Children and natural health products: what a clinician should know

Question 1

What is complementary and alternative medicine (CAM)?

Answer 1

broad domain of healing resources that encompass all health systems, modalities and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period

Question 2

What is a natural health product (NHP)?

Answer 2

manufactured, sold, or represented for use in the diagnosis, treatment or prevention of a disease or disorder and for restoring or correcting organic functions or maintaining and/or promoting health

Question 3

What do NHP encompass?

Answer 3

1. Homeopathic preparsations
2. Susbtance or substances used as traditional medicine (e.g. Chinese, Ayurvedic, or North American Aboriginal)
3. Mineral or a trace element, a vitamin, an amino acid, an essential fatty acid, or other botanical-, animal-, or microorganism- derived substance

Question 4

What is homeopathy?

Answer 4

The principle of similtude where treat like with like. The active preparation is made by diluting the agent and rapidly agitating the dilutions (succussion) with greater dilution equaling greater potency.

Question 5

What is Traditional Chinese Medicine (TCM)?

Answer 5

Emphasized the importance of Qi, whose action manifests as all life phenomena, including physical, mental and spiritual aspects. Disturbances in Qi manifest as disease.

Question 6

What are the main modalities of TCM?

Answer 6

1. Acupuncture/acupressure
2. Traditional Chinese herbal remedies
3. Traditional Chinese dietary therapy
4. Traditional Chinese and natural health products
5. Chinese exercise therapy
6. tuna massage
7. traditional Chinese diagnosis

Question 7

What is chiropractic treatment?

Answer 7

Subluxation, a complex of functional and/or pathological articular changes that compromise neural integrity and may influence organ system functions and general health.

Question 8

What populations have higher rates of NHP use?

Answer 8

up to 70%

1. children with arthritis
2. children with cancer
3. children with rheumatoid arthritis
4. children with CF
5. hospitalized children
6. adolescent girls with eating disorder 30%
7. homeless youth

Question 9

What are some indications for vitamin A?

Answer 9

158 RCTs

1. measles
2. respiratory conditions
3. GI (diarrhea) conditions
4. HIV
5. anemia

Question 10

What are some indications for vitamin B?

Answer 10

20 RCTs

1. anemia
2. protein loss
3. anticonvulsants
4. muscular dystrophy

Question 11

What are some indications for vitamin C?

Answer 11

24 RCTs

1. autism
2. ADHD
3. URTI
4. Oral health conditions

Question 12

What are some indications for vitamin E?

Answer 12

34 RCTs

1. premature birth
2. low birth weight

Question 13

What are some indications for magnesium?

Answer 13

12 RCTs

1. autism
2. asthma

Question 14

What are some indications for folic acid?

Answer 14

14 RCTs

1. diarrhea
2. leukemia
3. rheumatoid arthritis
4. hemoglobinopathies

Question 15

What are some indications for zinc?

Answer 15

45 RCTs

1. abnormal growth
2. diarrhea
3. recovery from malnutrition

Question 16

What are some indications for Chinese herbal medicine?

Answer 16

20 RCTs

1. liver conditions
2. respiratory conditions
3. eczema
4. diarrhea
5. asthma

Question 17

What are some indications for homeopathy?

Answer 17

9 RCTs

1. Pain
2. Warts
3. Adenoids
4. Diarrhea conditions
5. Respiratory conditions

Question 18

What are some concerns regarding NHP?

Answer 18

1. Poor standardization
2. Dosage
3. Drug-herb interactions

Question 19

What are recommendations for counseling families who choose complimentary and alternative medicine (CAM)?

Answer 19

1. Ask about use, inquiring does not equal endorsing use
2. Try to have a non-judgmental attitude
3. Seek information for yourself and be prepared to share it with families
4. Evaluate scientific merits of specific therapeutic approaches
5. Identify risks or potential harmful effects (including opportunity costs, whereby known effective therapies are not pursued, and possible financial burden)
6. Provide families with information on a range of therapeutic options (avoid therapeutic nihilism)
7. Educate families to evaluate information about all treatment approaches
8. Avoid dismissal of alternative therapies in a way that communicates a lack of sensitivity or concern for the family’s perspective
9. Recognize feeling threatened and guard against becoming defensive
10. Offer to assist in monitoring and evaluating the patients in ongoing follow-up

Question 20

What are some first principles to review with regards to CAM in children?

Answer 20

1. First, do no harm
2. Ensure no opportunity cost e.g. delay in treatment of a serious illness for which there is known effective therapy
3. If the CAM therapy carries little risk of harm, then consider its use and follow the patient closely;
4. If the CAM therapy carriers serious risk of harm, advise the patient accordingly and follow the patient closely
5. Where possible, it is recommended to try to follow an evidence-based rationale for therapy, and
6. Where evidence is lacking, try to maintain an open and and a balanced approach. The use of CAM is a patient-led phenomenon
7. If we are to counsel patients about the potential risks and benefits of CAM, we have to engage them in meaningful discussion that is based on reason and evidence, not prejudice or emotion