefit especially in normal children. • Premature babies might need longer Tui Na treatment but the evidence is weak. • Future studies should consider age subgroups and long term implementation outcomes. This study aims to evaluate the effectiveness and safety of pediatric Tui Na on children’s growth. The protocol of this review was registered in INPLASY (10.37766/inplasy2024.2.0116). We searched seven databases and two ongoing trial registers up to June 8, 2024, for randomized controlled trials (RCTs) on pediatric Tui Na, to assess the impact of Tui Na lasting over 3 months on children’s growth. Risk of bias was assessed with the RoB1 tool. Results were presented and synthesized via RevMan 5.4. A total of 46 RCTs involving 11,284 children were included. We found that Tui Na increased height compared to routine health care alone (29 trials, mean 3.68 cm, 95% CI (confidence interval) [2.92, 4.43], low-certainty evidence) and to touch (2 trials, mean 1.72 cm, 95% CI [1.22, 2.22], low-certainty evidence). Adding Tui Na to touch resulted in a height increase of 1.99 cm (5 trials, mean 95% CI [1.04, 2.95], low-certainty evidence). Subgroups of normal children (Tui Na for 3-4 months, 5-6 months, 12 months) and preterm children (Tui Na for 3-4 months, 12 months) both showed significant benefits. Tui Na was also beneficial for the growth of height, weight, head circumference, chest circumference, waist circumference and BMI, as well as parental satisfaction compared to routine health care. Compared to touch, Tui Na was beneficial for growth of height, weight and head circumference. Tui Na also showed additional benefits in growth of height, weight and head circumference added to touch. RevMan 5.4 was used for the meta-analyses and funnel plots. This evaluation indicates that Tui Na over 3 months can promote children’s growth and appears to be safe, with high parental satisfaction. However, large-sample and high-quality RCTs and real-world observations with long-term follow-up are needed to confirm these findings.