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

Research on Family-Centered Care in pediatric patients: A Bibliometric Analysis

OBJECTIVE

This study is conducted as a bibliometric analysis to determine the trends in studies related to family-centered care in children.

MATERIALS AND METHODS

The Web of Science database was used to collect study data. A search was conducted on Web of Science using the keywords "family-centered care", "family centered care", "family-centred care", "family centred care", "family-integrated care", "family integrated care", "patient and family centered care", "patient- and family-centered care" and "child" or "pediatric" or "pediatrics" or "child" or "newborn" or "neonatal" or "adolescent" together. The VOSviewer program was used for data analysis and visualization. The analysis included the number of publications by year, distribution by journals, most cited studies, countries with the highest publication output, most frequently used keywords, and co-authorship dimensions, presented with visual maps.

RESULTS

A total of 2525 studies conducted from 1980 onwards were analyzed. The analysis revealed that the initial publications related to the subject emerged in 1980, and the United States was identified as the country with the highest number of publications, based on the Web of Science database. The Journal of Pediatric Nursing: Nursing Care of Children and Families (JPN) was determined as the journal with the highest number of publications, while the journal receiving the most citations was PEDIATRICS.

CONCLUSION

The study found an increasing importance given to the Family-Centered Care Approach since the 1980s, with a majority of studies being descriptive in nature. It was determined that the studies were concentrated in the USA indicating a lack of global interest in the Family-Centered.

PRACTICAL IMPLICATIONS

Nursing researchers can build upon this study in the field of family-centered care by conducting more specific and in-depth investigations. This contributes to adding new information to the nursing literature and filling gaps in this area.

Acupuncture for pediatric chronic pain: A systematic review

OBJECTIVES

To survey, analyze and discuss the scientific evidence supporting the use of acupuncture and related techniques in the management of chronic pain in the pediatric population.

SOURCES

A survey of databases (MEDLINE, Scopus and Scielo) was carried out with search strategies, following the PRISMA statement, without limits on publication dates and languages. Clinical studies (clinical trials, single-arm, and case series) were accepted for review if they included participants aged up to 22 years. Study quality was assessed by MMAT, and the randomized clinical trial was analyzed under the STRICTA criteria.

SUMMARY OF THE FINDINGS

2369 articles were retrieved. After excluding repetitions, 1335 underwent the initial selection. Only 16 articles were selected for full reading, of which 5 were included in the review, being two case series, two single-arm studies, and one randomized clinical trial. The articles were considered of good quality by the adopted criteria.

CONCLUSION

The analyzed studies showed important clinical results such as the reduction of pain intensity, and improvement in school attendance and social life. However, there are many limitations in study design and sample size. Therefore, there is weak evidence to support the use of acupuncture in the context of pediatric chronic pain, but the positive results reinforce the need for further investigation of the topic with the conduct of larger and well-designed studies, to obtain more data and greater scientific conviction of the findings.

The Effect of Ear Acupressure on Behavioral Problems in Children with Attention-Deficit/Hyperactivity Disorder: A Randomized Clinical Trial

Objective

Due to the limits on treatment for people with attention-deficit/hyperactivity disorder (ADHD), ear acupressure treatment has been considered. This study examined the effect of ear acupressure on behavioral problems of children with ADHD.

Materials and Methods

This randomized controlled trial was conducted in 70 children with ADHD who were randomized into 2 groups. The intervention group received ear acupressure in treatment points and the control group received massage at neutral points. Behavioral problems were measured 3 times: (1) baseline; week 4; and week 8. The last timepoint was a follow-up, using the Child Behavior Checklist.

Results

The intervention group had fewer behavioral problems at all 3 timepoints than the control group (Cohen's ∂ = 1.49; 95% confidence interval at week 4: 20.97, 47.43).The ear acupressure group had a large effect size with respect to reduction of attention problems at week 4 (∂ = 1.88) and week 8 (∂ = 1.48) than the control group.

Conclusions

Ear acupressure induced significant reduction of the behavioral problems of children with ADHD. Further research can evaluate the use and continuity of the effectiveness of this treatment as a complementary treatment in addition to the usual treatments for these children.

Assessment of complementary health approaches use in pediatric oncology: Modification and preliminary validation of the "Which Health Approaches and Treatments Are You Using?" (WHAT) questionnaires

OBJECTIVE

Complementary Health Approaches (CHA) are commonly used by children with cancer; however, a few health care providers (HCPs) inquire about the use of CHA. A standardized questionnaire could facilitate such clinical discussions. We aimed to adapt and determine the face and content validity of the "Which Health Approaches and Treatments are you using?" (WHAT) child and parent-report questionnaires in pediatric oncology.

METHODS

An electronic Delphi survey that included children with cancer (8-18 years), parents, and HCPs and CHA researchers was conducted to reach consensus on the content of the WHAT questionnaires in pediatric oncology. Children and parents from the Hospital for Sick Children (SickKids), and HCPs and researchers from the International Society of Pediatric Oncology and Pediatric Complementary and Alternative Medicine Research and Education Network completed the survey. To determine the face and content validity of the questionnaires, two iterative cycles of individual interviews were conducted with purposive samples of children (8-18 years), parents, and HCPs from SickKids.

RESULTS

Consensus was reached on all domains and items of the original WHAT questionnaires after one Delphi cycle (n = 61). For face and content validity testing, the first cycle of interviews (n = 19) revealed that the questionnaires were mostly comprehensive and relevant. However, the paper-based format of the original WHAT was not user-friendly, and generic items were vague and not aimed at facilitating clinical dialogues about CHA use. The WHAT questionnaires were then modified into electronic cancer-specific self- and proxy-report questionnaires including 13 and 15 items, respectively. The second cycle (n = 21) showed no need for further changes.

CONCLUSIONS

The modified electronic cancer-specific WHAT questionnaires showed adequate face and content validity. The next step is to determine inter-rater reliability, construct validity, and feasibility of administration of the modified WHAT questionnaires in pediatric oncology.

Ethnic differences in parental experiences during the first six months after PICU discharge in Singapore: a qualitative study

Introduction

Literature on parental experiences after childhood critical illness has limited representation from diverse ethnic backgrounds. Parents from global ethnic majority groups have reported worst psychological outcomes and required more social support after childhood critical illness.

Aim

To explore the experiences of Chinese, Malay, and Indian parents in the first six months after Pediatric Intensive Care Unit (PICU) discharge of their child in Singapore.

Methods

Sequential semi-structured qualitative interviews were conducted to collect data from a convenience sample of 28 parents at one month (n = 28) and at six months (n = 22) after their child's discharge from a multidisciplinary PICU. Framework Analysis was adopted as the qualitative analysis strategy. The PICS-p framework was applied a priori in the Framework Analysis.

