Talking with families about herbal therapies

Plant toxins and acute medicinal plant poisoning in children: A systematic literature review

BACKGROUND

For many years, medicinal plants and herbal therapy have been widely used in different societies for the treatment of various diseases. Besides their therapeutic potency, some of the medicinal plants have strong toxicity in human, especially in children and elderly. Despite common beliefs that natural products are safe, there have been few reports on their toxicities.

MATERIALS AND METHODS

In the present study, we aimed to systematically review the literature wherein acute plant poisoning and herbal intoxication have been reported in pediatric patients. After literature search and selection of the appropriate documents, the desired data were extracted and described qualitatively.

RESULTS

A total of 127 articles with overall 1453 intoxicated cases were collected. The results of this study showed that some medicinal plants can cause acute poisoning and complications such as hepatic and renal failure in children.

CONCLUSION

The findings of this survey showed that acute plant poisoning can be life?threatening in children, and since a single?ingested dose of toxic plants can cause acute poisoning, parents should be aware of these toxic effects and compare the side effects of self?medication with its potential benefits.

An ethnomedicinal survey on phytotherapy with professionals and patients from Basic Care Units in the Brazilian Unified Health System

ETHNOPHARMACOLOGICAL RELEVANCE

In this study, an ethnomedicinal survey was conducted in the city of Pelotas, Brazil, with professionals and patients in the Unified Health System (SUS). With the approval of the National Policy on Medicinal Plants and Herbal Medicines, and with the adoption of a National Policy on Integrative and Complementary Practices in the SUS in Brazil, there is growing concern regarding Brazilian medicinal plants and their proper use in medicine. The expansion of the therapeutic options offered to the users of the SUS includes access to medicinal plants and herbal drugs, as well as related services, such as phytotherapy. For improving health and for the social inclusion of phytotherapies, safety, efficacy, and quality are important strategies.

MATERIALS AND METHODS

Interviews of both professionals and patients were conducted at five Basic Care Units, and a sample size of 393 was obtained.

RESULTS

Of the patients attending the Basic Care Units, 91.6% had experienced the use of medicinal plants at least once to treat certain diseases. Of the professionals, 65% had used medicinal plants but only 10% prescribed phytotherapeutics to their patients. Generally, the users were homemakers (26%) of the female gender (71.5%) who were older than 60 years (26%) and had a family income between 1 and 2 Brazilian minimal salaries. The professionals were predominantly female (80%), and a high proportion (80%) believed in the positive effects of phytotherapy (80%), even though these professionals had not been taught phytotherapy as undergraduate students (75%) and had not discussed the topic with their teachers (85%). Patients (81.5%) and professionals (45%) reported that their knowledge of medicinal plants came from their parents or grandparents. From a total of 66 different herbs used by the subjects, mauve (24%) was the most commonly used, often to treat toothaches (24.2%).

CONCLUSION

It is concluded that a high proportion of users and professionals made use of medicinal plants, and of the large number of plants mentioned in the questionnaire, mauve was the most commonly used, mainly for the treatment of toothaches. The major source of the transmission of knowledge concerning herbal medicine was parents or grandparents.

Use of complementary and alternative medicine in healthy children and children with chronic medical conditions in Germany

OBJECTIVES

Use of complementary and alternative medicine (CAM) in children is common and probably increasing. However little is known about differences between healthy and chronically ill children with a focus on prevalence, reasons for use/non-use, costs, adverse effects and socio-demographic factors.

DESIGN

A questionnaire-based survey with 500 participants visiting the outpatient clinic of the University Children's Hospital Homburg, Germany was conducted over a 4-week period in 2004. Recruitment was stopped when 500 questionnaires were handed out in total.

RESULTS

Of the 405 (81%) respondents (242 with chronic conditions, 163 healthy children incidentally visiting the hospital for minor ailments) 229 (57%) reported lifetime CAM use (59% with chronic conditions versus 53% healthy children). Among CAM users the most prevalent therapies were homeopathy (25%), herbal remedies (8%), anthroposophic medicine (7%), vitamin preparations (6%) and acupuncture (5%). The main reasons for use were to strengthen the immune system, physical stabilisation and to increase healing chances/maintain health. Socio-demographic factors associated with CAM use were tertiary education (mother: p=0.017; father: p>0.001), higher family income (p=0.001) and being Protestant (p=0.01). Expectations towards CAM were high and most parents would recommend certain CAM (94%). 79% of the users informed a physician about CAM use. Side effects were rarely reported (4%), minor and self-limiting.

