Thinking About CAM Therapies for Young People
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- "It worked when I had the flu, so why shouldn't it work for my daughter's flu? I'll just give her a smaller amount."
- "This supplement claims to prevent colds in kids. Does it work?"
- "My grandson has migraines. I read on the Internet about a hands-on therapy that's supposed to be good for migraine."
- "The pediatrician recommended vitamin D for my breastfed baby. I wonder if she should be on fish oil supplements, too. My grandmother always made her children take cod liver oil."
Can complementary and alternative medicine (CAM) be helpful to children? Are CAM therapies safe? This article presents some general points to consider in addressing these questions. 1
1 Many people also use other terms in addition to or instead of "CAM," such as "integrative medicine," "holistic medicine," and "non-allopathic medicine."
Use of CAM in Children
How many children are using CAM? There has not yet been a large, nationally representative survey on this topic that covers the full range of CAM therapies. There have been more limited surveys. They support the fact that many young people are using CAM, with some groups having a particularly high rate of use--such as young people who have diseases and conditions that could be described as any or all of the following:
- Chronic (over 50 percent of children with chronic conditions, by one estimate)
- Serious
- Painful or uncomfortable
- Having an unpredictable course
- Disabling
- Not having an established cure.
Examples of diseases and conditions in which CAM is used include cancer, asthma, juvenile arthritis, cystic fibrosis, mental health problems, ADHD (attention deficit hyperactivity disorder), diabetes, chronic pain syndromes, upper respiratory illnesses, skin conditions, and headaches. CAM is also used for other health purposes, such as preventing illnesses like colds and ear infections, coping with symptoms like pain and fear, "enhancing" the immune system, weight loss, and general health promotion.
Other reasons that CAM is used in children include:
- One or both parents use CAM
- Word-of-mouth
- Cultural or ethnic tradition
- To improve quality of life
- Dissatisfaction with conventional medical treatment--for example, with complexity, discomfort, risks, and/or costs
- All options in conventional therapy have been tried
- To meet a faith-based or spiritual need
- For a greater sense of control (in contrast to a sense of powerlessness)
- To participate more actively in health care
- A desire for a more "holistic" or "natural" approach to care
- Effects of advertising.
Adolescents have a high rate of using CAM. In a national, generally representative survey of about 1,300 young people 14 to 19 years old, 80 percent had used CAM at least once in their lifetime and 50 percent within the past month.
Types of CAM Therapies
As has been reported in adults, CAM therapies from all domains and whole medical systems are used in children, including herbs, massage, acupuncture, chiropractic, naturopathy, special diets, biofeedback, hypnosis, homeopathy, and others.
© Bob Stockfield
Increasingly, so are dietary supplements. The overall market for children's supplements (which cover a broad range of products such as vitamins, minerals, and herbs) had reached an estimated $510 million per year in 2002, according to industry analysts. It is important to note that not all dietary supplements, and not all the ways they are used, are considered CAM. Some are part of conventional medicine, such as using vitamin K to prevent bleeding disorders in newborn babies or iron supplements to treat anemia. Dietary supplements are also marketed to the public (including to young people directly) for CAM purposes.
Discussions With Health Care Providers
Children and their parents often do not tell their pediatrician or other health care provider that a child is receiving CAM. Many adolescents, for example, are reluctant to have this discussion because they believe a provider doesn't know about CAM, is not interested in it or would not approve, or there are confidentiality concerns.
For their part, pediatricians appear to have mixed views on CAM. A 2001 survey of members of the American Academy of Pediatrics found that among 745 members:
- 87 percent had been asked about CAM therapies by a patient or a parent in the 3 months prior to the survey. Most often, these doctors were asked about herbs and dietary supplements.
- Fewer than 5 percent felt very knowledgeable about the CAM therapies they were being asked about.
- Two-thirds (66 percent) believed CAM therapies could enhance recovery or relieve symptoms. However:
- Three-quarters (75 percent) were concerned about possible side effects
- Three-quarters were concerned that CAM use might delay mainstream care.
Thus, pediatricians do not appear to be "against" CAM, but do not understand it as well as they do non-CAM therapies. An important message that has emerged from this and other studies, as well as from clinical practice, is that patients and their families need to talk with the their doctors about every therapy they are using or considering--regardless of the tradition or belief system it comes from--so that doctors can provide comprehensive care.
