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January 22, 2013

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Alternative medications may be beneficial for many children either along or complementary to prescription medication. However, due to the many sides effects and drug interactions that could potentially harm a child, it is important to discuss these with the child's pediatrician. Also, physicians need to ask whether or not parents have used aromatherapy, or relaxation techniques as the parents may not be aware this is an alternative option.

I like that they were able to show differences from the region of the country for incorporation of CAM. I think that it would be interesting to compare a Western Canada Children's population to a Western United States Children's population and see if there is any correlation, as well as comparing central to central between the two countries. I wonder if training for CAM is incorporated in training for Pediatricians in Canada how does that extent of training differ from the United States. I would have like to seen the vaccination rate comparisons between the two groups. Also, 43% knew that there insurance covered CAM, I believe that rate would be well above what we see in the United States.

It's only the natural progression based on the way society is thinking these days. People are trying to lean more towards 'natural' medicines - and we all know that word can lead to so much trouble. Further, the fact that many of these other therapy options haven't been studied in children adds to the risk of unknown effects, unknown dosing parameters, etc. As will prescription drugs as well, it's obviously difficult to conduct trials on a young population. Hopefully, parents have conversations with their pediatricians and keep them in the loop, while health care practitioners do their best offer appropriate advice.

I have seen more parents asking for integrative remedies for their children. This may be due to the fact that many OTC drugs cannot be used in younger children. I have also seen more parents giving their children multivitamin gummies and probiotics. It seems that parents are more willing to try integrative therapy to boost their children’s immune system. Parents should keep in mind that they do need to discuss all integrative therapy with their child’s physician to ensure there are no interactions.

I always thought in western societies people geared more towards medications and visiting the pediatrician rather than going towards alternative medicine in children. Therefore this article was very interesting, the study was preformed in two hospital outpatient clinics located in Canada(Edmonton and Ottawa). Edmonton had more cases of complementary/ alternative medicine use compared to Ottawa. It is very important that the physicians are aware of the complementary/ alternative medicine use to prevent any adverse effects and drug interactions among pediatric patients.

I think that integrative health practitioners and conventional health practitioners should have some sort of discussion about what is available for children. My nurse practitioner recommended my sister bring her infant daughter to a chiropractor to help with her colic. I had never heard of such a thing, and the idea of it made me nervous, even though I visit a chiropractor on a regular basis. When I asked him about working on small babies like that, he was somewhat horrified it had been suggested. It requires specific training, and nobody in our rural are is qualified to do as such.

This study stated that 85% of people surveyed gave their children vitamins/minerals. Information about many vitamins and minerals certainly is not lacking, especially when it comes to drug interactions and adverse effects. Parents may never consult a provider about a vitamin or mineral because the parent does not think any harm will come to the child from these products despite the fact that even vitamins and minerals can be dangerous in children and adults. I think it is the responsibility of the provider to not only ask their patients about integrative medicine they may be using, but to also develop good relationships with their patients so they feel comfortable consulting and being honest with providers. If the providers never ask then patients may never tell.

Integrative therapy should be used along with western medicine in children but these therapies need to be discussed with the child’s doctor. The study showed that 65.2% of patients who were taking a prescription drug and using CAM consulted with their physician and 41.9% consulted with a pharmacist. I think it would be really interesting to know why physicians or pharmacists were not consulted. Was it because the parents didn’t think the physician/pharmacist were knowledgeable about CAM products, that they wouldn’t be accepting of the parent’s choice or that they assumed all CAM is safe so why should they consult a physician? Physicians and pharmacists need to figure out why parents are not consulting them about CAM. This will help us figure out what needs to be changed so that hopefully in the future more parents will know to talk with their doctor/pharmacist about CAM.

I think the comments on this blog are almost as interesting as the topic of the blog itself. In my opinion, "lack of scientific evidence in children" doesn't give the parents an exemption from mentioning and/or discussing the alternative therapies they are using (or considering using) for their children with the pediatrician. Although it is ultimately the parents decision whether to have their child participate in alternative medicine therapies or not, a well-informed decision is of the utmost importance. It scares me to think that parents out there are basing their children's wellbeing on information from potentially bias and non-reputable online sources. Even if the doctor lacks knowledge on the alternative medicine of interest, they are trained to find reliable, trustworthy data in order to formulate a well-informed decision. I would always encourage honesty with one's physician!

I think using integrative therapy for children with certain disease states can be a wonderful addition to their current healthcare treatments, so long as the parents are responsible and keep all of their healthcare providers involved and up to date. I have a parent who is often in my pharmacy picking up antibiotics for her son who has chronic sinus issues, and she uses integrative therapies for her son. He sees an integrative provider who oversees his dietary regimen (due to many side effects of being on antibiotics long term) as well as prescribes dietary supplements for him. This type of therapy works very well for this particular family because the mother is very proactive about ensuring there are no interactions with his dietary supplements and other medications, and that each of her son's healthcare providers are aware of what the others are doing.

To add to my earlier comment, an additional reason that I feel a bit uneasy about integrative/CAM therapy use in children is related to the “events” project that students on rotation at Natural Standard participate in. While searching for events related to these therapies, it is almost always recommended that you seek out therapy from a practitioner who is registered or certified to administer the therapy. So, even if parents and children disclose information to their healthcare providers about using these therapies, will it necessarily help prevent side effects or dangerous effects experienced by children if their healthcare providers are not necessarily well-trained in those therapies (in terms of how to administer them, how they work, their safety, etc.)? I’m not so sure.

In my opinion, it’s tough to make the point that children and parents must discuss their integrative therapy use with their healthcare providers in order to prevent potential adverse effects. This is because while completing my audio recordings for Natural Standard’s Bottom Line Monographs for herbs and supplements, I have noticed that it is almost always stated that the CAM therapy is not recommended for use in children due to lack of scientific data. So, even if parents and children do let their healthcare providers know about all of their therapies, why will it necessarily help prevent bad effects associated with them, if they are not necessarily considered to be safe in children? Wouldn’t it maybe be better sometimes (in some cases) to simply recommend against them? I think the 80 reported integrative therapy-related adverse effects from the study are another good reason to question this.

In regards to the previous comment, I agree that making providers aware of all therapies including CAM therapies is the first step towards assuring safe and effective use. However, even if the parents did tell their health care provider about using alternative medicine in their children, I would imagine it would be difficult for the provider to give a strong recommendation about the therapy in many cases due to lack of data. This lack of data in younger populations is even an obstacle in recommending prescription therapies to children.

I wonder why the discrepancy between the western hospital vs. the central hospital? Almost 30% difference in CAM use is monumental and intriguing to think about... does the community studied in the west have ancestral roots in Europe and Asia where alternative medicine is much more commonly used? Are there more alternative medicine practitioners in western Canada? Are there different rates of vaccinations between the two hospitals? Are doctors better about communicating with patients about the use of alternative medicines at one place over the other? What is it? Any other suggestions? I'm very interested to hear what others come up with!

I think it is extremely important for parents to understand the necessity of telling healthcare providers, including pharmacists about medications they have their children on besides ones recommended to them. I think it is also important for healthcare providers to report adverse events not only with prescription medications but also with herbal and dietary supplements so that information can start to be gathered about the safety of these remedies to better educate healthcare providers as well as the consumer.

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