Transcript Alternative Medicine

HOLISTIC PEDIATRICS
A Primer
Victor S. Sierpina, MD
Associate Professor of Family Medicine
University of Texas Medical Branch at
Galveston
Susie Gerik, MD
Assistant Professor
UTMB Dept of Pediatrics
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
• 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?
• Alternative
• Complementary
• CAM
• Integrative
• Holistic
• Natural
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: 719724, Jul 2000
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
• 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)
• 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
• Over half would use CAM therapies
personally
• Most were interested in CME on CAM
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)*
• 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
• 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
• 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
• 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
• 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
• 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 Pediatrician
and 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
• Biochemical
• Lifestyle and Mind-Body Therapies
• Biomechanical Therapies
• Bioenergetic Therapies
Therapeutic Mountain
A Model of Care
• Biochemical: medications, herbs,
nutritional supplements
• Lifestyle and Mind-Body Therapies:
nutrition, exercise, environment, mindbody
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?
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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”
• 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
• 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
Integrative Healthcare:
Complementary and Alternative
Therapies for the Whole Person
By: Victor S. Sierpina, MD
FA Davis Philadelphia, 2001
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