Dietary supplement use is prevalent among children with a chronic illness

Herbal Supplement Use Among Adolescent and Young Adult Women in a Family Planning Clinic

STUDY OBJECTIVE

We aimed to evaluate herbal medicine and supplement use patterns among adolescent and young adult women at a clinic focused on family planning.

METHODS

We conducted a cross-sectional survey of patients (age 14-25) at an adolescent Title X clinic. Participants completed an electronic survey that assessed herbal medicine and supplement use, baseline demographic characteristics, and current contraceptive method. We evaluated supplement-drug interactions using the Natural Medicines database Interaction Checker. Quantitative analyses were performed using χ2 and independent medians tests.

RESULTS

We enrolled 99 participants with a median age of 20 (15-24) years. Overall, 42.4% of patients reported ever having used supplements or herbal medicines, with 29.9% of patients reporting current supplement or herbal medicine use. Patients with higher education and private insurance were more likely to report a history of and current supplement use (P < .05). The most common herbal supplements reported were green tea (n = 26), cannabidiol (n = 17), and cranberry (n = 16), with 29.6% of participants reporting use to their general health care provider. The most common reasons for use were general health and wellness (29.1%), immune support (23.2%), stress (16.8%), and menstrual irregularities (6.0%). We found 62 moderate risk supplement-drug interactions, with 50 interactions attributed to hormonal contraceptive therapies. The most common interactions were via cytochrome P450 enzyme (CYP3A4 or CYP1A2) inhibition, decreased caffeine clearance, and potential hepatotoxicity.

CONCLUSION

Adolescent and young adult women frequently reported past and current herbal medicine and supplement use, with high rates of moderate-risk supplement-drug interactions. Further research is needed to better elucidate these clinically relevant supplement-contraception interactions.

Dietary Supplements among Children Ages 0-3 Years in Poland-Are They Necessary?

(1) Background: One of the ways to prevent nutritional deficiencies may be supplementation. Experts have observed the increased use of dietary supplements, not only in adults but also in children. Considering controversies among dietary supplements and possible errors in children's feeding, the goal of our research was to evaluate use and reasons behind supplementation in terms of children's diet analysis. (2) Methods: Our research involved 507 legal guardians of the youngest children (up to 3 years of age) and was conducted via a questionnaire. (3) Results: 79% of all children received dietary supplements. The analysis of children's diets showed a need to implement omega-3 acids and vitamin D supplementation, which was very low in children. On the other hand, vitamin C, vitamin B, vitamin A, and copper levels were extremely high. (4) Conclusions: Popularity of dietary supplements in Polish children aged 0-3 years old is an omnipresent issue. Although the reasoning behind administering nutritional supplements to children seems justified, considering the supply of vitamin D and omega-3 fatty acids, it seems justified to increase parents' knowledge in this regard in terms of the use and means to choose the best supplement possible, as dietary supplementation should always be tailored to individual needs.

Complementary and Alternative Medicine Use Among Pediatric Emergency Department Patients in Singapore

OBJECTIVE

The aim of the study was to determine the prevalence and types of complementary and alternative medicine (CAM) use among pediatric emergency department (ED) patients and perceptions of CAM among the caregivers who administer CAM in Singapore.

METHODS

A survey was administered in a Singapore ED (June 2016-June 2017). A convenience sample of parents/carers accompanying pediatric patients completed a self-administered questionnaire. The primary outcome measures were prevalence of CAM use and perceptions of CAM.

RESULTS

Parents/carers of 610 patients participated. Four hundred seventy-five (78.0%, 95% confidence interval, 74.5-81.0) had taken a CAM within the previous 12 months and 110 (18.1%; 95% confidence interval, 14.8-21.0) had taken a CAM on the day of presentation. There were no sex differences between CAM users and nonusers (P = 0.691). The use of CAM was more common among preschool children and younger (62.9%). There was no difference in CAM use among those with and without chronic disease (P = 0.878). Vitamins/supplements, cod liver oil, and probiotics were the most commonly used CAM. A total of 0.7% of CAM use was reported to the ED doctor. There were no adverse effects reported. The perception that CAMs are safe was more common among parents or caregivers who had administered CAM (P = 0.008).

CONCLUSIONS

Complementary and alternative medicine use is very common among pediatric ED patients in Singapore and is more prevalent than in Australia and the United Kingdom. However, it is not always reported to the doctor. Parents or caregivers who administer CAM are more likely to perceive CAMs to be safe.

Prevalence of the Use of Herbal Medicines among Patients with Cancer: A Systematic Review and Meta-Analysis

Background

Although herbal medicines are used by patients with cancer in multiple oncology care settings, the magnitude of herbal medicine use in this context remains unclear. The purpose of this review was to establish the prevalence of herbal medicine use among patients with cancer, across various geographical settings and patient characteristics (age and gender categories).

Methods

Electronic databases that were searched for data published, from January 2000 to January 2020, were Medline (PubMed), Google Scholar, Embase, and African Index Medicus. Eligible studies reporting prevalence estimates of herbal medicine use amongst cancer patients were pooled using random-effects meta-analyses. Studies were grouped by World Bank region and income groups. Subgroup and meta-regression analyses were performed to explore source of heterogeneity.

Results

In total, 155 studies with data for 809,065 participants (53.95% female) met the inclusion criteria. Overall, the pooled prevalence of the use of herbal medicine among patients with cancer was 22% (95% confidence interval (CI): 18%–25%), with the highest prevalence estimates for Africa (40%, 95% CI: 23%–58%) and Asia (28%, 95% CI: 21%–35%). The pooled prevalence estimate was higher across low- and middle-income countries (32%, 95% CI: 23%–42%) and lower across high-income countries (17%, 95% CI: 14%–21%). Higher pooled prevalence estimates were found for adult patients with cancer (22%, 95% CI: 19%–26%) compared with children with cancer (18%, 95% CI: 11%–27%) and for female patients (27%, 95% CI: 19%–35%) compared with males (17%, 95% CI: 1%–47%).

Conclusion

Herbal medicine is used by a large percentage of patients with cancer use. The findings of this review highlight the need for herbal medicine to be integrated in cancer care.

Children's, parents', and other stakeholders' perspectives on the factors influencing the initiation of early dietary change in the management of childhood chronic disease: a mixed studies systematic review using a narrative synthesis

BACKGROUND

Early dietary change can provide vital medical benefits supporting childhood chronic disease self-management.

OBJECTIVE

To explore factors influencing the initiation of early dietary change in the management of childhood chronic disease, as described by children, parents', and other stakeholders, to inform practice change in early paediatric service delivery.

METHODS

This systematic review crossed seven databases from 2000-2018 to identify empirical research (qualitative, quantitative, and mixed-method designs), including grey literature. Methodological quality was appraised using validated scoring systems.

RESULTS

Six studies met our criteria for inclusion in the review. Four themes of early dietary change emerged from these studies: (1) the role of education; (2) parents/caregivers' roles; (3) the role of self-management, and the (4) identification of enablers and barriers to dietary change.

CONCLUSION

Obtaining the perspectives of children, parents' and other stakeholders' on factors influencing early dietary change is key to the self-management of childhood chronic disease.

PRACTICE IMPLICATIONS

Early dietary change provides an essential resource in the self-management of many chronic diseases. In collaboration, children, parents' and healthcare professionals recognise the value of regular, engaging education, supported by workshops to empower and upskill, enabling change in everyday dietary habits, while using enablers and recognising challenges.

