Pediatric Complementary and Alternative Medicine

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Biologically Based Therapies

Biologically based therapies include substances found in nature, such as homeopathic medications, herbs, dietary supplements, and vitamins. 1 The categories of homeopathy, herbs, and dietary supplements often overlap.  How these products are regulated and manufactured and their indications for use help define how they are classified.  According to the US Dietary Supplement Health and Education Act passed by Congress in 1994, herbal products are regulated as dietary supplements but when they are diluted and prepared as homeopathic remedies, they become pharmaceutical products. 2  

Homeopathy

Homeopathy is based on the Law of Similars, or the belief that "like treats like". In other words, if a substance can cause sickness in a healthy person, it should cause wellness in a sick person.  Homeopathy was founded by German physician, Dr. Samuel Hahnemann over 200 years ago. 3 It involves giving very small diluted, shaken doses of naturally occurring substances called remedies that are believed to produce the same or similar symptoms of specific illnesses in healthy people if they were given in larger doses.4  The remedies seek to stimulate the body's own defense mechanisms and processes as a way to prevent or treat illness.

The method of action for homeopathy is not known.  It is particularly difficult to understand how it works since the remedies are so diluted that the initial starting substance can't even be measured. 5 In general, it is believed that homeopathy is safe if patients are under the supervision of trained professionals.  Homeopathic remedies are not known to interfere with other medications the patient might be taking.  Of concern in pediatrics is that liquid homeopathic medicines can contain higher levels of alcohol than conventional medications.4   

Examples of Use

There are several randomized double-blinded control studies looking at the use of homeopathic medications in children.  Oberbaum, et al. (2001),6 found that traumeel S, a homeopathic skin cream, reduced the severity and length of pain and inflammation inside the mouth of pediatric bone marrow transplant patients.  Pappano et al. (2007) 7, reported that although individualized homeopathic remedies statistically reduced the duration and frequency of stools in children with acute diarrhea this treatment is not widely used by pediatric providers because of concerns of efficacy, safety, and lack of experiential knowledge.    

The National Center for Homeopathy provides "A Parent's Guide to Children's Health Through Homeopathy" on their website,  http://nationalcenterforhomeopathy.org/articles/child_resource_guide.pdf .8  This guide contains information for parents on the use of homeopathic treatment of otitis, fever, and flu in children.  However, these treatments are not found to be supported by the results of a systematic review of randomized clinical trials done by Altunc, Pittler, & Ernst (2007).5

Herbs

The use of herbal dietary supplements is common in children and adolescents.   Several national and international surveys estimate their use at 28-40%.  They are used for a number of reasons including maintaining health, preventing disease, and treating chronic or acute disease.  There also appears to be a strong cultural influence in their use.  The use of herbal dietary supplements is often not disclosed to health care providers.  This can be a particular problem in pediatrics since many of the treatments have not been clinically tested for safety and efficacy in children and they can often interact with other medications. 8,9

Examples of Use

Herbs that have been commonly used in pediatrics include aloe (for burns) chamomile (primarily for stomach upset, colic, and diarrhea), Echinacea (for colds), garlic (for cardiovascular and infectious disease problems), ginger (for nausea and stomach upset), ginkgo (for ADHD), lavender (to promote relaxation), peppermint oil (for stomach upset), and St. John’s wort (for depression and nervous conditions). 10,11 

Although there are a number of articles, books, and internet resources available for health care providers about the use of herbs for adults, resources about the use of herbs for children are much more limited.  In addition, some published randomized control studies were flawed by a small sample size, lack of product quality control, or only a single study was done.  Further well-designed pediatric studies are needed.12

See the additional Herbal Therapies resources page for more specific pediatric focused information.    

Herbal Therapies Resources 

Diet Supplements

Diet supplements include products such as vitamins, minerals, amino acids, herbs, and other botanical products.  Their purpose is to supplement the diet to improve the structure and function of the body.  However, most of these product benefits have not been backed by research or supported by the FDA.  In fact, product manufacturers must label their products with a disclaimer that informs the user that beneficial claims have not been evaluated by the FDA. 2

There have been great variations in the quality and manufacturing practices of diet supplements.  In response to this, in 2007, the FDA finalized the Good Manufacturing Practice Regulations.  These regulations help standardize product quality, manufacturing, packaging, labeling, and storing processes.  The goal of the regulations is to provide safely manufactured and standardized products for consumers. 2

