Complementary and alternative medicine for children: does it work?

Parent-Directed use of Over-the-Counter Medications and Complementary and Alternative Medicine Therapies among Pediatric Patients: A Cross-Sectional Study

Objective

The use of over-the-counter (OTC) drugs and complementary and alternative medicines (CAM) as initial options by parents is common in the pediatric population. Despite the widespread use of parent-directed medication (PDM) among the pediatric population, we have scarce data in the Indian context. This study was done to assess the PDM practices and its determinants in the Indian population.

Methods

It was a descriptive cross-sectional study assessing a representative sample of 284 parents of pediatric patients visiting the pediatrics department of a tertiary care hospital.

Findings

Majority (64.08%; 182 out of 284) of the parents agreed to have used some form of PDM in the past 3 months. While higher socioeconomic status and having 2 or more children were associated with higher practice of PDM (P < 0.05), it was similar between educated or uneducated parents, rural or urban backgrounds, and nuclear or joint families (P > 0.05). CAM was the most commonly used option (58.12%; 161 out of 277), followed by OTC conventional allopathic medications (41.88%; 116 out of 277). Homeopathic medicines were the most preferred alternative therapy under the Alternative Medical System Category of National Centre for Complementary and Alternative Medicine. Majority of parents (71.43%; 130 out of 182) were confident that the treatment chosen could not harm the health of their children and they attributed time constraints or availability of prior prescriptions as reasons for such practice.

Conclusion

PDM is a widespread phenomenon in the Indian pediatric population. The parents as well as the prescribers need to take a more balanced, practical, and judicious approach toward medications given to a child.

Complementary and Alternative Medicine Methods Used Among Turkish Pediatric Oncology Patients

PURPOSE

Complementary and alternative medicine (CAM) methods are gradually becoming common in pediatric oncology. The aim of this study was to determine the current use of CAM methods by Turkish mothers for their children with cancer.

DESIGN AND METHODS

The sample for this descriptive and cross-sectional study consisted of the mothers (n = 110) of children with cancer undergoing treatment in a hematology-oncology clinic and outpatient clinic. The data were collected using a questionnaire that included the CAM methods used by mothers for their children with cancer.

RESULTS

Of 110 children, 65 (59.1%) were diagnosed with leukemia and 107 (97.3%) underwent chemotherapy. More than half of the mothers (53.6%) were using CAM methods. The most common CAM method was the use of natural products (93.2%), of which the most frequently used were carob, mulberry, and grape molasses. Mothers used CAM to support the treatment of their children with cancer and alleviate the side effects of chemotherapy and, in most cases, without previously consulting healthcare professionals about their use.

CONCLUSIONS

This study revealed that most mothers used CAM methods for their children.

PRACTICE IMPLICATIONS

It is important that healthcare professionals are aware about the use of CAM methods in children with cancer to prevent any possible negative interaction between conventional (i.e., chemotherapy) and alternative treatments.

Pediatric Health Care Providers’ Attitudes and Referral Predictors for Therapeutic Massage and Acupuncture

The objective of this study was to assess pediatric health providers’ attitudes, experience, and referral patterns with respect to therapeutic massage and acupuncture (TM&A). A written survey of experience with and attitudes about TM&A was distributed to a convenience sample of pediatric health care providers attending a regional postgraduate course in April 2002. Bivariate analyses were performed using Fisher’s exact test and the chisquare statistic. Pediatric care providers’ practices of referring patients to TM&A were associated with their own familiarity with and prior use of TM&A as well as their professed comfort level in discussing these modalities. There were no significant differences by professional status, gender, or years in practice in 42% of the respondents who reported making TM&A referrals. Pediatric health care providers’practices in referring patients for TM&A are positively associated with their familiarity with and personal use of TM&A.

Pilot Study of Massage to Improve Sleep and Fatigue in Hospitalized Adolescents With Cancer

BACKGROUND

Adolescents with cancer experience many troubling symptoms, including sleep disruptions that can affect mood and quality of life. Massage is a safe and popular intervention that has demonstrated efficacy in pediatric and adult patients with cancer. This study aimed to assess the feasibility of conducting a massage intervention to help with sleep in hospitalized adolescent oncology patients.