Safety
Are CAM therapies safe for children? It is not possible to answer this for CAM as a whole, which is like trying to answer the question "Is surgery safe for children?" It depends on the therapy, the child, the health condition, and other factors.
One can, however, begin to address the question of whether a specific CAM therapy is safe for a specific child by knowing, first, that children are not small adults. They differ from adults--for example, in how their bodies absorb, use, and eliminate medications and other substances. Their immune and central nervous systems are not fully developed, which can make them (especially infants and young children) respond to treatments differently than adults. In addition, individual children, even of the same age, are different (for example, in weight) and will respond differently to the same treatment.
Second, many CAM therapies are generally safe but have side effects or risks for people with specific medical issues. For example, chamomile tea is considered safe in small doses, but not if a child is allergic to chamomile's family of plants or takes the tea in place of needed nourishment. In HIV-positive children, some herbs can influence the effectiveness of anti-HIV medications.
Parents also need to ask what is known from scientific studies about how safe a specific CAM therapy is in children. The best places to seek this information are from (1) the child's physician and (2) reports of scientific studies that have been published in peer-reviewed journals. For most CAM therapies, there have not been many rigorous studies in young people (if such studies have been done at all). More rigorous studies are needed. Anecdotes and testimonials (personal stories) about CAM therapies are common and can be compelling, but are not evidence.
When a therapy is delivered by a CAM practitioner, it is important to talk to the practitioner. Ask about their education, training, and experience in delivering care to children2; their values and philosophy on care and health; whether they tailor care to the individual child; and how they collaborate with other providers, including M.D.s. (See also NCCAM's publication Selecting a CAM Practitioner.)
2 Also ask about licensing, as some states have licensing requirements for certain CAM practitioners (such as chiropractors, naturopathic doctors, massage therapists, and acupuncturists).
For herbal and other dietary supplements, there are special points on safety:
- Plants and other ingredients can have direct effects--positive and negative--in the body. Many modern prescription drugs are derived from plants. Just because something is natural, however, does not automatically mean it is safe.
- An herb or supplement could interact with something else a child is taking, such as another herb, another supplement, or a drug, and change the way these act in the body.
- Herbal and other dietary supplements are not regulated by the U.S. Food and Drug Administration (FDA) as strictly as are prescription drugs. 3 These products and their ingredients can vary a great deal, even from lot to lot or bottle to bottle. Some dietary supplements have been analyzed and, in some cases, found to contain ingredients that are unlabeled (such as hormones or stimulants) or contaminants (such as heavy metals).
- Herbs can cause problems with surgery (such as interactions with drugs and complications in bleeding). A few known examples from adult patients are echinacea, garlic, ginkgo, St. John's wort, and valerian.
3 See NCCAM's publication What's in the Bottle? An Introduction to Dietary Supplements.
Other Points To Consider
If you are a parent or health care provider considering treating a child with CAM (or if you are a young person considering CAM), also consider the following points:
- It is important to discuss the therapy with your health care provider(s). Give them a full picture of what you do to manage health. This will help ensure coordinated and safe care.
- On the question of whether a therapy works, ask the child's physician and seek results of rigorous scientific studies on the specific therapy in the age group of concern.
- A CAM therapy should not be used instead of conventional care or to delay seeking that care.
- Make sure you have received an accurate diagnosis from a licensed health care provider.
- If you decide to use CAM, do not increase the dose or length of treatment beyond what is recommended. More is not necessarily better.
- If the child experiences an effect that concerns you, contact a health care provider.
- If you are a woman who is pregnant or breastfeeding, remember that therapies you take can also affect your unborn child or your infant.
- Be realistic in your expectations about a therapy. If something sounds too good to be true, it probably is. The Federal Trade Commission (FTC) and the FDA have publications to help you evaluate health-related claims made, for example, about supplements, devices, and other products.
- Store herbal and other supplements out of sight and reach of children.
In summary, many young people and their parents are turning to CAM--because of deeply held beliefs, a wish to try other options beyond what conventional medical care offers, and for other reasons. This picture fits with the widespread use of CAM and integrative medicine described in the Institute of Medicine's 2005 report on CAM. For most CAM therapies, more scientific evidence from rigorous studies (including those supported by NCCAM) is needed in order to firmly answer questions about their safety and effectiveness in young people.
For More Information
NCCAM ClearinghouseThe NCCAM Clearinghouse provides information on CAM and NCCAM, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.