Findings

Three interdependent domains and seven themes framed the 28 accounts in which ethnically diverse parents reported psychological stressors (PICS-p: emotional health), support received (PICS-p: social health) and practical challenges (transitional health) in the first six months after childhood critical illness. In the emotional health domain, parents were affected by different stressors and had different priorities over their child's survivorship. Only Indian parents reported experiences of stress symptoms, at six months post discharge. Malay parents sought solace from their religion more than Chinese and Indian parents. In the social health domain, parents reported various sources and degree of support received. Familial supports were strong across all groups, while community support was more prominent in Malay as compared to Chinese and Indian parents. A third domain, transitional health, was introduced to capture the difficulties parents faced during the transition from PICU survival to home. Parents from non-Chinese families were more likely to report financial challenges and more involvement of spouses after discharge. Complementary medicine or commercial health products were utilized by Chinese and Malay families.

Conclusion

These findings reveal preferred strategies that parents from a global ethnic employ to address the emotional, social and transitional health impacts of their child's critical illness. Future care delivery may consider tailored care plans, communication strategies, and emotional support in PICUs that address the unique ethnic needs of parents during the critical six-months post their child's illness.

Public Use of Complementary Medicine for Children in Saudi Arabia: A Questionnaire-Based Cross-Sectional Study

BACKGROUND AND OBJECTIVES

The use of complementary and alternative medicine (CAM) is growing among adults and children. Extensive data is available regarding the pattern and frequency of CAM used in adults in Saudi Arabia, but limited data is available for children. This study aims to examine the level of knowledge, attitude, and practice about the use of CAM in the pediatric population in Saudi Arabia.

SUBJECTS AND METHODS

A cross-sectional descriptive study on the use of CAM in children was carried out in the general population of Saudi Arabia. Data was collected by non-probability consecutive sampling technique through an online-based questionnaire from 132 participants. In addition, data analysis was done using IBM's Statistical Package for the Social Sciences (SPSS). The data collected consisted of socio-demographic details, knowledge, attitude, and practice of CAM in children.

RESULTS

CAM was reported in all 132 participants (100%), with 45% (N=59) using it without informing their physicians. The mean age of the children was 17 months old, 55.3% (N=73) children were males, and 44.7% (N=59) were females. The most common form of CAM used was herbal medicine, 91% (N=120), while alternative medicine was used in 16.7% (N=12) of the children. Honey was the most used herb (68.2%, N=90), followed by anise (65.2%, N=86), Zamzam water (holy water) (59.1%, N=78), and olive oil (56.8%, N=75).

CONCLUSIONS

The use of CAM is very common for children in the general population of Saudi Arabia, with herbal medication being the most common. This constitutes a dire need to regulate this field and provide enough information for the public and health care practitioners to provide the best health care. In addition, future awareness campaigns are needed to bridge the communication gap between parents and physicians and provide better information about the benefits and safety of CAM use.

Inter-Rater Reliability, Construct Validity, and Feasibility of the Modified "Which Health Approaches and Treatments Are You Using?" (WHAT) Questionnaires for Assessing the Use of Complementary Health Approaches in Pediatric Oncology

BACKGROUND

This study aimed to test the inter-rater reliability, construct validity, and feasibility of the modified "Which Health Approaches and Treatments Are You Using?" (WHAT) questionnaires in pediatric oncology; Methods: Parent-child dyads were invited to complete self- and proxy-report-modified WHAT, Pediatric Quality of Life Inventory, demographics, a diary of the child's recent use of CHA, and a questionnaire assessing the aspects of feasibility. Parents were asked to complete a satisfaction of their children's use of the CHA survey; Results: Twenty-four dyads completed the study. The mean weighted kappa showed strong inter-rater reliability (k = 0.77, SE = 0.056), and strong agreements between the modified WHAT and the diary (self-report [k = 0.806, SE = 0.046] and proxy-report [k = 0.894, SE = 0.057]). Significant relationships were found only between recent and non-recent CHA users in relation to the easy access to CHA (self-report [p = 0.02], proxy-report [p < 0.001]). The mean scores of the feasibility scale (out of 7.0) for the self- and proxy-report were 5.64 (SD = 0.23) and 5.81 (SD = 0.22), respectively, indicating the feasibility of the modified WHAT; Conclusions: The findings provide initial evidence of the reliability and validity of the modified WHAT and their feasibility. Further research is needed to test the theoretical relationships and further explore the validity and reliability of the modified WHAT.

Parental Perceptions and Usage of Unlicensed Cannabidiol Products in Children With Anxiety and Neurodevelopmental Disorders

OBJECTIVE

Data evaluating the use of unlicensed cannabidiol (CBD) products for the treatment of -symptoms associated with anxiety and neurodevelopmental disorders in children are limited despite increasing -product availability. The objectives of this study are to quantify the usage of unlicensed CBD products among pediatric patients diagnosed with anxiety and neurodevelopmental disorders and compare the -perceptions of CBD between parents who administer a CBD product to a child and parents who do not.

METHODS

A survey containing 31 items was designed after pretesting with pediatric health care professionals. The refined survey was distributed using Qualtrics Panels to a representative sample of US parents of a child 7 to 18 years of age diagnosed with attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and/or generalized anxiety disorder (GAD). Responses were analyzed with descriptive -statistics and compared using a χ2 or Mann-Whitney U test.

RESULTS

Of the 518 completed surveys, 162 parents (31.3%) reported the administration of an unlicensed CBD product to a child with ADHD, ASD, and/or GAD. The highest prevalence of use was found in the West geographic region and among children diagnosed with GAD or with 2 or more diagnoses (i.e., ADHD, ASD, GAD). Parents who administered CBD products had more positive views of product safety and higher -perceived community support for usage.

CONCLUSIONS

Nearly one-third of parents have administered an unlicensed CBD product to a child with ADHD, ASD, and GAD. Health care providers should assess pediatric patients for CBD use and be prepared to engage parents in conversations regarding the safety of these products.

The Development of a Multidisciplinary Support Network to Support Hospitalized Pediatric Patients, Their Families, and Hospital Staff During the COVID-19 Pandemic

Background

The COVID-19 pandemic led to emotional and behavioral challenges for hospitalized pediatric patients, their families, and staff. Visitor restrictions, closure of patient lounges and playrooms, masking requirements, and enhanced isolation rules resulted in limited access to typical sources of psychosocial support during this traumatic event. Complementary and integrative health therapies such as acupuncture and related therapies are well suited to provide the humanitarian support patients and families need during times of crisis.

Objective

The Multidisciplinary Support Network (i.e., Network) was formed to redesign the delivery of acupuncture and other integrative therapies alongside psychosocial support for hospitalized children, their families, and staff.

Intervention

Network members represented a broad range of previously siloed disciplines including integrative therapies, art therapy, child life, nursing, pastoral care, adolescent medicine, pediatric hospital medicine, psychology, and child and adolescent psychiatry. The Network aimed to identify gaps in service and create resources to support children and families during this challenging time.

Results

The Network compiled existing complementary and integrative services, provided training on integrative therapies to staff, pediatric trainees, and faculty, developed the Comfort Box containing items to provide symptom relief including pain, anxiety and difficulty sleeping, as well as closed-circuit programming, a pediatric companionship program connecting medical student volunteer companions with pediatric patients, and a well-being workbook.

Conclusion

Collaborative teamwork across disciplines using integrative therapies was key to humanitarian efforts to support hospitalized children and their families during this crisis.

