Complementary and alternative medicines for children's health

DEFINITION: Complementary and alternative medicines and therapies that are focused on infants, toddlers, and young children.

Overview

Like adults', children’s health issues can range from mild to severe and can be physical or mental. For milder, common conditions, many parents turn to complementary and alternative medicine (CAM) to relieve their child’s symptoms. The 2012 National Health Interview Survey (NHIS) found that 11.6 percent of children in the United States had used some form of alternative medicine. The same survey found that nearly ten million parents of children with mental health issues reported the use of CAM therapies. The use is greater among children whose parents used CAM and whose parents had higher education levels, had multiple health conditions, and were white. The use of CAM was also greater among families who delayed conventional care because of cost.

While it is thought that CAM will spare the child from harsh conventional medications and treatments, caution is warranted. Many alternative treatments are not tested and regulated for safety in children. In addition, some treatments, such as restrictive diets, may be difficult for children to adhere to. Also, some parents may think that one can give children extra natural medicine without causing harm, but even natural substances in the wrong doses can be toxic.

While additional research needs to be done, evidence regarding CAM has increased for certain therapies. Many of these studies, however, were based on the testing of adults, not of children or adolescents. With a pediatrician’s guidance, conventional and alternative medicine can be used together safely.

The most commonly used natural therapies among children in the United States, in descending order, are herbal products, chiropractic/osteopathic care, deep breathing, yoga, homeopathic treatment, traditional healing, massage, meditation, diet-based therapies, and progressive relaxation. Children are most often using CAM for back and neck pain, head and chest colds, anxiety and stress, musculoskeletal conditions, attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), and insomnia.

The National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, places CAM into four major categories: biologically based (supplementing the diet with nutrients, herbs, particular foods, and extracts), manipulative and body-based (using touch and manipulation, such as chiropractic and massage), mind/body (connecting the mind to the body and spirit in practices such as yoga and meditation), and energy therapies (aiming to restore balance to the body’s energy with therapies such as qigong). Other whole, ancient, medical systems include traditional Chinese medicine, Ayurveda, homeopathic medicine, and naturopathic medicine.

Common Health Issues

There are a number of health issues that predominate during childhood, including infant colic and ear infections. CAM is one place parents begin to address these issues. Other good starting points for optimum health during these growth years are proper nutrition, adequate rest, and good coping skills.

Alternative therapies for colic. Infant colic (excessive fussiness, crying, and discomfort for more than three hours at a time and for a minimum of three days per week) is a condition experienced by many parents and their newborns between about four and five months of age. There is supporting evidence that fennel oil improves symptoms and is effective in reducing crying time for infants with colic. Also used for indigestion, fennel is a carminative. That is, it helps the body expel gas. Herbal combinations such as fennel, chamomile, vervain, licorice, and balm mint have also been shown to help relieve colic. Gripe water, a popular over-the-counter liquid supplement, contains such herbal combinations and is marketed to relieve colic, gas or indigestion, and general fussiness among infants.

Alternative therapies for ear infections. Xylitol is a sweetener and natural sugar found in plums, strawberries, and raspberries. It inhibits the growth of certain types of bacterial strains, such as Streptococcus mutans and related species, and of Haemophilus influenzae. Chewing gum with xylitol and ingesting xylitol sweetener five times per day can help to prevent middle ear infections. Lower doses, however, are not effective.

Once symptoms have begun, some homeopathic ear drops provide symptom relief in children with mild to moderate pain. Another popular method for relieving ear pain or ache among children is through chiropractic means. Chiropractic practitioners use manipulation to improve the function of the tensor veli palatini, which they believe can help treat or prevent ear infections.

Herbal and Nutrition Therapies

The NHIS reported the most common natural health products being used by children. These products include echinacea, fish oil/omega 3, combination herbal pills, and flaxseed oil/pills.

Echinacea, also known as coneflower, is a herbaceous group of flower plants found in prairies and open fields in North America. Echinacea is commonly used by children, teenagers, and adults for colds and flu. Double-blind, placebo-controlled studies enrolling more than one thousand people found that various forms and species of echinacea can reduce the symptoms and duration of a common cold in adults. It is thought that echinacea works by temporarily stimulating, strengthening, and nourishing the immune system. There is limited scientific evidence, however, to support these claims. Although echinacea might stimulate the immune system temporarily, there is no evidence of long-term effectiveness.

As with all herbal medicines, the precise species and part or parts of the plant being used are key. There are three main species of echinacea: E. purpurea, E. angustifolia, and E. pallida. The flowers, leaves, and stems of E. purpurea, when used together, provide the best supporting evidence for benefits in treating colds and influenza. The root of E. purpurea has not been shown to be effective, while the root of E. pallida may be the active, and effective, part of that species.

