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Complementary and Alternative Medicine and Pediatrics

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Related terms
Background
Author information
Bibliography
Cam research
Prevalence in pediatrics
Safety concerns

Related Terms
  • CAM, folkloric, holistic, irregular, integrative, naturopathy, non-allopathic, non-conventional, non-Western, traditional, unconventional, unorthodox, unproven medicine.

Background
  • The term complementary and alternative medicine (CAM) encompasses a broad group of healing philosophies, diagnostic approaches, and therapeutic interventions that do not belong to the predominant conventional health system of a particular society. Some authors separately define alternative therapies as those used in place of conventional practices, while complementary or integrative medicine can be combined with mainstream approaches.
  • In the United States and other Western nations, CAM therapies are often defined as interventions that are not taught in medical schools and are not available in hospital-based practices, such as dietary supplements (amino acids, herbal products/botanicals, minerals, vitamins, and substances that increase total dietary intake), modalities (manipulative therapies, mind-body medicine, and energy/bioelectromagnetic-based approaches), spiritual healing, and nutritional/dietary modification.
  • Boundaries between CAM and conventional therapies are not always clear and often change over time. Scientific evidence has led to broader mainstream acceptance of some CAM therapies and rejection of others.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Ernst E, Cassileth BR. The prevalence of complementary/alternative medicine in cancer: a systematic review. Cancer 8-15-1998;83(4):777-782.
  2. Farah MH, Edwards R, Lindquist M, et al. International monitoring of adverse health effects associated with herbal medicines. Pharmacoepidemiol Drug Safety 2000;9:105-112.
  3. Hagen LE, Schneider R, Stephens D, et al. Use of complementary and alternative medicine by pediatric rheumatology patients. Arthritis Rheum. 2-15-2003;49(1):3-6.
  4. Kelly KM. Complementary and alternative medical therapies for children with cancer. Eur.J Cancer 2004;40(14):2041-2046.
  5. Loman DG. The use of complementary and alternative health care practices among children. J Pediatr.Health Care 2003;17(2):58-63.
  6. Losier A, Taylor B, Fernandez CV. Use of alternative therapies by patients presenting to a pediatric emergency department. J Emerg.Med. 2005;28(3):267-271.
  7. Martel D, Bussieres JF, Theoret Y, et al. Use of alternative and complementary therapies in children with cancer. Pediatr.Blood Cancer 6-15-2005;44(7):660-668.
  8. Moher D, Soeken K, Sampson M, et al. Assessing the quality of reports of systematic reviews in pediatric complementary and alternative medicine. BMC.Pediatr. 2002;2:3.
  9. National Center for Complementary and Alternative Medicine (NCCAM). .
  10. Noonan K, Arensman RM, Hoover JD. Herbal medication use in the pediatric surgical patient. J Pediatr.Surg. 2004;39(3):500-503.
  11. Orhan F, Sekerel BE, Kocabas CN, et al. Complementary and alternative medicine in children with asthma. Ann.Allergy Asthma Immunol. 2003;90(6):611-615.
  12. Rogers EA, Gough JE, Brewer KL. Are emergency department patients at risk for herb-drug interactions? Acad.Emerg.Med. 2001;8(9):932-934.
  13. Sawni A, Thomas R. Pediatricians' attitudes, experience and referral patterns regarding Complementary/Alternative Medicine: a national survey. BMC Complement Altern Med. 2007 Jun 4;7:18.
  14. Sparber A, Wootton JC. Surveys of complementary and alternative medicine: Part II. Use of alternative and complementary cancer therapies. J Altern.Complement Med. 2001;7(3):281-287.
  15. Vohra S, Cohen MH. Ethics of complementary and alternative medicine use in children. Pediatr Clin North Am. 2007 Dec;54(6):875-84; x.