Dietary supplement use in Korean children and adolescents, KNHANES 2015-2017

OBJECTIVE

To date, there have been few studies on dietary supplement (DS) use in Korean children and adolescents, using nationally representative data. This study aimed to investigate the current status of DS use and its related factors, among Korean children and adolescents from the Korean National Health and Nutrition Examination Survey (KNHANES) data.

DESIGN

A cross-sectional study.

SETTING

Data from the KNHANES 2015-2017. Participants completed 24-h dietary recall interviews, including DS products that the subjects consumed.

PARTICIPANTS

The study population was 4380 children and adolescents aged 1-18 years.

RESULTS

Approximately 20.3 % of children and adolescents were using DS; the highest use was among children aged 1–3 years old, and the lowest use was among adolescents aged 16–18 years. The most frequently used DS was prebiotics/probiotics, followed by multivitamin/mineral supplements. Factors that were associated with DS use were lower birth weight in children aged <4 years; younger age, higher household income, regular breakfast intake and lower BMI in children aged 4-9 years; and regular breakfast intake and use of nutrition facts label in adolescents aged 10-18 years. Feeding patterns in infancy and having chronic diseases were not associated with DS use.

CONCLUSIONS

We report that over 20 % of children and adolescents use DS. Nutritional education for parents and children about proper DS consumption is needed.

An integrative review on the information and communication needs of parents of children with cancer regarding the use of complementary and alternative medicine

Background

Parents often choose Complementary and Alternative Medicine (CAM) as a supportive agent with the aim to reduce cancer treatment-related symptoms in their children. Therefore, it is necessary to understand parents´ information and communication needs regarding CAM. The aim of the present study was to review the research literature as to identify the information and communication needs of parents of children with cancer, and the children themselves, regarding the use of CAM.

Methods

An integrative systematic review design was chosen. Searches were performed in AMED, CAMbase, CINAHL (Ebsco), EMBASE, PubMed and PsycInfo, Theme eJournals and Karger. The search was limited to studies published in English, German, Dutch, and the Scandinavian languages. Using predefined inclusion and exclusion criteria, two reviewers independently screened the title and abstracts of the relevant papers. A data extraction form and critical appraisal checklists were used to extract data for analysis, and a mixed methods synthesis was applied.

Results

Out of 24 studies included, 67% were of quantitative and 33% of qualitative study design. Five main themes emerged from the analysis of 21 studies: Information on CAM, sources of CAM information, communication about CAM, informed decision-making on CAM, and Risk/benefit of CAM. The majority of the parents did not disclose the CAM use of their children because they feared negative reactions from the attending oncologist. To make informed treatment decisions for their children, parents wanted unbiased information about CAM and would act accordingly. They demand open communication about these modalities and respect for the family’s autonomy when choosing CAM for their children.

Conclusion

There is an urgent need for parents of children with cancer for high quality information on CAM from reliable and scientific sources. Development of authoritative evidence-based decision tools is thus warranted to enable health care professionals and parents of children with cancer to make well informed, individual decisions concerning CAM.

Natural Health Product-Drug Interaction Causality Assessment in Pediatric Adverse Event Reports Associated with Attention-Deficit/Hyperactivity Disorder Medication

Background: Some pediatric patients with attention-deficit/hyperactivity disorder (ADHD) use natural health products (NHPs) such as herbal remedies. Although herbal remedies are generally considered to be safe when they are used appropriately, they may contain active components that can interact with medications being used concurrently, with potential for NHP-drug interactions leading to adverse events. Objectives: The objectives of this study were (1) to identify adverse event reports (AERs) involving commonly used herbal remedies and ADHD prescription medicines in children and adolescents; (2) to evaluate the quality of collected AERs; and (3) to assess whether NHP-drug interactions can be causally linked to reported adverse events. Methods: We systematically searched the FDAble database (FDAble.com) for herbal remedies commonly used by patients (4-18 years old) also taking ADHD drugs from 1997 to 2015. We assessed the completeness of the AERs and used three causality assessment tools modified for NHPs (Naranjo Adverse Drug Reaction Probability Scale, HORN Drug Interaction Probability Scale, and World Health Organization Uppsala Monitoring Centre Scale). Results: Of the 23 identified AERs involving both an herbal remedy and an ADHD prescription medication, most involved multiple (>3) substances with inadequate detail to assess multiple potential interactions. Following data extraction and evaluation of completeness, five AERs involving only one herbal remedy and one ADHD medication were evaluated for causality. An NHP-drug interaction was assessed to be probable in one case and to be possible in another. Both these reports involved a methylphenidate formulation and St. John's wort. Conclusions: Eighteen of the 23 identified AERs involving both an herbal remedy and an ADHD drug also involved other multiple ingredient products. The reporting quality was poor for the five AERs examined. Further research is needed to study the interaction between St. John's wort and methylphenidate.

Determinants of taking dietary supplements in Iranian children and adolescents: the CASPIAN-V study

Aim

Tendency for taking dietary supplements is dramatically increasing. However, limited studies exist in this regard. We aimed to assess the frequency and determinants of dietary supplement use among a nationally-representative sample of Iranian children and adolescents.

Methods

This population-based cross-sectional study (the CASPIAN V) was conducted in students aged 7 to 18 years old in 2015. Multistage, stratified cluster sampling method was used to select participants from thirty provinces in Iran. Data regarding taking vitamin and mineral supplements were collected. Demographic information, anthropometric indices, physical activity, screen time and body image were also evaluated. Multivariate logistic regression model was used for analyses.

Results

The prevalence of dietary supplements use was 34.1% and the most popular dietary supplement was Iron (12.9%). Multivariate logistic regression showed that boys (0.84, 95%CI: 0.78, 0.91) and body image perception (OR: 0.84, 95%CI: 0.75, 0.94) used less dietary supplements compared to others. Children aged 11 to 14 years (OR: 1.15, 95%CI: 1.06, 1.26) and those with moderate family socioeconomic status (OR: 1.12, 95%CI: 1.007, 1.25) used more supplement compared to other groups. Moreover, those with higher paternal educational level (OR: 0.77, 95%CI: 0.64, 0.93) used less supplements. However, living area, family size, paternal occupation, children BMI, Intended weight loss, and body image by student did not indicate any significant association.

Conclusion

Our findings indicated that about one-third of Iranian children and adolescents used dietary supplements; iron supplements were the most frequent ones. Children aged 11 to 14 years, those with higher educated mothers and moderate family socioeconomic status used more supplements compared to others. However, boys, children with excess weight and those with high-educated parents used less supplements compared to others. More studies are needed to clarify the efficacy and safety of dietary supplements in different age groups in various societies.

Food Fortification and Supplement Use-Are There Health Implications?

Dietary supplements are a multi-billion dollar industry in the U.S., and their use is increasing exponentially. Additionally, many foods and beverages are increasingly being fortified with single or multiple vitamins and minerals. Consequently, nutrient intakes are exceeding the safe limits established by the Institute of Medicine. In this paper, we examine the benefits and drawbacks of vitamin and mineral supplements and increasing consumption of fortified foods (in addition to dietary intake) in the U.S.

POPULATION

The pros and cons are illustrated using population estimates of folic acid, calcium, and vitamin D intake, highlighting concerns related to overconsumption of nutrients that should be addressed by regulatory agencies.

Complementary and alternative medicine among hospitalized pediatric patients

OBJECTIVES

To estimate the prevalence and describe the characteristics of complementary and alternative medicine (CAM) use among hospitalized children, and to discover the awareness of medical staff regarding CAM use.