CONCLUSIONS

Clinical care and the physician-patient relation would benefit from an enhanced understanding of CAM and a greater candidness towards the parental needs. The safety and efficacy especially of CAM with high prevalence rates should be determined in rigorous basic and clinical researches.

Complementary medicine regulations

There is a need for regulations in applying complementary and alternative medicine methods, especially in the case of oncology patients.

Predictors of ductal closure and intestinal complications in very low birth weight infants treated with indomethacin

OBJECTIVE

To describe factors associated with failure of patent ductus arteriosus closure and development of gastrointestinal complications in subjects treated with indomethacin.

STUDY DESIGN

Infants <or=30 weeks and <1,500 g delivered between 1997-2003 with patent ductus arteriosus treated with indomethacin were included in this single-center retrospective study. Risk factors for failed ductal closure rates and gastrointestinal complications were identified with uni- and multivariable analyses.

RESULTS

Among 210 subjects treated with indomethacin, ductal closure increased from 43% at 23 weeks to 87% at 27 weeks (OR 1.51 per week gestation, 95% CI 1.14-2.01, p = 0.004) and was unchanged thereafter. Gastrointestinal complications decreased with increasing gestational age (OR 0.67/week, 95% CI 0.52-0.84) but increased with male gender (OR 2.41, 95% CI 1.07-5.45). SNAP-II (Score for Neonatal Acute Physiology-II) scores at birth and at the time of first indomethacin therapy were not associated with likelihood of closure or with gastrointestinal complications. Duration of ductal patency was not associated with risk of necrotizing enterocolitis or intestinal perforation after adjusting for gestational age and gender.

CONCLUSIONS

Ductal closure with indomethacin is linearly associated with gestational age in infants <or=27 weeks. Illness severity at the time of treatment is not predictive of treatment outcome or gastrointestinal complications. The duration of ductal patency is not associated with an increase in adjusted risk of necrotizing enterocolitis or intestinal perforation in patients treated with indomethacin.

Use of alternative therapies by patients presenting to a pediatric emergency department

Complementary and alternative medicine (CAM) is used by some patients to supplement their health care. Information on the use of CAM in children who are not chronically ill is sparse. We conducted a survey of caregivers presenting to a tertiary pediatric Emergency Department to determine CAM use in this population. Six hundred twenty questionnaires (77.6% of those distributed) were available for analysis. Approximately 13% of caregivers reported using CAM for their child. The most common CAM therapies used were homeopathy (20%), prayer/spiritual approaches (19.7%), and massage therapy (16.7%). Age of child greater than 1 year was associated with CAM use (p < 0.05), as was parental higher education (p < 0.0001). Income, ethnicity, parental age, and chronic illness were not correlated with CAM use. CAM therapies are infrequently used in pediatric patients presenting to the Emergency Department.

Use of complementary/alternative medicine among paediatric patients

The use of complementary/alternative medicine (CAM) is increasing. The aim was to characterise the use of CAM among patients in a paediatric department. All patients (aged 0-18 years), out-patients or hospitalised, in contact with the Department of Paediatrics, Odense University Hospital during a 2 week period in the autumn of 2001 were asked to participate. In total, 622 (92%) patients participated. The data were collected in an interviewer administered questionnaire during a short structured interview with the patient and parents. CAM was divided into herbal medicine (herbal drugs or dietary supplements) (HM), alternative therapy (AT) (i.e. acupuncture) or chiropractic (CHI). Of all patients, 53% had tried CAM at least once and 23% had tried CAM within the last month (15% HM, 7% AT and 2% CHI). There was no correlation between use of CAM and gender, age or if the patient was out-patient or hospitalised. The users were pre-school children. HM (Bio-Strath and Echinacea) was especially used to strengthen the immune system. Among AT, reflexological treatment was the most popular treatment. The most frequent users of CAM were patients with asthma, eczema or allergy plus patients suffering from gastrointestinal diseases or hospitalised for observation. More than 50% of the users experienced positive effects and 6% had side-effects from AM. Of the CAM users, 11% or 2% of the total paediatric population used CAM instead of conventional medicines.

CONCLUSION

Of the paediatric patients, 53% had tried complementary/alternative medicine, which was used as a supplement to conventional medicine although we did not know how long it was used. Paediatric patients should be interviewed about their use of complementary/alternative medicine with regard to side-effects, interactions or lack of compliance with conventional medicine.