Cam research
  • The safety and efficacy of many CAM approaches are not well studied, although the body of research is growing. In 1992, the U.S. Congress established the Office of Alternative Medicine (OAM) within the National Institutes of Health (NIH), with a budget of $2 million to "investigate and evaluate promising unconventional medical practices." In 1998, Congress elevated the status of the OAM to a National Institutes of Health (NIH) Center, at which point it became known as the National Center for Complementary and Alternative Medicine (NCCAM).
  • NCCAM's budget has progressively increased, from $50 million in fiscal year 1999 to $114 million in 2003. Its mission is to "support rigorous research on CAM, to train researchers in CAM, and to disseminate information to the public and professionals on which CAM modalities work, which do not, and why."

Prevalence in pediatrics
  • As of 2007, the NIH reported that there had not yet been a large national survey that broadly addressed a range of CAM treatments. Small surveys conducted in the United States and Canada since 2001 have yielded a wide range of prevalence of CAM among pediatric and adolescent patients (younger than 18 years). Approximately 1.8% of the general pediatric United States population uses CAM. However, use varies by region. For example, reports have shown 12% usage in suburban Detroit compared with 33% in a Midwestern metropolitan area.
  • Rates of CAM treatment are higher for pediatric patients with chronic conditions, such as asthma, juvenile arthritis, cancer, cystic fibrosis, and cerebral palsy, as well as autism and attention deficit hyperactivity disorder. Studies show that in these cases, CAM is used both to fight the disease itself and to manage its symptoms. Data shows that 49%-84% of these patients have tried CAM therapy, typically as adjunctive therapy for pain. CAM is also used in generally healthy children to boost the immune system and to prevent colds and infections. Earlier studies report a lower overall prevalence of CAM use (9%-54%), possibly due to increasing rates of utilization, or to broadening of the definition of CAM both in survey questionnaires and in respondents' views.
  • The most popularly reported CAM therapies include herbal supplements, high-dose vitamin therapy, homeopathy, nutritional supplements, naturopathy, folk/home remedies, chiropractic care, prayer/spiritual approaches, and infant massage therapy. In addition, 21%-81% of pediatric cancer patients take high-dose vitamins, 9%-60% use herbs and supplements, 7%-25% use combination herbal teas (such as Essiac®), and 9%-24% follow specific diets, such as a vegan or macrobiotic diet. Use of massage, acupuncture, biofeedback, and hypnotherapy has also been reported.
  • U.S. pediatricians on the whole are reportedly open to CAM therapies, but conversations about CAM are most often initiated by patients and their parents. One study published in 2007 indicated that 71% of the American Academy of Pediatrics fellows surveyed would consider sending their patients to CAM practitioners, but that only 37% asked if patients were using CAM in routine check-ups. One report found that 86% of CAM users learned about CAM therapies through friends, whereas just 6% were introduced to them by their physicians.

Safety concerns
  • Although use of CAM is increasing in certain pediatric populations, there are still questions about the efficacy and safety of these interventions.
  • As the NIH points out, children differ from adults in size, as well as in how their bodies metabolize medications and other substances. Even among children in the same age groups, body weight and other factors impact these reactions. These issues are further complicated among pediatric patients with chronic medical conditions.
  • Many common herbal medications may cause major complications with surgery. This makes it essential to have current information regarding herb and supplement interactions with other drugs and surgery. For instance, St. John's wort and garlic are commonly used herbs that may complicate surgery by increasing bleeding and interactions with other drugs. Research has shown that kava and ginkgo should be discontinued 24-36 hours before surgery because of possible cardiovascular effects and interference with anesthetic drugs.
  • Significant potential morbidity and cost have been indirectly associated with herb/supplement-drug interactions, including increased emergency room visits, outpatient clinic visits, and other complications before, during, or after surgery. But the true direct and indirect costs, morbidity, and mortality associated with CAM-related interactions or adverse effects are not known.
  • With the potential therapeutic effects and risk of these herbs and supplements, it is vital that parents and patients make clinicians aware of the fact that they are using any such treatments, and that parents and practitioners know about current research in these areas. Furthermore, to ensure that the pediatric community maximizes the safe use of CAM interventions, systematic reviews must be conducted and reported at the highest possible quality.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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