As a parent, I have been using complimentary medicines for the past three years; I feel healthier as a result. I would like to know more about the safety and benefits of these treatments for children.
The use of complimentary and alternative medicine (CAM) in pediatrics has become more and more popular over the past decade. In fact, in December 2008 the American Academy of Pediatrics published an official clinical report on this topic. The report stated that CAM can no longer be ignored by pediatricians, specifically that "pediatricians and other clinicians who care for children have the responsibility to advise and counsel patients and families about relevant, safe, effective and age-appropriate health services and therapies regardless of whether they are considered mainstream or CAM." (Pediatrics, December 2008).
There are definite trends in the education of medical students and pediatricians toward a better awareness of what CAM involves. Recent data showed that in the USA 64% of medical schools reported having CAM curricula. This number is lower for pediatric training programs in Canada and the US. However, the Canadian Pediatric Society has offered workshops for pediatricians at recent educational events.
By definition, complimentary medicine is used in conjunction with conventional medicine. When a child experiences chronic pain, for example, the parents may also take the child in for massage, guided imagery, or acupuncture. By contrast, alternative medicine is used in place of conventional Western medicine. For example, in an adolescent with depression, herbs may be used rather than an antidepressant.
Some experts in the field suggest that the distinction between CAM and mainstream medicine has lessened over the past few years as many practices have undergone rigorous research. For that reason, the CAM terminology has been replaced increasingly with terms such as "holistic" or "integrative" medicine.
To fully understand the scope of the different treatment modalities, Dr. Kathi Kemper wrote a book The Holistic Pediatrician (Second Edition, Harper Collins, 2002). This model of holistic care defines four main areas of care:
- Biochemical: the use of dietary supplements, vitamins, minerals, and herbal remedies.
- Lifestyle: nutrition, exercise/rest, and therapies such as heat, ice, music, vibration, light, meditation, hypnosis, and biofeedback.
- Biomechanical: massage, chiropractic, and osteopathic adjustments.
- Bioenergetic: acupuncture, magnets, healing touch, prayer, and homeopathy.
A negative perception of CAM among the majority of pediatricians is still seen as a major concern for proponents of CAM use in children. Even though more and more robust data from prestigious centers such as Harvard and Yale have been published, most pediatricians remain skeptical - and in some cases passionately hostile - toward CAM.
However, according to the clinical report in Pediatrics (December 2008), one third of pediatricians reported that they or their families used some type of CAM therapy: massage therapy was used by 70%; chiropractic care by 21%; and acupuncture by 13%. A Canadian study showed that 11% of children used care such as chiropractic, homeopathy, naturopathy, and acupuncture. (This percentage may actually be lower than reported given the majority of patients who use CAM fail to inform their pediatricians about it, mostly out of fear that they will be judged negatively.)
Parents' reasons for seeking care from CAM providers included (in decreasing order of frequency):
- word of mouth
- particular treatment was considered effective
- fear of adverse effects from drugs
- dissatisfaction with conventional medicine
- need for more personal attention
The latter probably gets compounded when pediatricians are not open to having a respectful and clear communication style with the families in their practices who seek CAM care.
Adolescents - desiring independence, autonomy and privacy - are more likely to use the Internet as a source for obtaining dietary supplements which promise relief for conditions such as acne or obesity, or which promise to enhance energy and sport performance.
The use of CAM is most common in patients with chronic conditions such as asthma, attention deficit/hyperactivity, autism, cancer, cerebral palsy, cystic fibrosis, inflammatory bowel disease, and juvenile arthritis. In all fairness to pediatricians who are highly critical of CAM, there is little or insufficient research on the effectiveness of most CAM therapies for many of the above mentioned conditions. Yet, according to the Section on Complimentary and Integrative Medicine (SOCIM) of the American Academy of Pediatrics, more and more data are accumulating showing that although CAM use is more and more common in children, there have been few reports of serious side effects.
More and more pediatricians are becoming aware of the importance of asking families specifically about their use of CAM, as opposed to waiting for patients to report it spontaneously. This has become critically important since some of the therapies (such as herbal remedies) may have bad interactions with conventional medications if used simultaneously.
A major concern regarding some biochemical products used in CAM is the fact that labeling of these products is not always nor consistently subject to a high standard. Given regulations differ from those governing the use of pharmaceuticals, there may be concerns about the purity and potency of herbal products and dietary supplements. (Which portion of the plant used determines its potency: the root, stem, leaves or flowers all deliver different amounts. The time of harvest may also lead to inconsistent levels.)
The take home message on all of this is that CAM use is on the increase and that more research is needed in order to reduce skepticism among pediatricians. For more information on complimentary and alternative medicine, see www.nccam.nih.gov. Currently, the Canadian Pediatric Society does not have a section dealing with this topic.
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