DESIGN/SETTING

Parents of children aged 0-18 years admitted to the Pediatric Division at Assaf Harofeh Medical Center in Israel between January and July of 2015 (n=146) were provided a questionnaire regarding socio-economic status and evaluating the CAM use. The medical charts of the participants were reviewed in order to establish whether or not CAM use was documented.

RESULTS

Of those who completed the questionnaire, 78 (54.3%) were using CAM. The major indications for CAM use were colic and teething. CAM use was advised by the family in 44.9%, physician 34.6%, pharmacist 34.6%, friends 30.8%, previous experience 23.1, advertisements 18%, nurses 6.4%, and homeopaths 2.6%. The family physician was aware of CAM use was in 42%. During the admission, only 5 patients were asked about CAM use (3.4%) by the medical staff. Reviewing the medical charts revealed there was no documentation of CAM use in any of the participants. Socio-demographic analysis of our population revealed no differences between users and non users of CAM, but significant differences in belief in CAM (p=0.018) were found. CAM use was age related; the older the child the less the use (p=0.010).

CONCLUSION

CAM use is common among hospitalized pediatric patients and is often overlooked by the medical staff. CAM use should be included in the medical history.

The Feasibility of Developing an Inpatient Acupuncture Program at a Tertiary Care Pediatric Hospital

OBJECTIVES

Use of complementary and integrative health approaches has increased significantly in recent decades, with hospital-based acupuncture programs becoming more common. This article presents the feasibility of developing an inpatient acupuncture program at a pediatric hospital.

DESIGN AND SETTING

In January 2014, Seattle Children's Hospital, a tertiary care pediatric hospital serving patients from a five-state region, began a 6-month pilot project offering inpatient acupuncture. During the pilot, inpatient acupuncture and related manual therapies were provided to pediatric patients age 0-23 years who were admitted to Seattle Children's Hospital or were seen for an outpatient surgical procedure.

MEASURES

The following data were collected: the reason for the acupuncture consult, type and number of treatments provided, any reported response to treatment, and any reported adverse events. Patients and referring providers gave feedback via questionnaires.

RESULTS

During the pilot program, 338 treatments were provided to 87 patients. High interest, demand, and positive feedback from hospital providers, patients, and families led to the development of a full-time inpatient acupuncture program.

CONCLUSIONS

The positive response to Seattle Children's inpatient acupuncture program with feasibility and acceptability demonstrated by increasing consults and patient and provider questionnaire data suggest that similar programs may be of interest to other pediatric hospitals.

Complementary and alternative medicine use among paediatric emergency department patients

AIM

To determine the period prevalence and nature of complementary and alternative medicine (CAM) use among paediatric emergency department (ED) patients and the perceptions of CAM among the CAM administrators.

METHODS

A survey was undertaken in four Victorian EDs (January to September 2013). A convenience sample of parents/carers accompanying paediatric patients completed a self-administered questionnaire. The main outcome measures were CAM use and perceptions of CAM.

RESULTS

The parents/carers of 883 patients participated. Three hundred eighty-eight (43.9%, 95% confidence interval (CI) 40.6-47.3) and 53 (6.0%, 95% CI 4.6-7.8) patients had taken a CAM within the previous 12 months and on the day of presentation, respectively. There were no gender differences between CAM users and non-users (P = 0.83). The use of CAM was significantly more common among older patients (P < 0.001), those with European ethnicity (P = 0.046) and among those with chronic disease (P < 0.01). Fish oil, garlic, chamomile and acidophilus were the most commonly used CAM. Only 4.4% of CAM use was reported to the ED doctor. There were reports of potentially dangerous CAM use (St John's wort, ginseng). Parents/carers who had administered CAM were more likely to report that CAMs are safe, drug free and could prevent illness (P < 0.01). In addition, a number of this group reported that CAMs are more effective than prescription medicines and safe when taken with prescription medicines.

CONCLUSION

CAM use is common among paediatric ED patients although rarely reported to the ED doctor. Parents/carers who administer CAM have differing perceptions of CAM safety from those who do not.

Complementary and alternative medicine in pulmonology

PURPOSE OF REVIEW

To provide a comprehensive review of complementary and alternative medicine (CAM) therapies for the treatment of pulmonary disorders in children.

RECENT FINDINGS

The use of complementary medicine (CAM) is commonly used by both children and adults with breathing problems, and especially in chronic pulmonary disorders such as asthma and cystic fibrosis. Many clinics and hospitals now offer CAM, even though most of the conventionally trained health practitioners have little knowledge or education regarding CAM therapies. Research in CAM that demonstrates overall benefit is lacking, especially in children. Often parents do not report CAM use to their child's healthcare provider and this could compromise their overall quality of care. Although many research studies evaluating CAM therapies have methodological flaws, data exist to support CAM therapies in treating children with pulmonary disorders.

SUMMARY

This review examines the latest evidence of CAM use and effectiveness in children with pulmonary disorders. Physicians should be aware of the many CAM therapy options and the research surrounding them in order to provide their patients with the most current and accurate information available.

An overview of integrative therapies in asthma treatment

Treatment of asthma lends itself to an integrative medicine approach due to the multifactorial nature of the disease. It is well established that asthma has a neuromuscular component (bronchospasm), an immunological component (inflammation), and a psychological component. This encourages the use of diverse approaches to address all avenues of pathophysiology, aiming for the most effective blend of treatment approaches possible. Integrative medicine is defined by NIH NCCAM ( http://nccam.nih.gov ) as medicine that blends the use of evidence-based complementary therapies with conventional medicine. Statistics from the 2007 National Health Interview Survey (NHIS), conducted by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS), showed that approximately four out of 10 adults and approximately one in nine children and more than 50 % of children living with chronic illness, including asthma, used complementary therapies in the USA in 2007. Asthma and allergies rank among the top 15 most common medical conditions in which integrative therapies are used in both children and adults. To date, integrative treatment approaches with some evidence for benefit in asthma treatment include the following: nutrition modification, mind-body medicine, physical activity, and certain dietary supplement interventions.

Patterns of utilization of complementary and alternative medicine in 2 pediatric gastroenterology clinics

OBJECTIVES

The aim of the present study was to assess the prevalence and patterns of complementary and alternative medicine (CAM) use among pediatric patients with gastrointestinal (GI) disorders at academic clinics in Canada.

METHODS

The survey was carried out at 2 hospital-based gastroenterology clinics: the Stollery Children's Hospital in Edmonton and the Children's Hospital of Eastern Ontario (CHEO) in Ottawa.

RESULTS

CAM use at the Stollery was 83% compared with 36% at CHEO (P < 0.001). The most common reason for not using CAM was lack of knowledge about it. Most respondents felt comfortable discussing CAM in their clinic and wanted more information on CAM. The most common CAM products being taken were multivitamins (91%), calcium (35%), vitamin C (32%), probiotics (14%), and fish oil/omega-3 fatty acids (13%). The most common CAM practices being used were massage (43%), chiropractic (27%), faith healing (25%), and relaxation (18%). Most respondents believed that CAM was helpful, and most of the 23 reported adverse effects were minor. Seven were reported as moderate, and 3 were reported as severe. Many (42%) patients used CAM at the same time as prescription medicines, and of these patients, concurrent use was discussed with their physician (76%) or pharmacist (52%).

CONCLUSIONS

CAM use is high among pediatric patients with GI disorders and is much greater among those in Edmonton than in Ottawa. Most respondents reported their CAM use as helpful, with little or no associated harm. Many patients fail to disclose their concurrent use of CAM and conventional medicines to their doctors, increasing the likelihood of interactions.