The physical and psychological outcomes of art therapy in pediatric palliative care: A systematic review

Background

The integration of art therapy in health care is a growing trend in the care of cancer patients. Therefore, this study aimed to identify the physical and mental benefits of art in children with cancer.

Materials and Methods

A systematic review of English articles using Google Scholar, MEDLINE via PubMed, Scopus, the Cochrane Database of Systematic Reviews, and the Web of Science was conducted. Relevant keywords for cancer, child, art therapy and their synonyms were used accordingly. All searches were conducted to December 31, 2021.Relevant articles were included studies published in English and involving children aged 0-18 years. Studies evaluated the effects of art therapy in children with cancer.

Results

Seventeen studies had inclusion criteria, of which 12 studies were performed by clinical trial and 5 studies were performed by quasi-experimental method. Sixteen studies evaluated one type of art-therapy intervention, while one study used a combination of art-therapy approaches.The results showed that art-based interventions in the physical dimension lead to more physical activity, stability in breathing, and heart rate, and these children reported less pain. In the dimensions of psychology had less anxiety, depression, and anger but at the same time had a better quality of life and more coping-related behaviors.

Conclusion

It seems that the use of art therapy in pediatric palliative care with cancer can have good physical and psychological results for the child, but it is suggested to evaluate the effects of these interventions in children at the end of life.

Acupuncture for the treatment of childhood anorexia: A systematic review and meta-analysis

OBJECTIVES

Childhood anorexia, among the commonest symptoms of children, involved long-term loss of appetite/decreased food intake and refusal to try or eat certain foods. Acupuncture is increasingly popular in childhood anorexia due to the side effects and dissatisfaction of conventional treatment, but, the efficacy and safety of acupuncture for childhood anorexia have not been reviewed systematically.

METHODS

From 12 electronic databases, randomized controlled trials (RCTs) assessing acupuncture for childhood anorexia were identified in June 2021, with posttreatment improvement in clinical symptoms of anorexia as the primary outcome. A meta-analysis was conducted if two or more studies used the same interventions or same outcome measures. The risk of bias and quality of evidence were evaluated.

RESULTS

A total of 32 RCTs with 3518 participants were included. When acupuncture was used as monotherapy or adjunctive therapy, the total effectiveness rate based on anorexia symptoms, hemoglobin levels, abdominal subcutaneous fat, and body weight significantly improved. However, results in nutritional indices were inconsistent. The recurrence rate of anorexia was significantly lower in the acupuncture group. No serious adverse events in relation to acupuncture were reported. in general, the risk of bias of the included studies was unclear and the quality of evidence for the main findings was low to moderate.

CONCLUSIONS

Acupuncture may improve symptoms of childhood anorexia without serious adverse events. However, because of the low methodological quality and quality of evidence in existing reports, further high-quality clinical trials are needed to conclusively establish the efficacy and safety of this treatment.

Complementary Medicine Practice and Use of Dietary Supplements in Pediatric Cancer Patients in Croatia

Introduction: The use of complementary and alternative medicine (CAM) has become a customary practice among pediatric cancer patients worldwide. The frequency of its use by pediatric cancer patients in Croatia has not been previously determined. 

Methodology: In order to establish the frequency and detect factors affecting the use of CAM, a single-center, observational, cross-sectional study was conducted at the Children's Hospital Zagreb during a two-year period. The patients' parents and caregivers were offered an anonymous, multi-item questionnaire that collected socio-economic and clinical data, as well as details on CAM and dietary supplement practice. 

Results: Almost half of the participants reported CAM and more than two-thirds reported dietary supplement consumption, predominantly in the intensive phase of the treatment. Factors regarding children or parents had no effect on CAM and supplement utilization. Herbal medicine, vitamins, and minerals were among the most commonly used items. Every 10th child experienced at least one adverse event during CAM and supplement use.

Conclusion: Awareness of the CAM and dietary supplement application in pediatric oncology patients needs to be raised due to the potential interactions with conventional treatment modalities. For this reason, it is extremely important to inform parents and caregivers of pediatric oncology patients about the use of CAM and dietary supplements to predict and mitigate the occurrence and intensity of the side effects. In the majority of our cases, the patient's guardians informed the healthcare professionals about the CAM and supplement implementation in their children, therefore, they were offered additional information about the possible negative impact of CAM and supplement use on standard medical care in a timely manner.

From Prescription Drugs to Natural Health Products: Medication Use in Canadian Infants

Limited data exist on pharmaceutical product use by infants, although available data suggests higher prevalence of use among children under 12 months of age. We conducted a descriptive study of 3050 infants recruited in the CHILD Cohort Study, a prospective, multicenter, longitudinal cohort following children from pregnancy through childhood. Parents were surveyed for use of prescription and over-the-counter drugs, and natural health products (NHPs, including homeopathic products and vitamins) at 3, 6, and 12 months after delivery. By one year of age, 96.0% of children had taken at least one pharmaceutical product. Among 307 reported products, 32 were given to at least 1% of cohort infants. Vitamin D, acetaminophen, ibuprofen, topical hydrocortisone, amoxicillin, and nystatin were the most common medications and natural health products (NHPs) received, with 8/32 of the most frequently used products being NHPs. Overall, 14.7% of pharmaceutical products administered to children were off-label and 35.8% were NHPs or products without a Drug Identification Number (DIN). The use of over-the-counter medications and NHPs is common and off-label use of drugs is frequent, even in the first year of life. This study highlights the importance of conducting studies on medication use in infants, and of infant medication use monitoring by healthcare providers.

Predictors of Headache/Migraine and the Use of Complementary Medicine in U.S. Children: A Population-Based Analysis of 2017 National Health Interview Survey Data

Background: This study set out to determine the prevalence and possible risk factors of headache and/or migraine in U.S. children, as well as the prevalence of complementary medicine use in this population. Methods: This is a secondary analysis of data from the 2017 U.S. National Health Interview Survey. Sociodemographic and clinical characteristics were compared between individuals with and without headaches. A backward stepwise procedure with a logistic regression statistic was used to test for potential predictors. Results: Six percent of children reported headaches and/or migraine within the past 12 months. Headaches were predicted by older age, female sex, non-Hispanic white ethnicity, and living in the southern United States. Inability to afford balanced meals and feeling sad or depressed in the past 6 months were also associated with higher odds of headache. A total of 19.2% of children with headaches reported using mind-body medicine, compared with 12.2% of children without headaches. Most frequently used therapy was yoga (57.2%), followed by spiritual meditation (31.1%) and mindfulness meditation (24.0%). The prevalence of visits to a complementary medicine practitioner or healer was 12.5%. Most frequently seen practitioners were chiropractors (62.1%), followed by naturopaths (21.2%), homeopaths (14.1%), and traditional healers (2.5%). Conclusions: The common use of complementary medicine among children suffering from headaches is worth noting. Understanding the motivation for using complementary medicine, as well as the choice of different forms of such therapy, may shed further light on the health-seeking behavior of this population.

