CAM Use in Children
Pediatric complementary and alternative medicine (CAM) has become of increasing interest as data shows increasing numbers of children seeing CAM providers and using CAM at home. The 2007 National Health Information Survey (NHIS) asked selected adult respondents about CAM use for children in their households. Responses indicate that 12% of children in the U.S. use some form of CAM. This increases the need for discussion about the safety and appropriateness of CAM approaches to pediatric health. This pathway provides a brief overview of the current evidence concerning management, safety, and use of CAM in pediatric healthcare.
Among the top 10 therapies reported are natural products and homeopathics, chiropractic (and osteopathic) manipulations and massage. Conditions most frequently reported for CAM treatment include asthma, cancer, cerebral palsy, cystic fibrosis, gastrointestinal conditions (inflammatory bowel disease), back and neck pain, other musculoskeletal pain, colds, and mental health conditions (anxiety, depression, insomnia, ADHD, autism). Most pediatric patients who use CAM also receive conventional care.
A 2002 review identified more than 1400 random controlled trials (RCTs) and 47 systematic reviews of pediatric CAM. Formal evaluation of these determined that the quality of RCTs of CAM is “as good as that of RCTs of conventional medicine, and the quality of systematic reviews of CAM exceeds that of systematic reviews of conventional medicine.” As most literature highlights, there is a paucity of controlled clinical data regarding side effects of CAM in the pediatric population. Despite limitations of CAM evidence, healthcare providers need to be aware of the current evidence that does exist with regard to CAM therapies and not to assume such evidence is lacking or is of inferior quality. That being said, there are very few published reports of serious adverse effects of CAM use in children and lawsuits alleging CAM as harmful are rare.
Patient Preference and Autonomy
Confidence in and use of CAM is increasing by families for their children. Many use CAM because they are attracted to the CAM philosophies and health beliefs, dissatisfied with the process or results of conventional treatments, or concerned about their adverse effects. Many families reported that CAM was “more congruent with their own values, beliefs, and philosophical orientations towards health and life.” The fear of known side-effects of conventional medications is another reason why some families seek CAM. When patients choose to use CAM, general trends suggest that between 50-80% report clinical benefits and side effects were perceived to be few.
Pediatric Patient Management
With all therapies, especially pharmacological treatments, prescribing and dosing should be performed by a professional with professional training and expertise in the field. All clinicians should ensure that they have the appropriate skills to treat the patient “while complying with regulatory and institutional policies, and are legally authorized to provide treatment in the jurisdiction in which they practice.” All providers must recognize their limits and refer appropriately. Whether a treatment is conventional or CAM, healthcare providers must weigh the risks and benefits of all available treatment options, inform their patients of these, and respect their patients’ values, beliefs, and preferences.
The Pediatrics Clinical Pathway complete with references, patient and clinician resources are at available www.chpgroup.com behind the secure provider log-in.