The status of dietary supplements intake in korean preschool children: data from the Korea national health and nutrition examination survey 2010-2012

PURPOSE

The use of dietary supplements (DS) has increased in most nations. We investigated the amount of DS intake in the Korean population by analyzing a national survey, to support the preparation of a national institutional strategy regarding DS intake and marketing.

METHODS

The data of the fifth Korea National Health and Nutrition Examination Survey (a year between 2010 and 2012) were investigated, analyzing the rate of DS intake, and the characteristics of the intake group and non-intake group in Korean preschool children.

RESULTS

The intake rate of DS was 49.0-54.2% (1,313,874-1,491,240) and 19.6-30.3% (250,603-421,922) in children from 1 to 6 years old and in those less than 1 year, respectively, from 2010 to 2012. The highest intake rate was observed in the age group of five. The mean age was significantly higher in the DS intake group than in the non-intake group. Intake of essential nutrients, minerals, and vitamins were also higher in the DS intake group. The level of family income was significantly associated with the intake rate (p<0.001). In children less than 1 year, probiotics accounted for the highest intake of DS.

CONCLUSION

Korean preschool children have high consumption of DS. Therefore, problems may arise from the waste of money purchasing unnecessary DS, and from the overuse of DS in preschoolers who do not require DS intake. We hope these results can be used to produce an appropriate national institutional strategy regarding DS intake and marketing.

CAM use in pediatric neurology: an exploration of concurrent use with conventional medicine

BACKGROUND

Previous studies have found that up to 60% of children with neurologic conditions have tried complementary and alternative medicine (CAM).

OBJECTIVE

To assess the use of CAM among patients presenting to neurology clinics at two academic centers in Canada.

METHODS

A survey instrument was developed to inquire about use of CAM products and therapies, including reasons for use, perceived helpfulness, and concurrent use with conventional medicine, and administered to patients or their parents/guardians at the Stollery Children's Hospital in Edmonton and the Children's Hospital of Eastern Ontario (CHEO) in Ottawa.

RESULTS

Overall CAM use at the Stollery was 78%, compared to 48% at CHEO. The most common CAM products used were multi-vitamins (84%), vitamin C (37%), homeopathic remedies (24%), and fish oil/omega 3 s (22%). The most common CAM practices used were massage (47%), chiropractic (37%), faith healing (18%), aromatherapy (16%), homeopathy (16%), and relaxation (16%). Many patients used CAM products at the same time as conventional medicine but just over half (57%) discussed this concurrent use with their physician.

CONCLUSION

CAM use is common in pediatric neurology patients and most respondents felt that it was helpful, with few or no harms associated. However, this use is often undisclosed, increasing possibility of interactions with conventional drugs. We urge clinicians to inquire about CAM use during routine history taking at every patient visit. Parents would clearly like more information about CAM from their specialty clinics; such information would be easier to share if more primary data were available about the safety and effectiveness of commonly used therapies.

Prevalence and predictors of children's dietary supplement use: the 2007 National Health Interview Survey

BACKGROUND

Little is known about the characteristics of US children who are dietary supplement users.

OBJECTIVE

We described the prevalence and predictors of and reasons for giving children dietary supplements.

DESIGN

The study included children <18 y of age who participated in the Complementary and Alternative Medicine supplement of the National Health Interview Survey of 2007 whose proxies provided complete information on child dietary supplement use.

RESULTS

A total of 37% of subjects used dietary supplements, 31% of subjects used multivitamin mineral (MVM) products exclusively, 4% of subjects used single vitamins or minerals solely or in combination with MVMs, and 2% of subjects used nonvitamin, nonmineral products either solely or in combination with other supplements. Users were more likely than nonusers to be Asian, white, or non-Hispanic; belong to families with higher parental education and income levels; reside in areas other than the South; be in good, very good, or excellent health; have private health insurance; and have a usual place at which they received conventional medical care. Children (3%) with the most disease burden and health care were more likely to use supplements than were healthier children. Supplements were given for the prevention or treatment of many illnesses and conditions. Neither the caregiver's reasons nor specific supplements used were consistently associated with particular conditions.

CONCLUSIONS

The 37% of US children who used any type of dietary supplements differed from nonusers in family socioeconomic status and many other health-related characteristics. Users were given supplements to prevent or treat many illnesses and conditions for which there is only limited evidence of their efficacy.

Use of complementary and alternative medicine among children, adolescent, and young adult cancer survivors: a survey study

PURPOSE

The main objective of this study was to investigate the prevalence of complementary and alternative medicine (CAM) use, types and reasons for use, and determinants of use among survivors of childhood cancer.

METHODS

An interviewer-based survey of CAM use was administered to 197 survivors or their guardians. Demographic data, CAM therapies used, purpose and referral for use, and communication about use was collected.

RESULTS

A total of 115 (58%) survivors reported using CAM in survivorship, 72% of which used biologically based therapies. The majority of therapies were used for relaxation and stress management (15%), referred for use by the parent (25%), reported as very effective (62%), and initiated 0 to 4 years after completion of cancer treatment (41%). Among CAM users, young adults used manipulative and body-based therapies [odds ratio (OR)=3.3; 95% confidence interval (CI), 1.4-7.8] and mind-body therapies (OR=2.8, 95% CI: 1.2-6.4) more than children. Use of mind-body therapies was associated with not attending religious services regularly (OR=2.4; P<0.01). Half (51%) of all CAM therapies were disclosed to the physician.

CONCLUSIONS

Survivors of childhood cancer frequently use CAM for health promotion and mitigation of physical and psychological conditions. Clinicians should consider the role of CAM in the adoption of healthy lifestyles among this population.

Complementary and alternative medicine use by pediatric specialty outpatients

OBJECTIVE

Complementary and alternative medicine (CAM) use is high among children and youth with chronic illnesses. The objective of this study was to assess the prevalence and patterns of CAM use in 10 subspecialty clinics in Canada and to compare CAM use between 2 geographically diverse locations.

METHODS

This survey was carried out at 1 Children's Hospital in western Canada (Edmonton) and 1 Children's Hospital in central Canada (Ottawa). Questionnaires were completed by parents in either French or English.

RESULTS

Although demographic characteristics of the 2 populations were similar, CAM use at the western hospital was 71% (n = 704) compared with 42% (n = 222) at the central hospital (P < .0001). Most respondents agreed or strongly agreed that they feel comfortable discussing CAM in their clinic. The most common CAM products currently used were multivitamins/minerals, herbal products, and homeopathic remedies. The most common CAM practices currently used were massage, chiropractic, relaxation, and aromatherapy. Eighty adverse effects were reported, and 55 (68.8%) of these were self-assessed as minor.

CONCLUSIONS

Results of this study indicate that CAM use is high among pediatric specialty clinic outpatients and is much greater in the western than in the central hospital. Most respondents felt that their CAM use was helpful with few or no harms associated. Many patients, using CAM alongside their conventional medicines, are still not discussing their CAM use with their physicians and are increasing the likelihood for potential interactions and preventable harms.

Association of age and family history with supplement use in pediatric patients with allergy

This study was conducted to determine the frequency and characteristics of supplement use in pediatric patients with allergic disorders in Japan. A total of 229 patients with various allergic disorders aged between 0 and 15 years were enrolled. Supplements were defined as preparations that provided nutritional content in the form of a tablet, capsule, powder, liquid, or jelly. The parents of each subject were asked to complete a questionnaire on their child's use of supplements over the previous year. Demographic information, parents' perceived view of the child's health status over the previous month, and family history of both allergic disorders, and supplement use were collected. Four hundred eight age- and sex-matched healthy children served as the controls. Twenty-nine (12.7%) patients had used supplements. This frequency was not significantly different from that in the control group (15.0%). The types of supplements most commonly used were vitamins, followed by minerals, probiotics, and chlorella. Univariate analysis revealed that older age and a positive family history of supplement use were associated with patients' supplement use. The types of allergic disorders, health status from the point of view of the parents, and a family history of allergic disorders did not show any significant association. To our knowledge, this is the first cross-sectional study to demonstrate the frequency and the factors affecting supplement use in pediatric patients with allergic disorders.

