Roughly 12% of U.S. children--and more than half of those with chronic medical conditions—have used therapies developed outside conventional Western medicine. An updated clinical report from the American Academy of Pediatrics (AAP) equips pediatricians with the information they need to counsel families about these complementary therapies.
In addition to providing background information and updated research on selected complementary therapies, the report, "Pediatric Integrative Medicine," in the September 2017 Pediatrics (published online Aug. 28,) calls for expanded medical education on integrative medicine and urges more reliable safety standards for complementary therapy use in children, particularly for "natural" supplements with potentially toxic effects.
Many complementary therapies have a growing body of evidence suggesting they can safely help treat a variety of ailments, according to the report. For example, docosahexaenoic acid (DHA) in fish oil has been shown to support healthy pregnancy and development of fetal brain development and is linked with improved attention-deficit/hyperactivity disorder symptoms in some children, and research shows certain strains of probiotics may shorten the duration of infectious diarrhea and help prevent dermatitis flare-ups. Other studies suggest therapies such as acupuncture show promise in reducing pediatric pain--especially associated with tension and migraine headache.
Some popular treatments, however, have slim supporting evidence and can potentially endanger a child's health. The report cites concerns about the purity and potency of herbal products and other dietary supplements routinely marketed to families, for example. These are classified as food rather than pharmaceuticals and are therefore subject to less rigorous regulations that do not require pre-market testing.
"Some natural products have therapeutic qualities but also potentially harmful effects," said Hilary McClafferty, MD, FAAP, lead author of the clinical report. Certain herbal products, she said, may expose children to heavy metals such as lead, mercury and arsenic.
"Parents may assume these products are harmless because they come from plants or food," McClafferty said, "but natural doesn't always mean safe."
In addition, the report warns that some natural products interact with prescription medications and cause adverse reactions. One example is St. John's Wort, commonly used to treat mild to moderate depression, which can interfere or react with hundreds of prescription drugs ranging from oral contraceptives to anxiolytics and various blood pressure and heart medications.
The AAP report encourages pediatricians to ask patients and their families about complementary therapies they have used while respecting the different perspectives, values and cultural beliefs in "open, ongoing communication centered on the patient's well-being."
"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," McClafferty said.
"The key," she said, "is open and ongoing discussion about promising benefits, weighed against possible risks, of any treatments used."