Examples of Use

Although not always disclosed to their health care providers, many children and adolescents use dietary supplements.  Vitamins and minerals (multivitamins and calcium) are the supplements most commonly used.  Although these supplements may be beneficial for some children and adolescents, the need for use by all has not been recommended. 2

American Academy of Pediatrics Resources on Dietary Supplement Use

Calcium: http://aappolicy.aappublications.org/cgi/reprint/pediatrics;117/2/578.pdf

Drugs and sports: http://aappolicy.aappublications.org/cgi/reprint/pediatrics;52/3/460.pdf

Folic Acid: http://aappolicy.aappublications.org/cgi/reprint/pediatrics;104/2/325.pdf

Vitamin A: http://aappolicy.aappublications.org/cgi/reprint/pediatrics;48/4/655.pdf

Vitamin D: http://aappolicy.aappublications.org/cgi/content/full/pediatrics%3b111/4/908

(www.aap.org, accessed 5/6/08)   

Probiotics

Probiotics are another example of a dietary supplement that is used by children and adolescents.  Probiotics are nonpathogenic microbes (generally lactic acid producing) that are taken orally to improve or normalize the balance of GI microflora.  Probiotics are extremely safe for use by healthy children and may be so even in immunocompromised or seriously ill children. 13 

Examples of Use

Research has supported probiotic use in reducing the risk of antibiotic associated diarrhea and reducing the duration of acute infectious diarrhea.14  Typically probiotic treatment is initiated at the same time an antibiotic is being given to prevent antibiotic associated diarrhea.  The typical duration of therapy varies from 1 to 4 weeks depending upon the resolution of symptoms.13 

Although the safest forms of probiotic bacteria are found in fermented foods such as yogurt, supplemental forms usually provide higher more effective amounts of bacteria. 13  The exact composition of the most effective probiotic for children has not been determined but it has been shown that an adequate dose of any probiotic is key to its’ effectiveness.  Doses in the range of 5 to 10 billion colony forming units (cfu) per day or higher are considered appropriate for most children. 14  


References

  1. http://nccam.nih.gov/health/backgrounds/biobasedprac.htm, accessed 4/3/08

  2. Gardiner, P. & Riley, D. (2007).  Herbs to homeopathy – medicinal products for children.  Pediatric Clinics of North America, 54, 859-874.

  3. http://nationalcenterforhomeopathy.org/articles/view,35, accessed 5/12/08

  4. http://nccam.nih.gov/health/homeopathy/, accessed 4/3/08

  5. Altunc, U., Pittler, M., & Ernst, E. (2007).  Homeopathy for childhood and adolescence ailments:  Systemic review of randomized clinical trials.  Mayo Clinic Proceedings, 82(1), 69-75.

  6. Oberbaum, M., Yaniv, I., Ben-Gal, Y. Stein, J., Ben-Zvi, N., Freedman, L., Branski, D. (2001).  A randomized, controlled clinical trial of the homeopathic medication Traumeel S in the treatment of chemotherapy-induced stomatitis in children undergoing stem cell transplantation.  Cancer, 92(3), 684-690.

  7. Pappano, D., Conners, G., McIntosh, S., Humiston, S., Roma, D. (2007).  Why pediatric health care providers are not using homeopathic antidiarrheal agents.  The Journal of Alternative and Complementary Medicine, 13(10), 1071-1074.

  8. http://nationalcenterforhomeopathy.org/articles/child_resource_guide.pdf , accessed 5/12/08

  9. Barclay, L. & Lie, D. (2005).  Clinical evidence reviewed for common botanical dietary supplements in children.  www.medscape.com/viewarticle/501265_print, accessed 11/29/07.

  10. Gardiner, P. & Kemper, K. (2000).  Herbs in pediatric and adolescent medicine.  Pediatrics in Review, 21(2), 44-58.

  11. Kemper, K. (2002). The Holistic Pediatrician, 2nd edition, New York:  Harper Collins. 

  12. Hrastinger, A., Dietz, B., Bauer, R., Sagraves, R., & Mahady, G. (2004). 

  13. Charrois, T., Sandhu, G., & Vohra, S. (2006).  Probiotics.  Pediatrics in Review, 27(4), 137-139.

  14. Kligler, B., Hanaway, P., & Cohrssen, A. (2007).  Probiotics in children.  Pediatric Clinics of North America, 54, 949-967.

Author's Note: This website does not intend to provide specific CAM practice guidelines, but will provide information on how CAM could be used in pediatrics.  In addition, links will be provided to more specific practice information when they are available.