Attitudes Towards Complementary and Alternative Medicine Among Pediatricians in Saudi Arabia

Background Complementary and Alternative Medicine (CAM) refers to a variety of healthcare practices outside the domain of conventional medicine, which may be integrated with conventional medicine by many physicians. Objectives This study aims to assess the attitudes and beliefs of pediatricians toward the use of CAM on children and to evaluate their knowledge and experience regarding CAM therapies and their desire for additional CAM training courses. Methods This is a cross-sectional study that was conducted in Saudi Arabia. A self-administered electronic questionnaire consisting of 27 questions was distributed among pediatricians to assess the demographics, beliefs, experiences, and attitudes of pediatricians related to the use of CAM for children. Non-probability convenience sampling was used in selecting the sample of pediatricians. Data analysis was performed using SPSS version 21 (IBM Corp., Armonk, NY). Results In this study, 140 participants completed the questionnaires. Most of the participants were of the male gender (83, 59.3%) and Saudi nationals (127, 90.7%). With regards to questions related to the experiences and opinions of participants regarding the use of CAM, 101 (72.1%) subjects reported the use of CAM among family members. Pediatricians cited affirmative encounters of use of CAM in 94 (67.1%) by parents. Pediatricians were not in favor of the use of CAM for end-stage (114, 81.4%) and chronic disease (108, 77.1%). The overall median self-reported CAM knowledge score was statistically higher for males in comparison with females [3 (IQR 1-5)] versus 2 (IQR 2-4), P = 0.030]. Also for nationality, median scores were significantly greater for the Riyadh region in contrast to other regions [[3 (IQR 2-5)] versus 2 (IQR 1-4), P = 0.041]. There was a significant difference in median scores for qualification of participants (P = 0.002). A multiple pairwise comparison revealed a statistically significant (P = 0.012) difference between participants with the qualification of residents and specialization. No differences in median CAM scores were found for responses related to the experiences, opinions, and attitudes of pediatricians towards the use of CAM therapies. Conclusion Most of the pediatricians in Saudi Arabia don't recommend the use of CAM treatment in their practice, but they acknowledge that learning more about CAM and imparting appropriate knowledge regarding it may incorporate its use in their routine clinical practices in a safe way.

Characteristics of chiropractic patients treated at the University of Johannesburg chiropractic student clinic and relevance to the educational process

OBJECTIVE

This study aimed to analyze the demographic and descriptive information of new patients presenting to an educational institution-based chiropractic student clinic in South Africa that could then be used to draw comparisons to other international chiropractic student clinics and local practices.

METHODS

We conducted a retrospective descriptive study of all new patient files from January 1, 2016, to July 31, 2016. The variables extracted were age, health profiles, number of musculoskeletal complaints, treatment protocol, and number of treatments that patients received for the initial complaint. Data were analyzed using cross-tabulations and multidimensional χ2 tests.

RESULTS

There were 865 files reviewed. Most patients were aged between 20 and 24 years. Lumbar and pelvic complaints were most common (42.2%), followed by the cervical spine (28%). Lumbar (18.8%) and cervical (16.8%) biomechanical conditions, followed by lumbar myofascial pain syndrome (7.6%), were the most common problems. Musculoskeletal conditions were reported in 99% of cases. The majority (80%) of patients received 9 or fewer treatments for their initial complaint. Manipulation was used in 93.9% of cases, followed by mobilization (8.8%), interferential current (23.5%), and dry needling (19.1%).

CONCLUSIONS

Data gathered suggest that there are some general similarities with international training institutions. There are also differences between the study sample and international institutions and South African private chiropractic practice. The dissimilarities were a younger patient population, a lower number of treatment visits, and low exposure to nonmusculoskeletal conditions. These differences may affect the breadth of student education and require further investigation.

Use of Complementary and Alternative Medicine in Pediatric Respiratory Diseases

In this study, our purpose was to determine prevalence of complementary and alternative medicine (CAM) in pediatric respiratory diseases and methods of CAM use accordingly. Each of the CAM treatment has a special risk/benefit combination and it is absolutely crucial for health care professionals to question those methods.

Patterns of Nutritional Supplement Use in Children with Tourette Syndrome

Very little is known about the use of nutritional supplements in children with Tourette syndrome. The current study aimed to address the frequency of nutritional supplements and the use of special diets in children with Tourette syndrome and typically developing children. Additional data also sought to address the motivations behind using them, their cost and perceived benefits. A total of 76 responses from an anonymous online survey (Tourette syndrome = 42; typically developing = 34) were completed and analyzed. Fifty-six per cent of children with Tourette syndrome compared to 15% of typically developing children were currently taking nutritional supplements, with the majority take two or more. Thirty-five per cent of the Tourette syndrome compared to 6% typically developing were currently or had previously adopted a special diet. Supplements most used for children with TS included probiotics, omega-3, multivitamins and magnesium. For children with TS, supplementation often began around the age of eight, for a duration on average of 35 months. The average cost was £32.44 a month compared to £8.25 for typically developing children. Seventy-five per cent of supplement users in the Tourette syndrome group noted improvement, mainly in motor and vocal tics, sleep quality and anxiety reduction. Most caregivers learned of supplements through the Internet. In almost 42% of the Tourette syndrome group, their pediatrician was unaware of the supplement use and this rose to 65% for special diets. Given the popularity of nutritional supplements, more research on the effectiveness and safety of such interventions is crucial.

Pediatric healthcare professionals' perceptions, knowledge, and use of essential oils

OBJECTIVES

Complementary and Integrative Medicines (CIM) are widely used by adults and children. Despite this, studies have shown that Healthcare Professionals' (HCPs) views about CIM vary. Because underlying knowledge, perceptions and biases may influence HCPs' acceptance of a new aromatherapy program, the investigators sought to assess HCPs' views regarding aromatherapy before implementing an aromatherapy program in a pediatric hospital.

DESIGNS AND MEASURES

A convenience sample of HCPs at an academic pediatric hospital in the United States completed an investigator developed online questionnaire about their perceptions, knowledge, and use of essential oils.

RESULTS

The sample included 987 respondents, of which: 62.0% were nurses. Overall, 94.2% of HCPs indicated that they "rarely, never, or seldomly" discussed essential oil use with patients. Most indicated a willingness to incorporate essential oils into their patient care with appropriate education. Furthermore, 47.4% of HCPs reported positive views about the use of essential oils, 4.9% reported negative views and opinions, and 45% raised specific concerns about safety, education and/or evidence.

CONCLUSION

Overall, this study suggests that HCPs have limited knowledge regarding essential oils, are open to learning more about them, and would like more evidence specifically regarding the efficacy and safety of using essential oils in pediatrics. Additionally, most HCPs are not currently discussing essential oils with pediatric patients. However, they are open to incorporating them into their patients' care if they receive proper education, and are open to our organization implementing an aromatherapy program if appropriate education and safety measures are provided.

Massage therapy in infants and children under 5 years of age: protocol for an overview of systematic reviews

INTRODUCTION

Massage is a popularly used complementary and alternative therapy. Previous randomised controlled trials have examined the effects of massage on children, and several systematic reviews have been conducted to synthesise these data. This study aims to assess and summarise the current evidence from published systematic reviews of controlled clinical trials on the practice of paediatric massage, specifically in infants and children aged < 5 years.