PROCEDURE

Adolescents ages 12-21 with cancer who were expected to be hospitalized for at least four consecutive nights were recruited from the inpatient unit at Children's National Health System and randomized to either massage intervention or a waitlist control. Patients in the intervention group received one massage per night, for two or three nights. Sleep was measured with actigraphy and patient and proxy reported instruments were used to measure fatigue, mood, and anxiety.

RESULTS

The majority (78%) of patients approached for the study consented, and almost all patients in the intervention group (94%) received at least one massage, 69% received two, and rates of completion of instruments among adolescents were high demonstrating feasibility. There were trends toward increased night time and overall sleep in the intervention group compared with standard of care, but no differences between groups in the patient reported outcome measures. Participant and parent feedback on the intervention was positive and was the impetus for starting a clinical massage service at the hospital.

CONCLUSIONS

Massage for hospitalized adolescents with cancer is feasible, well received, and can potentially improve patients' sleep. A randomized multicenter efficacy study is warranted.

Adolescents and media coverage of over-the-counter and complementary medicines

Focal points

Complementary and alternative medicine in pediatric oncology

Children with cancer and their families use complementary and alternative medicine (CAM) to reduce symptoms, cope with life-threatening illness, and improve overall well-being. Despite numerous published surveys on the use of CAM in pediatric oncology, few studies have tested CAM therapies for safety and efficacy. A growing body of literature in adult oncology provides evidence for the role of CAM to help manage symptoms and reduce distress. Translating this research to children requires studies with new models that address family roles and include measurement of outcomes relevant to children's developmental stages and unique responses. One of the limitations in pediatrics is the small samples available to single institutions. Conducting clinical trials through the cooperative group mechanism is one way of obtaining sufficient sample sizes to determine effectiveness and safety of CAM therapies. This article summarizes research to date and describes a beginning approach to measuring outcomes of supportive CAM therapies in children with cancer.

Integration of Complementary and Alternative Medicine in a Major Pediatric Teaching Hospital: An Initial Overview

OBJECTIVE

To describe the establishment of a multidisciplinary team of complementary and alternative medicine (CAM) providers and educators in an urban pediatric hospital and affiliated medical school.

BACKGROUND

Pediatric CAM use is increasing. Physicians are interested in CAM-related education but few programs had been developed in pediatrics. In 1998, Children's Hospital Boston established the Center for Holistic Pediatric Education and Research (CHPER), a CAM multidisciplinary team providing clinical services, education, and research.

METHOD

A retrospective review describing data from patient consultation notes, CAM lectures, clinical practice guidelines, curriculum materials, team meeting minutes, and team member manuscripts and publications.

RESULTS

Over 5.5 years, CHPER staff provided over 2100 consults: acupuncture, massage, holistic pediatrician, relaxation therapies, biofeedback, hypnosis, and bio-pharmaceutics. Acupuncture and massage therapies were incorporated into a Clinical Practice Guideline. Formal education was delivered through didactic sessions, workshops, self-learning modules, clinical observation, and clinical practice. CHPER faculty published 1 book and 64 articles on CAM-related topics.

CONCLUSION

An interdisciplinary team of CAM clinicians and educators can be integrated into an urban pediatric teaching hospital to provide CAM medical education and clinical services.

Adolescents' use of complementary and alternative medicine

OBJECTIVE

To examine the prevalence of complementary and alternative medicine (CAM) use in a random sample of adolescents living in Monroe County, New York.

METHODS

Questions about use of a variety of CAM therapies in the previous 6 months were asked of adolescents during a random-digit-dial telephone survey.

RESULTS

A total of 54% of the 361 adolescents surveyed had used at least 1 CAM remedy. The most frequently used therapies were massage (13.2%), prayer or faith healing (13.1%), herbs (11.5%), megadose vitamins (10.6%), and special exercises (10.1%). Natural performance enhancers were used by 14.7% of the boys, but less than 1% of the girls (P <.001). Use of health care without parental knowledge, time spent in school clubs, and perceived parental use and friend use of CAM were all associated with CAM use in a logistic regression model.

CONCLUSION

More than half of the adolescents in this county use CAM therapies, and a significant number use pharmacologically active substances. Physicians treating adolescents should ask adolescents about CAM use.