Nutrient intake from food in children with autism

OBJECTIVE

The impact of abnormal feeding behaviors reported for children with autism spectrum disorders (ASDs) on their nutritional status is unknown. We compared nutrient intake from food consumed by children with and without ASD and examined nutrient deficiency and excess.

METHODS

Prospective 3-day food records and BMI for children (2-11 years) with ASD participating in the Autism Treatment Network (Arkansas, Cincinnati, Colorado, Pittsburgh, and Rochester) were compared with both the National Health and Nutrition Examination Survey data and a matched subset based on age, gender, family income, and race/ethnicity (N = 252 analyzed food records).

RESULTS

Children with ASD and matched controls consumed similar amounts of nutrients from food. Only children with ASD aged 4 to 8 years consumed significantly less energy, vitamins A and C, and the mineral Zn; and those 9 to 11 years consumed less phosphorous. A greater percentage of children with ASD met recommendations for vitamins K and E. Few children in either group met the recommended intakes for fiber, choline, calcium, vitamin D, vitamin K, and potassium. Specific age groups consumed excessive amounts of sodium, folate, manganese, zinc, vitamin A (retinol), selenium, and copper. No differences were observed in nutritional sufficiency of children given restricted diets. Children aged 2 to 5 years with ASD had more overweight and obesity, and children 5 to 11 years had more underweight.

CONCLUSIONS

Children with ASD, like other children in America, consume less than the recommended amounts of certain nutrients from food. Primary care for all children should include nutritional surveillance and attention to BMI.

Pediatric integrative medicine: pediatrics' newest subspecialty?

BACKGROUND

Integrative medicine is defined as relationship-centered care that focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing, including evidence-based complementary and alternative medicine. Pediatric integrative medicine (PIM) develops and promotes this approach within the field of pediatrics. We conducted a survey to identify and describe PIM programs within academic children's hospitals across North America. Key barriers and opportunities were identified for the growth and development of academic PIM initiatives in the US and Canada.

METHODS

Academic PIM programs were identified by email and eligible for inclusion if they had each of educational, clinical, and research activities. Program directors were interviewed by telephone regarding their clinical, research, educational, and operational aspects.

RESULTS

Sixteen programs were included. Most (75%) programs provided both inpatient and outpatient services. Seven programs operated with less than 1 FTE clinical personnel. Credentialing of complementary and alternative medicine (CAM) providers varied substantially across the programs and between inpatient and outpatient services. Almost all (94%) programs offered educational opportunities for residents in pediatrics and/or family medicine. One fifth (20%) of the educational programs were mandatory for medical students. Research was conducted in a range of topics, but half of the programs reported lack of research funding and/or time. Thirty-one percent of the programs relied on fee-for-service income.

CONCLUSIONS

Pediatric integrative medicine is emerging as a new subspecialty to better help address 21st century patient concerns.

Complementary and alternative medicine in children attending gastroenterology clinics: usage patterns and reasons for use

BACKGROUND

The use of complementary and alternative medicines (CAM) appears to be increasing. This cross-sectional study aimed to assess the use of CAM in children, investigate factors influencing their use and attitudes towards them and to contrast to previous usage patterns.

METHODS

Parents of children attending gastroenterology outpatient clinics at a tertiary paediatric hospital completed a questionnaire providing details of CAM usage, awareness and attitudes.

RESULTS

Sixty-nine percent of the 98 respondents were using or had used CAM (n= 66). Nutritional supplements (n= 37, 56% of CAM users) and probiotics (n= 33, 50%) were most commonly used. Most CAM users sought complementary therapy to help a chronic problem (n= 43, 69.4%) and had been referred by a friend or family member (n= 33, 53.2%). Self-reported well-being was associated with CAM use (P= 0.0009) and CAM were described as partially effective by 40 parents (67.8%). Forty-six parents (75.4%) expressed that they would use CAM again. Seventy-two respondents (80%) believed that doctors should support the use of CAM.

CONCLUSION

Children attending this gastroenterology clinic are commonly given CAM. Awareness and acceptance of CAM by carers of children with gastroenterology conditions is high.

Natural health product-drug interactions: evolving responsibilities to take complementary and alternative medicine into account

Natural health products (NHPs) (known as dietary supplements in the United States) are a popular form of self-care, yet many patients do not disclose their use to clinicians. NHP-drug interactions are known to occur and can harm patients and affect the efficacy of conventional treatment. Using the example of an HIV-positive adolescent who had been responding well to antiretroviral therapy but then experienced a sudden unexplained deterioration in her condition, we review (1) clinicians' obligation to inquire about complementary and alternative medicine (CAM) use when assessing, treating, and monitoring patients, (2) how clinicians' duty to warn about risks associated with treatment has evolved and expanded, and (3) patients' and parents' responsibility to disclose CAM use. It also addresses the responsibility of hospitals and health facilities to ensure that the reality of widespread CAM/NHP use is taken into account in patient care to effectively protect patients from harm.

Vitamin use among children attending a Canadian pediatric emergency department

Increasing use of vitamins has been documented worldwide in children and adolescents, and potential for vitamin-drug interactions exists. The aim of this study was to identify vitamin use by children visiting a pediatric emergency department (ED). A survey of parents and/or patients 0-18 years was conducted at a large pediatric ED in Canada. A total of 1804 families were interviewed. The main outcome measure was prevalence of vitamin use by children in the preceding 3 months. A third (32.3%) of the patients in our cohort had used vitamins in the preceding 3 months, and 48% of them were taking vitamins daily. Over 8% of all children used vitamins within the last 24 h. The use of vitamins was higher with older patient and parental age (P<0.001), chronic patient illness (P<0.001), completed immunization (P<0.001), concurrent patient use of prescribed medications (P=0.02), higher parental education (P<0.01), and English as a primary language spoken at home (P=0.002). Prevalence of vitamin use among children in the ED is 32% in the preceding 3 months and 8% within the last 24 h. In light of these findings, pediatricians should ask about vitamin use and discuss with parents potential interactions and possible adverse effects.

Complementary and alternative medicine use among pediatric patients with leukemia: the case of Lebanon

BACKGROUND

International evidence indicates that caretakers of pediatric leukemia patients are increasingly using complementary and alternative medicine (CAM) therapies. Such a trend has never been substantiated in the Arab world.

OBJECTIVE

Examine the frequency, types, modes, and reasons of CAM use among pediatric leukemia patients in Lebanon.

METHODS

A cross-sectional design was utilized to survey (by phone) the caregivers of all pediatric leukemia patients on the rosters of the 2 largest cancer treatment facilities in Lebanon for years 2005-2009. A total of 125 parents out of 175 (71.4%) completed the questionnaire, which included 3 sections: socio-demographic characteristics, clinical information and CAM use details. Data analysis employed univariate descriptive statistics, t-test, and χ(2)

RESULTS

Overall, 15.2% of respondents reported using one or more CAM therapies for their child (95% confidence interval: 8.9% to 22.0%). The main CAM therapies used included dietary supplements, prayer/spiritual healing, and unconventional cultural practices (ingesting bone ashes). CAM therapies were used for strengthening immunity (42.1%) and improving the chance of cure (21%). Pediatric users of CAM were 2 years older than nonusers and had been diagnosed with leukemia for a longer period of time (4.76 ± 3.24 vs 3.49 ± 2.38, P<.05). The percentage of males among CAM users was higher than that among nonusers (89.5% vs 56.6%, P<.05).

