8 July 2003

Dear Editor,

Most infants and children respond to tickling with a giggle and laughter.

There are only six references made to tickling in MEDLINE. Two of these relate to the tickle being used to reward rats for desirable behaviour in the laboratory2,3.

Four others address why we cannot successfully tickle ourselves. Apparently effective tickling requires the ‘sense of unpredictability’ in the subject. Thus only externally produced stimuli can elicit a tickle response1,4,5,6.

This is meagre research on a ‘tool’ that appears to have important diagnostic as well as therapeutic applications. I have found that tickling children can be used at least in the following two ways:

  • 1An infant or child who has the capacity to respond positively to a tickle cannot be too sick. The patient is unlikely to have a serious condition such as septicaemia, intussusception, meningitis, etc.
  • 2Tickling is an engaging and effective way to carry out chest physiotherapy. Vigorous laughter is almost always followed by a good productive cough.

I recently came across a 6-year-old child with cystic fibrosis who has been having a lot of fun receiving twice a day tickling. Her mother had intuitively found that this was a good way to help her child cough.

It seems there are many other intuitive and engaging diagnostic and therapeutic modalities that have received insufficient attention. The use of magic tricks, humour, charm, entertainment, jokes and story telling must find their rightful place in our human interactions with children.