Echinacea may be beneficial in reducing symptoms or halting a cold once it has started. However, echinacea does not appear to prevent colds. It may not be effective in children and adolescents and has not been studied in these populations. As with all herbal supplements, the actual dosing, potency, and quality of the over-the-counter product are not regulated or guaranteed.

Omega-3s are the second most commonly used natural supplement in children. Omega-3s are naturally occuring polyunsaturated fatty acid (PUFA), considered "healthy fats," and are essential for good health. They have been broadly studied for its impact on heart health and on arthritis, asthma, cancer prevention, depression, and behavioral conditions like attention deficit hyperactivity disorder (ADHD). Many children’s natural vitamin products include fish oil or some form of omega-3. Supportive evidence for its benefits to heart health led the U.S. Food and Drug Administration (FDA) to allow the following statement on products containing fish oil: “Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease.”

Omega-3 is also approved by the FDA as an aid in lowering levels of bad cholesterol. Evidence of benefits from omega-3s has mounted. One randomized control trial even showed that women who took fish oil supplements during the third trimester of pregnancy helped to reduce the risk of asthma in their children for up to sixteen years. There is, however, no daily requirement or omega-3 standard recommended dose for children.

In a review of thirteen studies researching the effects of omega-3 supplements on children with ADHD, thirteen studies found positive results, linking the use of the supplement to improvements in hyperactivity, impulsivity, attention, visual learning, word reading, and working/short-term memory. Another survey of fifty-two studies found favorable correlations between fish oil supplements and dietary changes and modifications in children with ADHD symptoms.

Parents should use caution before giving children herbs or supplements, because most of these alternative products have not been tested on children. Herbalists may suggest taking one-quarter the adult dose. Many common herbs, such as ephedra, kava kava, lavender, monkshood, wormwood, deadly nightshade, foxglove, desert herb, star anise, lobelia, and mistletoe, as well as Ayurvedic herbal remedies, have been shown to be toxic to the cardiac and central nervous systems. Parents should discuss with their family doctor any plans to use alternative medications or other products for their children, especially because these medications could alter the effectiveness of traditional medication or could otherwise threaten the child’s health.

Mind/Body Therapies

The power of the mind to heal and bring about well-being has been demonstrated in self-reported quality-of-life measures. Strong evidence in the form of randomized controlled trials is lacking, in part because of the difficulty in devising placebo therapies and because of funding obstacles. Many practices, such as yoga, meditation, and Tai Chi may help children reduce symptoms and bring about a sense of relaxation.

Even young children are under a great deal of stress. Family and economic issues, the daily stresses of homework, chores, and being involved in every activity, can affect children deeply. Deep breathing and yoga are two of the more common mind/body therapies used by children, according to a national survey. Yoga emphasizes a healthy spine for a healthy body and incorporates deep-breathing exercises. Different poses and movements involving twisting and balancing are believed to stimulate the nerves along the spine and promote circulation and the flow of energy. Many professional athletes practice some form of yoga for increased flexibility, and yoga is often incorporated into cross-training exercise routines. Yoga practitioners claim that yoga can help children develop a good body- and self-image, self-control, flexibility, and body awareness. Children with ADD, ADHD, and oppositional defiant disorder (ODD) may also benefit from yoga poses, which can help instill a sense of calm and centeredness. Simple deep-breathing is a good coping strategy for children who feel overwhelmed or stressed.

Manipulative Therapies

After herbal products, chiropractic/osteopathic care is the second most commonly used complementary and alternative therapy. Pediatric conditions that are often treated by chiropractors and osteopaths include earache, asthma, allergies, colic, bed-wetting, sinus disorders, migraines, and muscle pain.

Chiropractic care is founded on the belief that adjustments to the spinal vertebrae (or other parts of the body) free the nerves from compression and maximize the body’s ability to heal itself and feel well. There are several chiropractic techniques, including diversified, activator, and sacrooccipital, to promote adjustments of the body and spine. Imaging studies are common in chiropractic care. In one study, chiropractors reported performing fewer imaging studies on children and charging less for pediatric visits. Chiropractors may also recommend herbal remedies or dietary supplements. There is scant research evidence to support or reject its effectiveness, especially in children.

Similarly, osteopathic care is centered on touch therapy. Osteopaths manipulate muscles and joints by stretching, adding resistance and gentle pressure. It is thought that these movements help diagnose, treat, and prevent injury.

Experts stress that natural therapies should be used in addition to the care children receive from their pediatrician or mainstream practitioner. The physician should also be involved in the process to determine whether there is a rick of interactions with a child's other medications.

Bibliography

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