Toll-free in the U.S.: 1-888-644-6226
TTY (for deaf and hard-of-hearing callers): 1-866-464-3615
Web site: nccam.nih.gov
E-mail: info@nccam.nih.gov
A service of the National Library of Medicine (NLM), PubMed contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. CAM on PubMed, developed jointly by NCCAM and NLM, is a subset of the PubMed system and focuses on the topic of CAM.
Web site: www.ncbi.nlm.nih.gov/entrez
CAM on PubMed: nccam.nih.gov/camonpubmed
The FTC is the Federal agency charged with protecting the public against unfair and deceptive business practices, including in the advertising of certain products. Its publications include Miracle Health Claims: Add a Dose of Skepticism and Weighing the Evidence in Diet Ads.
Web site: www.ftc.gov
Toll-free in the U.S.: 1-877-382-4357
The FDA oversees the safety of many products, such as foods (including dietary supplements), medicines, medical devices, and cosmetics. Its publications include Tips for the Savvy Supplement User.
Web site: www.fda.gov
Toll-free in the U.S.: 1-888-463-6332
Among the information this group offers are slide presentations by members on topics in pediatric integrative medicine and CAM, and print and Internet resources.
Web site: www.aap.org/sections/chim/practice.htm
References
References are primarily recent reviews on the topic of children, adolescents, and CAM in the peer-reviewed medical and scientific literature in English in the PubMed database or from Federal Government text.
Ang-Lee MK, Moss J, Yuan CS. Herbal medicines and perioperative care. Journal of the American Medical Association. 2001;286(2):208-216.
Breuner CC. Complementary medicine in pediatrics: a review of acupuncture, homeopathy, massage, and chiropractic therapies. Current Problems in Pediatric and Adolescent Health Care. 2002;32(10):353-384.
Committee on Children with Disabilities, American Academy of Pediatrics. Counseling families who choose complementary and alternative medicine for their child with chronic illness or disability. Pediatrics. 2001;107(3):598-601.
Committee on the Use of Complementary and Alternative Medicine by the American Public, Institute of Medicine of the National Academies. Complementary and Alternative Medicine Use in the United States. Washington, DC: National Academies Press; 2005.
Davis MP, Darden PM. Use of complementary and alternative medicine by children in the United States. Archives of Pediatrics and Adolescent Medicine. 2003;157(4):393-396.
Eisenberg DM. Advising patients who seek alternative medical therapies. Annals of Internal Medicine. 1997;127(1):61-69.
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Gardiner P, Dvorkin L, Kemper KJ. Supplement use growing among children and adolescents. Pediatric Annals. 2004;33(4):227-232.
Gewanter HL. Comment on behalf of the American Academy of Pediatrics Provisional Section on Complementary, Holistic, and Integrative Medicine. Presented at the twenty-fifth meeting of the National Advisory Council for Complementary and Alternative Medicine, September 8, 2006, Rockville, Maryland. Accessed on December 19, 2006.
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Kemper KJ, Cassileth B, Ferris T. Holistic pediatrics: a research agenda. Pediatrics. 1999;103(4 Pt 2):902-909.
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Peeler CL. The Regulation of Dietary Supplements: A Review of Consumer Safeguards: Prepared Statement to the Committee on Government Reform, United States House of Representatives (March 9, 2006) by the Deputy Director, Bureau of Consumer Protection, Federal Trade Commission. Accessed on January 31, 2007.
Raiten DJ, Picciano MF, Coates P. Dietary supplement use in children: who, what, why, and where do we go from here? Executive summary. Nutrition Today. 2002;37(4):167-169.
Sibinga EM, Ottolini MC, Duggan AK, et al. Parent-pediatrician communication about complementary and alternative medicine use for children. Clinical Pediatrics. 2004;43(4):367-373.
Spigelblatt LS. Alternative medicine: should it be used by children? Current Problems in Pediatrics. 1995;25(6):180-188.
Wilson KM, Klein JD, Sesselberg TS, et al. Use of complementary medicine and dietary supplements among U.S. adolescents. Journal of Adolescent Health. 2006;38(4):385-394.
Woolf AD. Herbal remedies and children: do they work? Are they harmful? Pediatrics. 2003;112(1 Pt 2):240-246.
Yussman SM, Ryan SA, Auinger P, et al. Visits to complementary and alternative medicine providers by children and adolescents in the United States. Ambulatory Pediatrics. 2004;4(5):429-435.
