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Alternative health care treatments such as acupuncture, biofeedback and massage might seem unusual in the pediatric sphere, but a study released last year by the American Academy of Pediatrics reveals that parents are increasingly turning to complementary and alternative medicine (CAM) to help keep their children healthy. Twenty to 40 percent of healthy children use some form of CAM. With chronically ill children, that number goes up to more than 50 percent.
However, many parents don’t discuss their child’s alternative treatments with their physician, which can result in serious medical consequences. Eugenia Chan, MD, MPH, from the Division of Developmental Medicine, weighs in on the shift to alternative care, and offers advice on what parents and physicians need to know.
Q: Why are more parents turning to CAM?
Parents may want more control over their child’s treatment, particularly if their child is taking very powerful medications that haven’t been adequately tested in children. Parents may be scared of the side effects and so they use the Internet and talk to friends to try to find alternatives. Others just want a more holistic approach, which is perceived to be healthier. There’s a belief that alternative treatments are safer because they’re natural when in fact, parents should treat these treatments with the same caution as they do more conventional medicine.
Q: Who is using CAM?
Children with chronic conditions, children whose conditions are typically treated with powerful medications and children who don’t have an effective treatment are most likely to use alternative therapies. Children with autism, ADHD, cerebral palsy, cystic fibrosis and various types of cancer tend to fall into that category. Also, for some families, especially in some Latino or Asian cultures, alternative therapy is a cultural norm.
Q: What are some of the most common CAM treatments?
It depends a lot on what the parents are familiar with. Dietary supplements and herbs tend to be used across the board. Multivitamins are the most common form of CAM used in children. For certain groups of children, massage, yoga or acupuncture may be more common. Many parents of children with autism try gluten-free diets. But most often, alternative therapies are used in conjunction with a more conventional form of medicine. In my clinical practice, I’ve found it very rare that someone uses CAM entirely independent of traditional treatments.
Q: How is CAM being integrated into medical institutions like Children’s?
It tends to vary across the country. Some institutions offer a CAM service, which parents can consult if they’re interested in alternative treatments; others have groups of researchers who focus on complementary therapies. One of the best examples of CAM integration is in anesthesia, where acupuncture is becoming more common as part of pain management.
Q: What are some possible risks of using CAM?
Just because something is touted as natural or organic or over the counter does not mean it’s necessarily safe for all kids. Many times, these treatments haven’t been properly tested or monitored in children, and therefore we don’t know what the different responses may be. It’s very important to consider potential interactions between anything ingested by a child; hospital databases can help clinicians assess these interactions. Also, parents need to weigh the costs and benefits of alternative therapies. The amount of family time, energy and money can become a potential risk, considering the intense involvement and expense required by some treatments. Neurofeedback for ADHD, for example, can be extremely time-consuming, which may take away from a child’s ability to participate in after-school activities. If a treatment becomes the single dominant force in a family’s life, is the outcome worth it?
Q: 66 percent of caregivers didn’t tell clinicians about their child’s CAM use. Why do you think that is?
For the most part, it’s not something physicians are trained to ask about, so they’re reluctant to address the issue. Either physicians may not have a great knowledge base in CAM, or they might have a bias towards more conventional medicine, or they simply might not know how to use CAM in conjunction with traditional treatments. A recent study revealed that, unlike conventional medicine, negative studies about CAM research are more likely to be published in well-known journals, while positive studies are more likely to appear in foreign-language journals.
For their part, parents may not realize how important it is for a physician to know about alternative treatments. Dietary supplements and herbs may seem healthy, but they can have interactions with medications a child may be taking. Also, there has been the preconception that CAM is not part of a physician’s role, so parents may not feel it’s an issue they need to bring up.
Q: What can clinicians do to address this issue?
A clinician needs to be the first person to ask. Often, parents won’t bring up CAM because they’re afraid of what the physician’s reaction might be. By asking if a parent has considered any alternative or complementary therapies, it lets the parent know that this is a necessary topic to discuss as part of the conversation of a child’s treatment. Even so, parents might not think to mention something like a multivitamin. As such, it’s helpful to be specific and list various treatments, such as vitamins, supplements, yoga, chiropractic, etc. Even if parents volunteer information, a list can trigger more responses they might not have otherwise considered. Clinicians should also make sure a child’s use of CAM is consistent, so he or she can set measured outcomes for these therapies. It’s difficult to assess a child’s progress if a physician doesn’t know what the child was like at baseline. Without consistency of dosage and follow-ups to see how treatments impact a child’s health, a child could be on something for years without knowing whether or not it actually benefits him or her.
Q: What are some of the most important things parents should know about CAM?
First, parents should know that there are licensing requirements for certain kinds of CAM providers, such as acupuncturists and homeopaths. Also, they should be aware that dosage recommendations on some supplements and vitamins are meant for adults, not children. Even though some treatments may seem more holistic, parents should be as skeptical about alternative therapies as they are about conventional therapies. |