CONCLUSION

Increasing awareness of both caretakers and physicians of pediatric leukemia patients on the effects and risks of CAM therapies is essential should rational, safe, and evidence-based utilization of CAM therapies be achieved.

Complementary and alternative medicine use and quality of life in pediatric diabetes

OBJECTIVES

The objectives of this study were to explore the association between complementary and alternative medicine (CAM) use as reported by youth, and parents' and children's reported quality of life in youth with diabetes.

DESIGN

The study design was a cross-sectional survey.

SETTING

Youth in Washington State participated in the SEARCH for Diabetes in Youth study, a national, multisite epidemiological study designed to assess the prevalence and incidence of diabetes in U.S. youth. Surveys assessing CAM utilization were mailed in January and April 2006.

PARTICIPANTS

One thousand four hundred and thirty-nine (1439) youth were mailed a CAM survey. The final sample consisted of 467 youth with both CAM survey results and quality-of-life data.

OUTCOME MEASURES

Difference in mean scores on Pediatric Quality of Life Inventory (PedsQL) between CAM users and nonusers overall, and specific CAM therapies were the outcome measures.

RESULTS

Of the 1439 participants approached, 587 (40.8%) returned the CAM survey. In adjusted analyses, children reported any CAM use as associated with more barriers to treatment (difference in mean scores -3.48, 95% confidence interval [CI] -6.65, -0.31). Children following a CAM diet reported higher quality of life (PedsQL Core Total difference 4.01, 95% CI [0.10-7.91]; Core Psychosocial difference was 6.45, 95% CI [1.95 to 10.95]), but those using stress-reduction activities reported poorer quality of life (Diabetes Total difference -4.19, 95% CI [-8.35 to -0.04]). Parent-reported quality of life was lower for children who used "other supplements" (Core Total difference -6.26, 95% CI [-11.29 to -1.24]; Core Psychosocial difference was -5.92, 95% CI [-11.65 to -0.19]).

CONCLUSIONS

CAM diets were associated with increased quality of life in youth with diabetes, whereas supplement use and stress-reduction activities were associated with decreased quality of life. The temporal sequence between CAM use and quality of life requires further study.

Prevalence of complementary medicine use in pediatric cancer: a systematic review

CONTEXT

Complementary and alternative medicine (CAM) is used by pediatric patients with cancer, but the actual frequency of CAM use is undetermined.

OBJECTIVE

In this systematic review we summarize the current evidence on the prevalence of CAM use in pediatric patients with cancer and assess the reported quality of included studies.

METHODS

We systematically searched 6 major electronic databases, reference lists of existing reviews, and personal files. We included full articles about primary research studies (without language restriction) that reported the prevalence of CAM use if all or a defined subsample of participants were pediatric patients with cancer. Detailed information regarding methods and results was extracted from the original articles. A quality-assessment tool was rigorously developed on the basis of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and used to assess reported study quality. Formal tests of interrater agreement were conducted.

RESULTS

We included 28 studies with survey data (collected from 1975 to 2005) from 3526 children. In 20 studies with 2871 participants, the prevalence of any CAM use (since cancer diagnosis) ranged from 6% to 91%; considerable heterogeneity across studies precluded meta-analysis. Study quality was mixed and not correlated with CAM prevalence. Herbal remedies were the most popular CAM modality, followed by diets/nutrition and faith-healing. Commonly reported reasons for CAM use included to help cure or fight the child's cancer, symptomatic relief, and support of ongoing use of conventional therapy. There was little evidence of an association between CAM use and patients' sociodemographic characteristics.

CONCLUSIONS

Many pediatric patients with cancer use CAM. It is important that pediatricians be aware of this fact and encourage open communication with patients and their parents. Using standardized survey methods and CAM definitions in future studies could improve their quality and help generate comparable data. Our quality-assessment tool could prove valuable for other reviews of prevalence studies.

Factors associated with pediatric use of complementary and alternative medicine

BACKGROUND

Limited data are available on the use of complementary and alternative medicine (CAM) and factors associated with use among the pediatric population in the United States.

METHODS

Using the 2007 National Health Interview Survey data among individuals <18 years of age (n = 9417), we compared CAM users (excluding those using vitamins and minerals) and non-CAM users. Using bivariable and multivariable logistic regression models, we examined independent associations of CAM use with sociodemographic factors, prescription medication use, delays in health care caused by access difficulties, and common medical conditions/symptoms.

RESULTS

In an adjusted multivariable logistic model, CAM users were more likely than non-CAM users to be adolescents rather than infants or toddlers (adjusted odds ratio [aOR]: 1.61 [95% confidence interval (CI): 1.11-2.34]); live in the West (aOR: 2.05 [95% CI: 1.62-2.59]), Northeast (aOR: 1.36 [95% CI: 1.02-1.80]), or Midwest (aOR: 1.35 [95% CI: 1.04-1.74]) compared with those in the South; more likely to have a parent with a college education (aOR: 4.33 [95% CI: 2.92-6.42]); and more likely to use prescription medication (aOR: 1.51 [95% CI: 1.19-1.92]). Pediatric CAM users were more likely to have anxiety or stress (aOR: 2.54 [95% CI: 1.89-3.42]), dermatologic conditions (aOR: 1.35 [95% CI: 1.03-1.78]), musculoskeletal conditions (aOR: 1.94 [95% CI: 1.31-2.87]), and sinusitis (aOR: 1.54 [95% CI: 1.11-2.14]). Use of CAM by a parent was strongly associated with the child's use of CAM (aOR: 3.83 [95% CI: 3.04-4.84]).

CONCLUSIONS

In 2007, pediatric CAM users were more likely to take prescription medications, have a parent who used CAM, and have chronic conditions such as anxiety or stress, musculoskeletal conditions, dermatologic conditions, or sinusitis. Research is required to guide pediatricians in making recommendations on CAM modalities for children including potential risks and/or benefits and interactions with conventional therapies.

Medication use among children <12 years of age in the United States: results from the Slone Survey

OBJECTIVES

Using data from the Slone Survey, we sought to define the prevalence of over-the-counter and prescription medication use among US children <12 years of age and to determine the prevalence and patterns of use of the most commonly used medications.

METHODS

The Slone Survey was a random-digit-dial telephone survey of medication use in the previous 7 days for a representative sample of the US population. Between February 1998 and April 2007, we enrolled 2857 children 0 to 11 years of age from the 48 contiguous US states.

RESULTS

The survey response rate was 61%. Overall, 56% of children had used >or=1 medication product in the 7 days preceding the interview, with 15%, 7.1%, 3.1%, and 1.9% taking 2, 3, 4, and >or=5 medications, respectively, during that time period. Twenty percent of children took >or=1 prescription-only medications, but <6% used >or=2 prescription-only drugs within a given week. Fewer than 0.5% of children were reported to have used any particular herbal product. The most commonly used over-the-counter medication products were acetaminophen alone, multivitamins, and ibuprofen alone. The most commonly used prescription-only medications across all age groups were amoxicillin, albuterol, and multivitamins with fluoride. The most commonly consumed active ingredients (excluding vitamins) were acetaminophen, iron, ibuprofen, and various cough/cold ingredients (pseudoephedrine, dextromethorphan, and various first-generation antihistamines).