METHODS

The online databases MEDLINE, Embase, Health Technology Assessment Database, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Allied and Complementary Medicine, China National Knowledge Infrastructure and Wanfang Data will be searched from the inception onwards for evidence of the treatment effects. We will include systematic reviews of randomised control trials evaluating the effects and safety of massage therapy in infants and children aged < 5 years. The primary outcomes will be any physical or psychological outcome, and adverse effects on children. Secondary outcomes will include any physical or psychological outcome on caregivers. Two reviewers will independently screen the articles for inclusion as per the eligibility criteria. They will extract information from the included studies and assess the methodological quality of the included studies. A table will be used to summarise of information of the included studies, which includes the basic information, method and findings. The methodological quality of the included systematic reviews will be assessed by A Measurement Tool to Assess Systematic Reviews version 2 (AMSTAR 2). Extracted data from the included studies will be collected and presented using narrative approach. The pooled effect estimates for meta-analysed outcomes will be extracted when possible. If there is a discrepancy in results of two or more reviews on the same topic, then the causes of such discrepancy will be further explored.

DISCUSSION

This overview of systematic reviews will summarise the current evidence on massage, specifically for infants and children aged < 5 years. We will comprehensively present the positive effects and adverse effects of this intervention. Findings from this overview will be published in a peer-reviewed journal.

SYSTEMATIC REVIEW REGISTRATION

CRD42020186003 .

Pediatric Complementary Medicine

Complementary medicine is being used more broadly by many patients and physicians; however, little formal education has been provided on the topic. Given the prevalence of its use, pediatricians should have awareness of the options available as well as a certain level of comfort in counseling patients and families. This article aims to broaden knowledge on this topic as well as the evidence to support its use. [Pediatr Ann. 2021;50(3):e91-e95.].

Opportunities and challenges of pharmacotherapy for pulmonary arterial hypertension in children

Pediatric pulmonary hypertension (PAH) is a rare disease that carries a poor prognosis if left untreated. Although there are published guidelines for the treatment of children with pulmonary hypertension, due to the limited number of robust pediatric clinical trials, recommendations are often based on limited data or clinical experience. Furthermore, many practical aspects of care, particularly for the pediatric patient, are learned through experience and best navigated with a multidisciplinary team. While newer PAH therapies have been approved for adults, there is still limited but expanding experience in pediatrics. This new information will help improve the targets of goal-oriented therapy. Lastly, this review highlights practical aspects in the use of the different therapies available for the treatment of pediatric pulmonary hypertension.

Complementary and integrative medicine: An observational study on pediatric clinicians' knowledge, beliefs and practices

OBJECTIVE

Complementary and Integrative Medicine (CIM) is a group of diverse health care therapies that often serve as adjuncts to conventional medical treatments. Our aim for this study was to evaluate the current knowledge, beliefs and practices of pediatric clinicians regarding CIM.

METHODS

Clinicians from the pediatric unit of a large US based teaching hospital in Connecticut were surveyed, through self-administered questionnaires.

RESULTS

We sampled 70 participants with a response rate of 99 %. Of the 70, 32 were Registered Nurses, 9 were Attendings, 7 were Fellows, 15 were Residents and 4 were Nurse Practitioners. Regarding use, 24 % had referred a patient to a CIM practitioner, 43 % reported using CIM while 47 % had a family member who had used CIM in the past year. Respondents were most familiar with massage (70 %) and yoga (69 %) least familiar with Ayurvedic medicine (20 %) and Qi Gong (24 %). Regarding attitude, 67 % believed that some CIM therapies hold promise for the treatment of symptoms while 59 % believed that incorporation of CIM would increase patient satisfaction. Most of the respondents indicated that they did not have easy access to clinical information on many CIM treatment modalities. Nurses were more familiar (p = 0.024), had more positive attitudes and beliefs (p = 0.001) and thought CIM therapies had a higher impact (p = 0.002) on patient care compared to physicians, even when controlled for gender.

CONCLUSION

This study highlights the need to bridge the gap in evidence based medicine and clinician's knowledge with the rise in CIM use. It also stresses the need for standardized learning competencies in the field of PIM.

Role of medicinal plants against neurodegenerative diseases

Diseases with a significant loss of neurons, structurally and functionally are termed as neurodegenerative diseases. Due to the present therapeutic interventions and progressive nature of diseases, a variety of side effects have risen up, thus leading the patients to go for an alternative medication. The role of medicinal plants in such cases has been beneficial because of their exhibition via different cellular and molecular mechanisms. Alleviation in inflammatory responses, suppression of the functionary aspect of pro-inflammatory cytokines like a tumor, improvement in antioxidative properties is among few neuroprotective mechanisms of traditional plants. Variation in transcription and transduction pathways play a vital role in the preventive measures of plants in such diseases. Neurodegenerative diseases are generally caused by depletion of proteins, oxidative and inflammatory stress, environmental changes and so on, with aging being the most important cause. Natural compounds can be used in order to treat neurodegenerative diseases Medicinal plants such as Ginseng, Withania somnifera, Bacopa monnieri, Ginkgo biloba, etc. are some of the medicinal plants for prevention of neurological symptoms. This review deals with the use of different medicinal plants for the prevention of neurodegenerative diseases.

The Proportion of Complementary and Alternative Medicine Utilization Among Saudi Population for Eye Care: Cross-Sectional Study

Purpose

To estimate the prevalence, determinants and perceived benefit of complementary and alternative medicine (CAM) use for ophthalmic purposes among the Saudi population.

Methods

A cross-sectional study was carried out in 2019 targeting visitors of King Khaled Eye Specialist Hospital (KKESH), Riyadh, Saudi Arabia. The survey had 18 questions in Arabic regarding the use of CAM for eye ailments. The magnitude was associated to the demographic and eye-related factors.

Results

We interviewed 999 participants. The prevalence of CAM usage was 21.9% (95% confidence interval 19.3; 24.5). Castor oil (49.3%), antimony (khohl alethmed) (40.6%), chamomile (19.6%), and green tea leaves (11.4%) were the most common medications used. Other traditional eye treatments included eye vitamins, faith healing (prayer, reciting Quran, Zamzam water), cautery, cupping, and acupuncture.

Conclusions

One in five Saudi eye patients used CAM. The factors governing this health behavior should be studied to change this practice pattern.

Pediatric Osteopathic Manipulative Medicine: A Scoping Review

CONTEXT

A common reproach precluding the use of osteopathic manipulative medicine (OMM) in pediatrics is a lack of evidence regarding its safety, feasibility, and effectiveness.

OBJECTIVE

We conducted a systematic, scoping review of pediatric osteopathic medicine to identify gaps in the literature and make recommendations for future research.

DATA SOURCES

We searched 10 databases using 6 key words and medical subject heading terms for any primary articles reporting OMM use in children published from database inception until initiation of the study.

STUDY SELECTION

Articles were selected if they reported primary data on OMM conducted in the United States on patient(s) 0 to 18 years old.

DATA EXTRACTION

Baseline study characteristics were collected from each article and the Grading of Recommendations, Assessment, Development, and Evaluations system was used to critically appraise each study.

