HOLISTIC PEDIATRICS :HOLISTIC PEDIATRICS A Primer


Slide 4:Victor S. Sierpina, MD Associate Professor of Family Medicine University of Texas Medical Branch at Galveston


Susie Gerik, MD :Susie Gerik, MD Assistant Professor UTMB Dept of Pediatrics


Objectives :Objectives To understand pediatricians’ attitudes toward Complementary/Alternative Medicine (CAM) To know the frequency and pattern of use of CAM therapies in the pediatric population To become aware of research being conducted in CAM on pediatric patients


Objectives :Objectives To become familiar with the evidence for and against certain commonly used therapies including issues of risk, harm, treatment delay, as well as benefits To have a resource list of scientific literature, websites, books, and other resources to help answer patient inquiries in this area


Terminology? :Terminology? Alternative Complementary CAM Integrative Holistic Natural


Evidence That Demands a Verdict :Evidence That Demands a Verdict Massage stimulates weight gain in premature infants Scafidi, Field, et al., Infant Behavior and Development 13, 167-188, 1990. Behavioral approaches to reducing infants’ pain during immunization Arch Pediatric Adolescent Medicine 154: 719-724, Jul 2000


Pediatric Pain Management :Pediatric Pain Management Rusy, Weisman, Pediatric Clinics of North America, 47:(3); 589-599, June 2000. Non drug therapies--behavioral interventions Imagery, biofeedback, distraction Suggestion, breathing techniques Acupuncture, TENS Hypnosis, progressive muscle relaxation Magic glove or blanket


Asthma and Warts--more Evidence :Asthma and Warts--more Evidence Improved pulmonary functions in asthmatic children after massage therapy Field, Henteleff, et al. Journal of Pediatrics, 132: 854-88, 1998 Hypnotherapy and imagery removes warts Noll, J Dev Behav Pediatr 15: 17-73, 1994 Spanos, Williams, Psychosomatic Medicine 52: 109-114, 1990


Pediatrician’s Attitudes (See Handout) :Pediatrician’s Attitudes (See Handout) Archives of Pediatrics & Adolescent Medicine article by Sikand and Laken of a survey of 860 pediatricians* Findings: Majority believed only a small percent of patients used CAM Would refer for therapies such as biofeedback, self-help, relaxation, hypnosis, and acupuncture or acupressure *Sikand,A, Laken M, Archives of Peds & Adol Med. 1998;152(11):1059-1064


Pediatrician’s Attitudes :Pediatrician’s Attitudes Over half would use CAM therapies personally Most were interested in CME on CAM


Prevalence of Use of CAM Therapies in Pediatrics :Prevalence of Use of CAM Therapies in Pediatrics Up to 70% of children with severe, chronic, or recurrent illness Cystic fibrosis Juvenile rheumatoid arthritis Cancer (100% used prayer) Use of CAM in acute illnesses not well studied but most likely related to parental use of therapies (over 40% in US surveys)


The Use of Alternative Medicine by Children (Canada)* :The Use of Alternative Medicine by Children (Canada)* 11% of parents (N=2000) reported use of CAM (? underreporting in hospital clinic setting) Higher education in mothers, professionals, parents that used CAM increased use in children 84% of children reported to be using CAM used: Chiropractic Homeopathy Naturopathy Acupuncture *Spigelblatt et al. Pediatrics 1994: 94(6) 811-14


CAM Use in Adolescents :CAM Use in Adolescents Gardiner, Wornham, Current opinions in Pediatrics. 12: 298-302; 2000 Asthma--chiropractic, massage, herbs UTI’s--cranberry Headaches--self-regulatory techniques, acupuncture Athletics--herbs, supplements, ergogenic aids Mental health--massage for bulimia, ADHD


Some Concerns :Some Concerns Most CAM therapies have not been studied in children Use of antioxidants and chemotherapy controversial Delay of proven conventional therapy in favor of CAM may be problematic Dosage of herbs and supplements in children?


University of Arizona :University of Arizona Program in Integrative Medicine NCCAM Center status for research in pediatric conditions including: Recurrent abdominal pain Otitis media Cerebral palsy


Children’s Hospital of Boston :Children’s Hospital of Boston The Center for Holistic Pediatric Education and Research Projects include studies in: Herbs and supplements in cancer Acupuncture for nausea/tonsillectomy, peripheral neuropathy, chronic pelvic pain Echinacea for URI Alternative tx of AOM


Children’s Hospital of Boston :Children’s Hospital of Boston Yoga for anorexia nervosa Arnica and other CAM therapies in ER Surveys of CAM use patterns in several populations, by care providers, and in conditions, e.g. asthma, cystic fibrosis, developmental disability Education in Holistic Pediatrics (see handout)


The Holistic Pediatricianand Other Delights :The Holistic Pediatricianand Other Delights Author Kathy Kemper, MD, MPH of Harvard A parent’s guide to therapy for 25 most common childhood ailments Provides an integrative approach: the best of modern medical science with proven alternative therapies Well referenced. Clear recommendations, prescriptions, and proscriptions


The Therapeutic Mountain :The Therapeutic Mountain Biochemical Lifestyle and Mind-Body Therapies Biomechanical Therapies Bioenergetic Therapies


Therapeutic Mountain A Model of Care :Therapeutic Mountain A Model of Care Biochemical: medications, herbs, nutritional supplements Lifestyle and Mind-Body Therapies: nutrition, exercise, environment, mind-body


Therapeutic Mountain A Model of Care :Therapeutic Mountain A Model of Care Biomechanical Therapies: massage and physical therapy, chiropractic, osteopathic, surgery Bioenergetic Therapies: acupuncture, therapeutic touch, healing touch, laying on of hands, reiki, qi gong, prayer and ritual, homeopathy


And How About ADHD? :And How About ADHD? Feingold diet has mixed reports of efficacy Biofeedback may be useful for up to 10 yrs. Massage has not been fully evaluated TCM/acupuncture useful in small trials No proven herbal or supplement approach Magnesium supplements (200 mg/d) helpful in one study of 50 children in Poland


You Are the “Informed Intermediary” :You Are the “Informed Intermediary” Not all commonly used CAM therapies are safe, effective, or evidence based Obtain some dependable references to be able to counsel patients in this area Do some reading and CME to bring yourself up to speed in your area of expertise (<30 hours required)


Conclusion :Conclusion Emphasize responsible self-care, safe home remedies, appropriate use of conventional therapies Look at this as providing extra options for pediatric patients and their families Behavioral techniques highly safe, useful Communicate, communicate, communicate! LISTEN--LEARN


http://cam.utmb.edu :http://cam.utmb.edu


Integrative Healthcare: Complementary and Alternative Therapies for the Whole Person :Integrative Healthcare: Complementary and Alternative Therapies for the Whole Person By: Victor S. Sierpina, MD FA Davis Philadelphia, 2001 www.B&N.com www.amazon.com Here Now