CONCLUSIONS

The majority of US children <12 years of age use >or=1 medication product in a given week. The preponderance of pediatric medication exposure involves over-the-counter products.

At the bottom of the differential diagnosis list: unusual causes of pediatric hypertension

Hypertension affects 1-5% of children and adolescents, and the incidence has been increasing in association with obesity. However, secondary causes of hypertension such as renal parenchymal diseases, congenital abnormalities and renovascular disorders still remain the leading cause of pediatric hypertension, particularly in children under 12 years old. Other less common causes of hypertension in children and adolescents, including immobilization, burns, illicit and prescription drugs, dietary supplements, genetic disorders, and tumors will be addressed in this review.

American Academy of Pediatrics. The use of complementary and alternative medicine in pediatrics

The American Academy of Pediatrics is dedicated to optimizing the well-being of children and advancing family-centered health care. Related to these goals, the American Academy of Pediatrics recognizes the increasing use of complementary and alternative medicine in children and, as a result, the need to provide information and support for pediatricians. From 2000 to 2002, the American Academy of Pediatrics convened and charged the Task Force on Complementary and Alternative Medicine to address issues related to the use of complementary and alternative medicine in children and to develop resources to educate physicians, patients, and families. One of these resources is this report describing complementary and alternative medicine services, current levels of utilization and financial expenditures, and associated legal and ethical considerations. The subject of complementary and alternative medicine is large and diverse, and consequently, an in-depth discussion of each method of complementary and alternative medicine is beyond the scope of this report. Instead, this report will define terms; describe epidemiology; outline common types of complementary and alternative medicine therapies; review medicolegal, ethical, and research implications; review education and training for complementary and alternative medicine providers; provide resources for learning more about complementary and alternative medicine; and suggest communication strategies to use when discussing complementary and alternative medicine with patients and families.

Dietary supplements: inpatient policies in US children's hospitals

BACKGROUND

Variations in hospital policies and practices regarding the use of vitamins, minerals, herbs, and other dietary supplements could compromise patient safety and quality of care. We undertook this study to describe pediatric hospital policies regarding dietary supplements.

METHODS

We administered a cross-sectional survey of a sample of National Association of Children Hospitals and Related Institutions members. Pharmacy personnel were asked about the following: written policies addressing dietary supplements; how such policies are made; and responsibilities for storage, administration, documentation, and checking for potential interactions. We created a 10-point hospital policy and practices quality score to assess the quality of each policy.

RESULTS

Of the 186 eligible National Association of Children Hospitals and Related Institutions hospitals, 109 responded (59%). Forty-four percent reported having written policies on vitamins and minerals, herbs, and other dietary supplements. Few hospitals had herbs (2%) or other dietary supplements (38%) on formulary. However, most (81%) allowed patients to use their home supply of dietary supplements under defined circumstances, and 64% allowed staff to make recommendations about dietary supplement use. In 70% of hospitals, nurses stored and administered the home supply of dietary supplements. Less than half (46%) required documentation of a check for drug or dietary supplements interactions. One third (32%) had surgical preoperative recommendations regarding dietary supplements. Only 11% of 109 hospitals satisfied the 10 criteria necessary for a perfect hospital policy and practices quality score indicative of quality practices regarding patient use of dietary supplements.

CONCLUSION

Even among those hospitals that have written policies about dietary supplements, there is a wide range in policy quality, which may compromise the safety of patients.

Factors and common conditions associated with adolescent dietary supplement use: an analysis of the National Health and Nutrition Examination Survey (NHANES)

Background

Little is known about the prevalence of dietary supplement (DS) use in American adolescents. We conducted this study to analyze the prevalence of DS use and factors associated with this use in a national population-based sample.

Methods

We used data from the 1999 – 2002 National Health and Nutrition Examination Surveys (NHANES) for adolescents age 11 to 19. Using weighted logistic regression, we identified demographic and clinical factors associated with the use of any DS, vitamins or minerals, herbs and other DS.

Results

Among the 5,306 responses representing approximately 36 million Americans 11–19 years old, 27% reported use of one or more DS in the prior month. The most commonly used DS were: multivitamins (16%) and vitamin C (6%). In the multivariable analysis, African American [adjusted odds ratio 0.40 (0.31–0.50) 95% CI] and Mexican American [0.55 (0.44–0.69)] adolescents were less likely to use DS compared with non-Hispanic whites. DS use was more common in those who used prescription medications [1.37 (1.10–1.72)] and among those who had a diagnosis of chronic headaches [1.25 (1.04–1.50)]. DS use was less common among those reporting fair or poor health status [0.59 (0.40–0.88)].

Conclusion

Twenty seven percent of American adolescents use DS. DS use is higher among teens that use prescription medications; physicians and pharmacists should be aware of this, ask patients, and check for potential interactions.

Dietary supplement use in pediatric patients with cystic fibrosis

PURPOSE

The use of dietary supplements and their perceived effectiveness in pediatric patients with cystic fibrosis (CF) were studied.

METHODS

A descriptive survey, comprising both open- and closed-ended questions, was developed to assess current and past use of dietary supplements, identify sources of dietary supplement information, determine the perceived effectiveness of these dietary supplements, and evaluate families' knowledge of regulations regarding dietary supplements.

RESULTS

A total of 121 pediatric CF patients and their families completed the survey. Assessment of dietary supplement use showed that 19% of patients (n = 23) were currently using dietary supplements and 10% (n = 12) reported past dietary supplement use. A total of 5 patients reported both current and past use of dietary supplements. Almost 40% of the patients who reported dietary supplement use did not inform their primary care provider about their use. While many factors may influence a patient's decision to begin therapy with a dietary supplement, 20% (n = 6) of patients felt their physician was most influential. Most patients (n = 104, 86%) correctly believed that dietary supplements are not regulated in the same manner as other prescription medications; however, only 60% (n = 72) would change the way dietary supplements are regulated.

CONCLUSION

The use of dietary supplements in pediatric patients with CF was common, although few patients and families perceived it as effective for treating CF.

Bringing evidence to complementary and alternative medicine in children with cancer: Focus on nutrition-related therapies

Children with cancer frequently use complementary and alternative medicine (CAM), especially in conjunction with conventional therapy. Dietary supplements are a commonly used CAM modality, with the prevalence of supplement use ranging from 35% to 50% of children with cancer in surveys completed in the United States. Less is known about the use of dietary supplements in developing countries. The evidence for some dietary supplements providing some benefit to children with cancer is reviewed. Preliminary studies have shown that antioxidant status may affect chemotherapy tolerance in children with acute lymphoblastic leukemia. Other supplements, including TRAUMEEL S, glutamine, vitamin E, Immunocal, colostrum, and probiotics, may help to reduce gastrointestinal toxicities of chemotherapy and radiation. However, more definitive evidence is needed. Most dietary supplements have not been tested adequately to determine their safety and efficacy, with even less understood about their potential interactions with conventional chemotherapy and radiation. With the greater use of dietary supplements by patients with cancer, increasing scientific attention is being paid to the investigation of these therapies. But research on dietary supplements is complex and usually more difficult than that on conventional medications. Strong research designs are critical in obtaining information that will ultimately influence clinical practice and public awareness.