RESULTS

Database search yielded 315 unique articles with 30 studies fulfilling inclusion and exclusion criteria. Of these, 13 reported the data required to demonstrate statistically significant results, and no significant adverse events were reported. The majority of studies were graded as providing weak clinical evidence because of significant methodologic flaws and biases.

LIMITATIONS

The review was limited to US-based studies and reports. Minimal discrepancies between reviewers were resolved via an objective third reviewer.

CONCLUSIONS

There is little strong, scientific, evidence-based literature demonstrating the therapeutic benefit of OMM for pediatric care. No strong clinical recommendations can be made, but it can be medically tolerated given its low risk profile. High-quality, scientifically rigorous OMM research is required to evaluate safety, feasibility, and efficacy in pediatrics.

Questionnaires assessing the use of complementary health approaches in pediatrics and their measurement properties: A systematic review

OBJECTIVES

To identify questionnaires assessing the use of complementary health approaches (CHA) in pediatrics, describe their content, and appraise the methodological quality of the studies and the measurement properties of the questionnaires.

METHOD

Major electronic databases were searched from 2011 to 2020. Studies which aimed to assess the use of CHA and studies which reported developing and validating CHA questionnaires in pediatrics were included. Two reviewers independently screened the studies, extracted the data, and rated the methodological quality of the studies and measurement properties of the questionnaires using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. When consensus was not reached, a third reviewer was consulted.

RESULTS

Thirty-eight studies were included. From these studies, 35 CHA questionnaires with a variety of different items were identified. Only two studies aimed to evaluate the measurement properties of two questionnaires. One questionnaire, available as a self- and proxy-report, was initially validated in children with juvenile idiopathic arthritis, and the other, available as an interviewer-administered questionnaire, was validated in children with cancer. According to the COSMIN, the methodological quality of both studies was inadequate or doubtful, and both questionnaires was not thoroughly validated.

CONCLUSION

This systematic review showed a lack of a thoroughly validated CHA questionnaire in pediatrics. However, two questionnaires were found to hold promise. To address this gap, one of the existing questionnaires should be adapted and further validated.

Complementary and Alternative Medicine Use in Children with a Developmental Disability and Co-occurring Medical Conditions

OBJECTIVE

The primary aim of this study was to evaluate differences in the prevalence of complementary and alternative medicine (CAM) usage among children with and without developmental disabilities (DD). Secondarily, the association between CAM usage and comorbid chronic medical conditions was explored among children with DD.

DESIGN

Data come from the 2012 Child Complementary and Alternative Medicine Supplement of the National Health Interview Survey, a nationally representative sample of children in the United States between the ages of 4 and 17 (n = 10,218).Main outcome measures Multiple logistical regression models provided insight into the relationships between parent-report CAM usage, DD, and chronic medical conditions.

RESULTS

Children with developmental disabilities were more likely to use CAMs compared to their typically developing peers (21% vs 16%). Children with DDs and comorbid chronic medical conditions used CAMs at even higher rates (23% vs 18%).

CONCLUSIONS

Results indicated that children with DD, especially those with a co-occurring chronic medical condition, use CAMs more often that typically developing children. Given scarcity of information on safety and effectiveness, clinical providers need to be alert to which children may be more likely to be exposed to CAMs. Communication between parents and providers needs to include discussion of CAM treatments.

Aroma Acupoint Therapy for Symptom Management with Adolescent Patients: Early Experiences from School-Based Health Centers

Objectives: The American Academy of Pediatrics has long recognized a need for more resources for integrative medicine for health care providers and for patients. The aim of this study was to introduce Aroma Acupoint Therapy (AAT)-a relatively new integrative medicine modality using essential oils to activate acupoints-and to describe the early experiences of providers using AAT for adolescents at school-based health centers (SBHCs). Materials and Methods: This was a case series of 15 adolescents treated with 1 of 2 AAT specific protocols plus standard medical therapy between April 2018 and February 2019 at SBHCs. Of these 15 patients, ages 12-19, 14 were female. Clinical characteristics and treatment courses were abstracted by retrospective review of the patients' electronic medical records. The main outcomes and measures for this research were clinical characteristics, treatment courses and pre- and post-treatment pain scores for adolescents treated with AAT. Results: All 15 patients had nonspecific symptoms, including headaches, menstrual cramps, nausea, shortness of breath, chest pain, back pain, or dizziness. Pain scores were recorded in 8 of 15 encounters, and suggested improvements in most patients. Subjective documentation by the providers also suggested that most of these patients had reduced symptoms. Conclusions: With the call for nonopiate and integrative approaches to pain management, there is an urgent need to study the effectiveness of such modalities, such as AAT. It is safe, inexpensive, easy to learn, and is well-received by both health care providers and patients.

Identifying Plant-Based Natural Medicine against Oxidative Stress and Neurodegenerative Disorders

Free radicals and oxidative stress are among the most studied factors leading to the imbalance in mental health. With no exception, free radicals also damage neuronal cells, leading to various degenerative diseases. With existing modern medications, around 80% of the world population relies on herbal medicine for various ailments. Phytochemicals in plants have a wide range of pharmacological properties, the major being their ability to scavenge free radicals. Plant polyphenols are among the major class of antioxidants identified in plants. This antioxidative property of plant compounds and their ability to downgrade the process of oxidative stress can be used to treat neurodegenerative diseases. However, selecting plants and their active compounds is a crucial step in framing the mechanism of action underlying their therapeutic potential.

Integrative Medicine in Child Neurology: What Do Physicians Know and What Do They Want to Learn?

Pediatric neurology patients frequently use integrative medicine; however, providers may feel uncomfortable or unfamiliar with these therapies. Child neurologist attitudes toward integrative medicine and educational needs in integrative medicine have not been assessed. A national, anonymous survey was distributed to Child Neurology residents (n=294) and program directors (n=71) to assess attitudes toward specific integrative medicine modalities, practices in discussing integrative medicine with patients, and perceived need for a curriculum on integrative medicine; 61 (17%) partially and 53 (15%) fully completed the survey. Comparative analyses applied chi-square and independent t tests. Qualitative content analysis was performed on free text responses. Most providers surveyed consider mind and body practices safe (93% of respondents) and effective (84%), but have concerns about the safety of chiropractic manipulation (56% felt this was harmful), and the efficacy of homeopathy (none considered this effective). Few inquire about patient integrative medicine use regularly. Child Neurology residents are interested in further education on this topic.

Use of Complementary Health Approaches for Acute Complaints Presenting to the Emergency Department

OBJECTIVE

This study aimed to determine the prevalence of complementary health approaches (CHAs) specifically for acute complaints in patients assessed in a pediatric emergency department (ED) and factors associated with use.

METHODS

A cross-sectional survey was offered to patients between the age of 28 days and 18 years assessed at a tertiary pediatric ED between December 2014 and July 2015. Univariate and multivariate logistic regressions were used to identify variables associated with CHA use.

