Recommendations on pediatric integrative medicine were released by the American Academy of Pediatrics (AAP) and published online August 28 in Pediatrics. The clinical report updates the original statement on complementary medicine published in 2008.
“To date, consumer interest in and use of complementary therapies has outpaced training options in pediatric integrative medicine, leaving pediatricians with a desire for more training and familiarity with resources,” Hilary McClafferty, MD, from the Department of Medicine, Center for Integrative Medicine, College of Medicine, University of Arizona, Tucson, and colleagues write.
More than one in 10 US children has ever used a complementary therapy, and more than half of those children with a chronic condition have, the authors explain. With such widespread use, many pediatricians find themselves grappling with how to best advise parents on an array of practices ranging from use of herbal supplements to yoga.
The clinical report is intended to help pediatricians guide parents through safe and effective use of complementary therapies in children. It summarizes some common complementary practices and the related evidence; presents medicolegal, ethical, and research implications; offers recommendations on broaching the topic in practice; and points physicians to additional resources on integrating complementary therapies into care.
The authors note that a 2012 survey showed just 16 of 143 pediatric training programs include an integrative medicine program. However, other groups have stepped in to help fill the void in education, including the AAP’s Section on Integrative Medicine, the Pediatric Complementary and Alternative Medicine Research Network, and the Academic Consortium for Integrative Medicine and Health.
Parents who use complementary therapies are most likely to try them for their children, the authors explain. These decisions may be driven by family beliefs, fear of adverse drug affects, a desire to boost the effects of conventional therapies, or a desire to improve overall health. However, many parents are reluctant to discuss such use with their pediatrician. This often leaves pediatricians in the dark about potential adverse interactions with conventional therapy or unable to help parents assess the benefits and risks of a given therapy.
Some complementary practices, such as yoga and acupuncture by a well-trained practitioner, pose minimal risk and are backed by evidence of effectiveness for certain pediatric conditions. For example, systematic reviews have found that yoga can improve psychological function in children and may help improve symptoms of conditions such as attention-deficit hyperactivity disorder, inflammatory bowel disease, and juvenile idiopathic arthritis in young patients.
Other complementary therapies may be harder to assess as a result of limited evidence and minimal regulation. The US Food and Drug Administration’s regulation of herbal products and dietary supplements is much more limited than its regulation of drugs. These products do not have to demonstrate safety or efficacy before marketing. Instead, the agency relies on adverse event reports from consumers and physicians to identify potentially harmful products after they are on the market.
These products may have beneficial effects, but they can also have dangerous interactions with drugs or contain harmful ingredients. For example, the supplement St John’s wort can affect the therapeutic doses of anticoagulants, calcium channel blockers, digoxin, and benzodiazepines, the authors write. There is also documented evidence of heavy metals in some ayurvedic herbal medications (Saper RB et al. JAMA. 2004;292:2868-2873).
“Some natural products have therapeutic qualities, but also potentially harmful effects,” Dr McClafferty said in a news release. “Parents may assume these products are harmless because they come from plants or food, but natural doesn’t always mean safe.”
The authors urge pediatricians to update themselves on common complementary therapies and the evidence on their benefits and risks. They also list resources that can help. Most important, they urge physicians to ask parents about use of complementary therapies, to be open-minded and respectful, and to help parents make evidence-based decisions.
“Many complementary therapies have significant potential to widen the scope of treatments available for children, especially for those dealing with pain or chronic conditions that are difficult to manage,” Dr McClafferty said. “The key is open and ongoing discussion about promising benefits, weighed against possible risks any treatments used.”
The authors have disclosed no relevant financial relationships.
Pediatrics. 2017;140:e20171961.
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