Ethics of complementary and alternative medicine use in children

Complementary and alternative medicine (CAM) has enjoyed tremendous public interest in North America in recent years. CAM is used most often by those who have serious, chronic, or recurrent illness, sometimes for symptom control and sometimes to combat the primary disease. Others use CAM to promote wellness or as a prophylaxis. CAM therapies are increasingly being offered in conventional medical settings and at various other centers and institutes. The relevant ethical commitments or values that must be considered are social commitment to public welfare, nonmaleficence, respect for patient autonomy/consumer choice, recognition of medical pluralism, and public accountability. This article explores the major ethical principles involved in pediatric CAM use and how they affect clinical care and research.

Herbs to homeopathy-medicinal products for children

Many pediatric patients and their families use dietary supplements and homeopathy. They do not always disclose this information to their health care practitioners. It is important that health care practitioners are aware of the research available in these areas and discuss the use of these products openly with their patients. As part of that dialogue, clinicians need to consider what level of effectiveness is acceptable to support the use of these products by their patients. This risk-benefit appraisal should consider safety, effectiveness, the medical condition being treated, and the personal beliefs and preferences of patients and their families.

Changes in use of herbs and dietary supplements (HDS) among clinicians enrolled in an online curriculum

BACKGROUND

Little is known about clinicians' use of herbs and dietary supplements (HDS), how their personal HDS use changes with time and training, and how changes in their personal use affect their confidence or communication with patients about HDS.

METHODS

We conducted a prospective cohort study of clinicians before and after an on-line curriculum about HDS in winter-spring, 2005.

RESULTS

Of the 569 clinicians who completed surveys both at baseline and after the course, 25% were male and the average age was 42 years old; 88% used HDS before and after the course. The average number of supplements used fell slightly from 6.2 at baseline to 5.8 after the course (P < 0.01). The most commonly used supplements at baseline were: multivitamins (65%), calcium (42%), B vitamins (34%), vitamin C (34%), green tea (27%), fish oil (27%) and vitamin E (25%). Use of fish oil increased to 30% after the course (P = 0.01). Use of supplements traditionally used to treat colds decreased: vitamin C (34% to 27%), zinc (13% to 10%), and echinacea (7% to 5%, P < 0.05 for all three). Changes in personal HDS use were not associated with significant changes in confidence or communication with patients.

CONCLUSION

Many clinicians use HDS personally; use changes seasonally and to a small extent with professional education. Professional use of HDS is dynamic and seasonal. Additional research is needed to understand the impact of personal use on professional attitudes and behavior in populations with lower baseline uses of HDS.

Disease prevalence among dogs and cats in the United States and Australia and proportions of dogs and cats that receive therapeutic diets or dietary supplements

OBJECTIVE

To estimate disease prevalence among dogs and cats in the United States and Australia and proportions of dogs and cats that receive therapeutic diets or dietary supplements.

DESIGN

Telephone survey. Sample Population-Dog and cat owners located in 5 geographic areas.

PROCEDURES

A telephone survey was administered to dog and cat owners.

RESULTS

Of 18,194 telephone calls that were made, 1,104 (6%) were to individuals who owned at least 1 dog or cat and agreed to participate. Information was collected for 635 dogs and 469 cats. Only 14 (1%) respondents indicated that their pet was unhealthy, but 176 (16%) indicated that their pets had 1 or more diseases. The most common diseases were musculo-skeletal, dental, and gastrointestinal tract or hepatic disease. Many owners (n = 356) reported their pets were overweight or obese, but only 3 reported obesity as a health problem in their pets. Owners of 28 (2.5%) animals reported that they were feeding a therapeutic diet, with the most common being diets for animals with renal disease (n = 5), reduced-calorie diets (5), and reduced-fat diets (4). Owners of 107 of 1,076 (9.9%) animals reported administering dietary supplements to their pets. Multivitamins (n = 53 animals), chondroprotective agents (22), and fatty acids (13) were the most common dietary supplements used.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that most dogs and cats reported by their owners to have a health problem were not being fed a therapeutic diet. In addition, the rate of dietary supplement use was lower than that reported for people.

Expertise about herbs and dietary supplements among diverse health professionals

BACKGROUND

Herbs and other dietary supplements are among the most commonly used complementary medical therapies. However, clinicians generally have limited knowledge, confidence and communication about herbs and dietary supplements (HDS). We compared diverse clinicians' expertise about HDS to better target future curricula.

METHODS

We conducted a cross-sectional survey of physicians, pharmacists, nurses, dietitians and trainees in these professions prior to e-curriculum about HDS in 2004-2005. The survey had 28 questions about knowledge, 19 questions about their confidence and 11 questions about their communication practices about HDS.

RESULTS

Of the 1,268 participants, 25% were male; the average age was 40 years. Mean scores were 66% correct for knowledge; 53/95 on the confidence scale and 2.2 out of possible 10 on the communication practices scale. On average, scores were lowest for those who used fewer HDS; and trainees and nurses compared with physicians, pharmacists and dietitians (P < 0.01 for all comparisons).

CONCLUSION

Clinicians have moderate levels of knowledge and confidence, but poor communication skills about HDS. Future curricula about HDS should target nurses, students, practitioners and those not currently using HDS. Research is needed to determine the most cost-effective educational strategies for diverse health professionals.

Oral protein energy supplements for children with cystic fibrosis: CALICO multicentre randomised controlled trial

OBJECTIVE

To determine whether oral protein energy supplements, used long term in children with cystic fibrosis who are moderately malnourished, improve nutritional and other outcomes.

DESIGN

Multicentre randomised controlled trial.

SETTING

Seven specialist paediatric cystic fibrosis centres and their associated shared care clinics and seven smaller paediatric cystic fibrosis clinics.

PARTICIPANTS

102 children with cystic fibrosis, aged between 2 and 15 years, who were moderately malnourished.

INTERVENTIONS

Oral protein energy supplements in addition to usual dietary advice compared with dietary advice alone, for 12 months.

MAIN OUTCOME MEASURE

Change in body mass index centile over one year.

RESULTS

Use of supplements was not associated with a change in body mass index centile (mean difference 2.99 centile points, 95% confidence interval -2.70 to 8.68) or other nutritional and spirometric outcomes in this group of children.

CONCLUSIONS

Long term use of oral protein energy supplements did not result in an improvement in nutritional status or other clinical outcomes in children with cystic fibrosis who were moderately malnourished. Oral protein energy supplements should not be regarded as an essential part of the management of this group of children.

TRIAL REGISTRATION

ISRCTN: 95744468.

Dietary supplement use in adolescents

PURPOSE OF REVIEW

As prevalence rates of dietary supplement use are observed to be increasing in adolescents and the population in general, questions need to be asked about the efficacy, motivations, and consequences of such usage. Focusing mainly on individuals between the ages of 12 to 19 (adolescents) this review will highlight current prevalence rates, types of supplements being consumed, reasons for consumption, and concerns regarding physiological, psychological, knowledge transfer, and regulatory aspects of supplement use.

RECENT FINDINGS

Studies have indicated the prevalence of dietary supplement usage by adolescents range from approximately 10% to as high as 74%. Some of the highest rates of usage appear in chronically ill adolescents. Multivitamin and mineral preparations are the most common supplements being consumed; however, many studies indicate that adolescents are using other substances like creatine, herbals, or protein supplements. Some of the most appealing supplements among this age group are those that enhance athletic performance or physical appearance. Recent literature suggests three key moderating factors for supplement use in adolescents: health status, gender, and level of physical activity involvement.

SUMMARY

As the dietary supplement industry is now a multi-billion dollar industry, there is growing pressure, and a subsequent need for research to establish the efficacy and safety of these products particularly for adolescent users. The psychological and educational components of such use cannot be ignored as they play an equally important role in the health and safety of adolescents.