RESULTS

Of 475 potential participants, 412 (86.7%) participated, of which 369 (89.5%) completed the survey. Overall, 28.7% (95% confidence interval [CI], 24.3-33.5) reported using any CHA for their child to treat the presenting complaint in the prior 72 hours to the ED visit. Gastrointestinal complaints had the highest use of CHA (46.3% of presentations endorsed use). The most common complementary health products used were vitamins and minerals (40.9%; 95% CI, 31.2-51.4); the most common complementary health practice used was massage (37.2%; 95% CI, 24.4-52.1). Multivariate analysis showed lower odds of using CHA for rash/skin complaint (odds ratio, 0.23; 95% CI, 0.09-0.59; P < 0.01) or musculoskeletal/extremity complaints (odds ratio, 0.23; 95% CI, 0.07-0.75; P = 0.01) compared with use for fever. No statistically significant association was found between CHAs use and child's sex, child's age, private insurance, or caregiver education.

CONCLUSIONS

Caregivers commonly use CHA for acute pediatric complaints requiring an ED visit, with greatest use for gastrointestinal complaints. Clinicians should consider the use and safety of CHA when evaluating children presenting to the ED with acute conditions.

Quality of Life and Health Services Utilization for Spanish Children With Cerebral Palsy

PURPOSE

To examine the health-related quality of life of children with cerebral palsy and its relationship with their use of health resources, taking into account sociodemographic factors concerning the family context.

DESIGN AND METHODS

Cross-sectional study of children with cerebral palsy in Granada (Spain). Quality of life was evaluated with PedsQL questionnaire.

RESULTS

A total of 75 children were analysed (mean age 7.41 years; SD 4.37; 50.7% male). They made an average of 22.80 visits (SD 12.43) per year; greater use was made of resources by children who had been diagnosed with cerebral palsy for <45 months (36.00 vs. 26.93 visits per year, p < 0.0001). Older children suffered more fatigue and pain. Children aged 2-4 years who presented with fatigue had more hospitalizations (r = -0.35; p = 0.20), whereas those >4 years who had a higher quality of life for daily activities had made more visits to hospital A&E (r = 0.35, p = 0.043). Among the children studied, there was no significant association between HRQOL and the parents' education or occupation.

CONCLUSION

These findings highlight variables that may influence children's quality of life and their use of health resources, identifying certain profiles of children who might need individualized interventions.

PRACTICE IMPLICATIONS

These findings could inform services provided by paediatric nurses to children with cerebral palsy, to individualize interventions and improve patient centred care.

Use of Complementary and Alternative Medicine in Children With Tourette Syndrome

INTRODUCTION

Tourette syndrome is a neuropsychiatric condition defined by motor and phonic tics with onset in childhood. Many families have concerns regarding potential side effects of pharmacologic treatments, and often have difficulty accessing comprehensive behavioral intervention for tics. Patients and caregivers may turn to complementary and alternative medicine (CAM) as they perceive these as "natural" and therefore "safe." Although there are anecdotal reports of an increased use of CAM in Tourette syndrome patients, the exact prevalence is unknown.

OBJECTIVE

The purpose of this study was to identify commonly used CAM therapies for children with Tourette syndrome at Penn State Hershey Medical Center.

METHODS

A questionnaire was administered to the caregivers of children (<18 years old) via telephone. The data pertaining to demographics, type of CAM use, duration of use, adverse effects, and caregiver's perception of the effectiveness were collected.

RESULTS

A total of 110 patients participated in this survey. When inquired about the different CAM methods, 69.1% of the participants reported using 1 or more CAM therapies, and 58% of those who used CAM informed the doctor about their use. Ninety-three percent of those who used CAM therapy reported a decrease in tic frequency. The most commonly used CAM therapies were stress management (44.6%), herbal medicine (18.2%), homeopathy (12.7%), and meditation (9.1%). In total, 46% of the participants said that CAM helped more than medication.

CONCLUSION

The majority of patients interviewed were using CAM therapies, and a significant portion reported benefit greater than medication. More than half of all participants discussed CAM therapies with their physicians, and 63% of participants felt that their physicians would support their use of CAM therapies.

Complementary and alternative medicine experiences of mothers in the treatment of infantile colic

Lack of effective medical treatment in infantile colic (IC) causes desperate mothers to apply for complementary and alternative medicine (CAM) treatments. Due to the possibility of benefits, the risks that may be incurred by these methods are often ignored by the parents. Therefore, information on the use of CAM methods in IC is needed. The aim of this study is to reveal the CAM experiences of mothers in IC treatment and the demographic characteristics that affect them. Mothers whose children were diagnosed as IC by a physician in the past were included in the study. The sociodemographic characteristics of the mothers, IC-diagnosed baby characteristics and CAM experiences were investigated face to face with a structured questionnaire. Sixty-six of 96 mothers who participated in the study used the CAM method. There was a statistically significant difference between the use of CAM and the education level of mothers (p < 0.05). We determined that 74% of mothers informed their doctors before starting treatments, and 82% do not believe if the CAM method could cause any harm that they would not notice by observing. The results showed that CAM methods are commonly used in IC treatment. According to these findings, mothers who use these methods believe that they are always harmless and have no side effects. For this reason, physicians should be careful about the adverse effects that may occur due to the CAM methods, which are widely used.

Nutritional traditional and complementary medicine strategies in pediatric cancer: A narrative review

Traditional and complementary medicine (T&CM) strategies are commonly used by pediatric cancer patients. Nutritional approaches to T&CM include bioactive compounds, supplements, and herbs as well as dietary approaches. Pediatric cancer patients and their families commonly request and use nutritional T&CM strategies. We review the potential risks and benefits of nutritional T&CM use in pediatric cancer care and provide an overview of some commonly used and requested supplements, including probiotics, antioxidants, cannabinoids, vitamins, turmeric, mistletoe, Carica papaya, and others. We also discuss the role of specific diets such as the ketogenic diet, caloric restriction diets, whole-food diets, and immune modulating diets. There is a growing body of evidence to support the use of some T&CM agents for the supportive care of children with cancer. However, further study is needed into these agents and approaches. Open communication with families about T&CM use is critical.

Characteristics and Treatment of Pediatric Patients in an Osteopathic Manipulative Medicine Clinic

Context

Osteopathic manipulative medicine (OMM) is recognized as an adjunctive medical approach for the treatment of pediatric patients, but few studies have detailed the pediatric conditions that prompt the use of osteopathic manipulative treatment (OMT) or the types and frequency of OMT used.

Objective

To present descriptive data of pediatric patients receiving OMT from a neuromusculoskeletal medicine/OMM outpatient clinic.

Methods

Data were drawn from electronic health records from a single outpatient specialty clinic for pediatric clinical encounters involving OMT that took place between January 1, 2014, and December 31, 2016. Encounter notes and billing records were reviewed for demographic information, presenting complaints, clinical assessments, somatic dysfunction assessments, OMT techniques used, and payment method. Data were categorized by patient age and analyzed.

