Pediatrics is this month’s featured topic for NCCAM (National Center for Complementary and Alternatives Medicine), the United States’ “lead agency for scientific research on the diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine.” As Chair of the AAP’s Section on Integrative Medicine, I recently joined NCCAM’s Dr. Wendy Weber to co-lead a “Twitter Chat” on the use of CAM therapies for children. While I often find these talks top-heavy on cautionary tales about the risks of dietary and herbal supplements, the focus on integrative children’s health was welcome. Mind you, it’s not that I’m opposed to public safety counseling and research, but let’s not forget how many hospitalizations and ER visits result from adverse effects from conventional medicine use. Additionally, it’s important to acknowledge published trials demonstrating the safety and efficacy of specific CAM therapies (i.e. yoga).
One fact is clear. A significant number of children are using CAM therapies and more so in certain subpopulations. The data most commonly cited comes from the 2007 National Health Interview Survey which gathered information on CAM use among more than 9,000 children younger than 18. Note that CAM, for this study’s purposes, included 39 different modalities.*
· Nearly 12 percent of the children (1 in 9) used some form of CAM during the past 12 months.
· CAM use was much more likely among children whose parents also used CAM.
· Adolescents aged 12–17, children with multiple health conditions, and those whose families delayed or did not use conventional medical care because of cost were also more likely to use CAM.
In addition, comprehensive analyses by the Data Resource Center for Child and Adolescent Health (DRC) led by Dr. Christina Bethell at Oregon Health & Science University illustrate in more detail which children are using CAM therapies. With funding from several federal children’s health bureaus, the DRC analyzes surveys conducted by the CDC's National Center for Health Statistics and synthesizes its findings for specific areas of inquiry. Two areas of interest include children with emotional, mental or behavioral (EMB) conditions and children with pain-related conditions.
· For children <18 years old with at least one EMB condition, 26.5% used any type of CAM.
· The number of CAM modalities used increases when number of EMB conditions child experiences increases.
· Children with EMB conditions who used CAM are more likely to use conventional medical care and experience access problems than children with EMB conditions who DID NOT use CAM.
· For children <18 years old with at least one pain-related condition, 26.6% used any type CAM.
· The number of CAM modalities used by children increases when number of pain-related conditions child experiences increases.
· Children with pain-related conditions who used CAM are more likely to use conventional medical care (except hospitalization and emergency room visits) and experience access problems than children with pain-related conditions who DID NOT use CAM.
Previously published studies have also demonstrated that children with special health care needs (i.e. cancer, autism) use CAM at rates higher than the general population. Given the large numbers of children and families using the variety of therapies termed “CAM” as well as the issues regarding access to and cost of conventional treatments, research on CAM safety and efficacy should be a national priority.
*Alternative Medical System/Energy healing therapies: acupuncture, Ayurveda, homeopathic treatment, naturopathy, traditional healers (Curandero, Espiritista, Hierbero or Yerbero, Shaman, Botanica, Native American healer or Medicine man, Sobador) and energy healing
Biologically-based therapies: chelation, herbal supplements, vitamins/minerals used to treat specific conditions in past 30 days, 7 special diets (Vegetarian, Macrobiotic, Atkins, Pribkin, Omish, Zone, South Beach)
Manipulative and body-based therapies: chiropractic or osteopathic manipulation, massage and movement therapies (Feldenkries, Alexander technique, Pilates, Trager psychophysical integration)
Mind-body therapies: biofeedback, meditation, guided imagery, progressive relaxation, deep breathing exercises, hypnosis, yoga, tai chai, qi gong, support group meeting and stress management class
Lawrence D. Rosen, MD is a board-certified general pediatrician committed to family-centered, holistic child health care. He practices primary care at the Whole Child Center in Oradell, NJ and consults at the Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, serving as Medical Advisor to The Deirdre Imus Environmental Health Center.
Dr. Rosen is an internationally recognized expert in Pediatric Integrative Medicine. He is a founding member and Chair of the American Academy of Pediatrics Section on Integrative Medicine. Dr. Rosen is appointed as Clinical Assistant Professor in Pediatrics at New Jersey Medical School. He is a graduate of New York Medical College and the Massachusetts Institute of Technology, and he completed his residency and chief residency in pediatrics at Mount Sinai Hospital in New York.
Dr. Rosen is a contributing author/editor for several books, including “Integrative Pediatrics” (Oxford University Press 2009), “Green Baby" (DK 2008), and "Pediatric Clinics of North America: Complementary and Alternative Medicine" (Elsevier 2007). He is a contributing editor and pediatric columnist for Kiwi magazine. Dr. Rosen is the co-author of Treatment Alternatives for Children, a practial, evidence-based guide for parents interested in natural solutions for common childhood ailments