Results

Five hundred thirty-seven pediatric patients (321 girls, 216 boys) received OMT during the study. These patients accounted for 1688 clinical encounters (1106 for girls, 582 for boys). Mean (SD) number of encounters was 2.7 (1.3) encounters for boys and 3.5 (1.1) encounters for girls. A higher percentage of patients younger than age 2 were boys, while a higher percentage of patients older than age 2 were girls (both P=.005). Musculoskeletal complaints and assessments were the most common for children aged 6 years and older; misshapen head, feeding difficulties, and colic were the most frequently reported for children younger than 6 years. There were 8557 somatic dysfunction assessments documented; thoracic and cervical somatic dysfunction were most commonly assessed. There were 8485 OMT techniques documented, and myofascial release was most frequently used. Encounters with self-pay patients (n=72) involved fewer somatic dysfunction assessments (P<.001) than encounters with patients using private insurance (n=1060) or Medicaid (n=542).

Conclusion

The electronic health records reviewed in the current study revealed descriptive data of pediatric patients presenting to an OMM clinic; these data were rarely documented in previous literature. They may be used by clinicians to better understand the role of OMM as a pediatric adjunctive medical approach and to identify conditions to target for future outcome studies based on common presenting complaints.

Phytotherapeutic approaches to treatment and prophylaxis in pediatric practice

Medicinal plants, their extracts and herbal medicinal products occupy a growing share of medicines in the pharmacy worldwide.

Historically, the first medicines were products of plants, as well as some of the most important medicines still in use today. With the development of phytochemistry, as part of the pharmaceutical science, great progress has been made in the isolation and in determining the value of a number of biologically active substances (BAS).

Many plants have yielded pure substances (or natural products) that are applied in modern medical practice. Other compounds are potentially useful or have toxic effects.

Traditional medicine incorporating many herbal medicines remains an important (and in some cases, the only) form of treatment in some countries, with increasing use in medical practice.

On the other hand, the fact that in pediatric patients there is a limitation, mainly moral and ethical, of the number of medications to be administered due to the difficulty of conducting clinical trials in children, stimulates the use of herbal medicines of proven quality, effectiveness and safety among this group of patients.

Mental Health Competencies for Pediatric Practice

Pediatricians have unique opportunities and an increasing sense of responsibility to promote healthy social-emotional development of children and to prevent and address their mental health and substance use conditions. In this report, the American Academy of Pediatrics updates its 2009 policy statement, which proposed competencies for providing mental health care to children in primary care settings and recommended steps toward achieving them. This 2019 policy statement affirms the 2009 statement and expands competencies in response to science and policy that have emerged since: the impact of adverse childhood experiences and social determinants on mental health, trauma-informed practice, and team-based care. Importantly, it also recognizes ways in which the competencies are pertinent to pediatric subspecialty practice. Proposed mental health competencies include foundational communication skills, capacity to incorporate mental health content and tools into health promotion and primary and secondary preventive care, skills in the psychosocial assessment and care of children with mental health conditions, knowledge and skills of evidence-based psychosocial therapy and psychopharmacologic therapy, skills to function as a team member and comanager with mental health specialists, and commitment to embrace mental health practice as integral to pediatric care. Achievement of these competencies will necessarily be incremental, requiring partnership with fellow advocates, system changes, new payment mechanisms, practice enhancements, and decision support for pediatricians in their expanded scope of practice.

Natural Products in Neurodegenerative Diseases: A Great Promise but an Ethical Challenge

Neurodegenerative diseases (NDs) represent one of the most important public health problems and concerns, as they are a growing cause of mortality and morbidity worldwide, particularly in the elderly. Despite remarkable breakthroughs in our understanding of NDs, there has been little success in developing effective therapies. The use of natural products may offer great potential opportunities in the prevention and therapy of NDs; however, many clinical concerns have arisen regarding their use, mainly focusing on the lack of scientific support or evidence for their efficacy and patient safety. These clinical uncertainties raise critical questions from a bioethical and legal point of view, as considerations relating to patient decisional autonomy, patient safety, and beneficial or non-beneficial care may need to be addressed. This paper does not intend to advocate for or against the use of natural products, but to analyze the ethical framework of their use, with particular attention paid to the principles of biomedical ethics. In conclusion, the notable message that emerges is that natural products may represent a great promise for the treatment of many NDs, even if many unknown issues regarding the efficacy and safety of many natural products still remain.

Dietary and Supplement-Based Complementary and Alternative Medicine Use in Pediatric Autism Spectrum Disorder

Previous literature has shown that complementary and alternative medicine (CAM) is steadily increasing in autism spectrum disorder (ASD). However, little data is currently available regarding its use, safety, and efficacy in children with ASD. Thus, the purpose of this study is to describe the use of supplement-based CAM therapies in children between the ages of 4 to 17 years with ASD. This population-based, cross-sectional study evaluated children with ASD regarding supplement use. A total of 210 participants were recruited from a variety of sources including educational and physical activity programs, and social media to complete a questionnaire. Primary caregivers provided information on current supplement based CAM use. Data evaluated the proportion of children that used supplement therapies, the types of supplements used, reasons for use, perceived safety, and demographic factors associated with use (e.g., income, parental education, severity of disorder). Seventy-five percent of children with ASD consumed supplements with multivitamins (77.8%), vitamin D (44.9%), omega 3 (42.5%), probiotics (36.5%), and magnesium (28.1%) as the most prevalent. Several supplements, such as adrenal cortex extract, where product safety has not yet been demonstrated, were also reported. A gluten free diet was the most common specialty diet followed amongst those with restrictions (14.8%). Health care professionals were the most frequent information source regarding supplements; however, 33% of parents reported not disclosing all their child’s supplements to their physician. In conclusion, the use of supplement therapies in children with ASD is endemic and highlights the need for further research concerning public health education surrounding safety and efficacy.

Safety of complementary and alternative medicine in children: A 16-years retrospective analysis of the Italian Phytovigilance system database

BACKGROUND

Dietary supplements and homeopathic medicines are largely used in children as complementary and alternative medicine (CAM) to treat different health conditions. Safety of CAM is unknown when they are marketed. This study analysed suspected CAM-related adverse reaction (AR) in pediatric population.

METHODS

The Italian Phytovigilance system was searched for reports of suspected AR related to CAM use in children (0-18 years) from 2002 to 2018. AR reports were evaluated and information about patient's demographic characteristics, suspected CAM, conventional medications, and ARs were collected. In particular, we evaluated whether patient's and CAM characteristics, and concomitant drugs could be potential predictors of ARs seriousness.

RESULTS

We evaluated 206 pediatric CAM-related AR reports, of which 69 were serious. Patients were mostly treated with only one CAM (n = 193), and 39% of AR reports were related to products containing 2-5 components. Most reported ARs were related to dietary supplements (57.18%), and skin and subcutaneous tissue disorders (40.29%) were the most involved System Organ Class. CAM-related AR reported as serious were higher in subjects exposed to homeopathic medicines (ROR 3.13 [1.88-5.22]), to CAM in presence of concomitant medications (ROR 1.77 [1.01-3.10]), to CAM containing 2-4 components (ROR 2.18 [1.13-4.22]), and to more than three concomitant CAM (ROR 7.81 [1.97-32.69]).

CONCLUSION

We provide new insights on factors that might increase the risk of serious AR associated with CAM use in children: products containing more than two components and simultaneously administered with conventional medications can represent a potential risk in children.