It’s what we don’t know that may hurt — CAM in babies and young children

Two recent articles in the journal Pediatrics didn’t make the news, but offer cautions for parents of young children, as well as doctors. Growing numbers of children are being treated for medical problems using alternative modalities, often without the knowledge of their pediatricians, or their well-meaning parents realizing the potential risks.

In the first study, pediatricians at the Université de Sherbrooke, Sherbrooke, Québec, Canada, conducted a cross-sectional study of pediatricians and 114 matching parents of children seen at their pediatric outpatient clinic one month. They found that more than half of the children had been given one or more types of alternative products over the previous year, and 52% were receiving alternatives at the time of their interviews. Most parents were using alternative modalities to treat musculoskeletal problems (27%), psychological problems (24%) or infections (20%). And 8% were giving their children alternatives to treat pain.

Most parents (75%) they interviewed believed that there were no possible adverse effects or interactions that could occur between the alternatives and the prescription medications their children were getting. Of course, there are numerous potential concerns that ideally should be openly discussed with a pediatrican and/or pharmacist for the safety and wellbeing of every child. So, it was especially worrisome that nearly half of the parents were giving their children alternative medicines simultaneously with prescription medications, although only 44% of them had told their child’s pediatrician.

Authors Dr. Dany Jean, M.D., and Dr. Claude Cyr, M.D., FRCPC, said that, according to some studies, complementary and alternative medicine (CAM) was being used in as many as 72% of children with chronic illnesses, such as cystic fibrosis, juvenile arthritis, cancer and asthma. Even children not suffering from any chronic illnesses were being given alternative medicines.

As a heads up to doctors, they raised the concern that most pediatricians (76%) wrongly believe that their patients’ families would tell them if they were using alternative medicines, when in fact, most weren’t, and that pediatricians significantly underestimate the percentage of kids being given these products. They cited recent research showing that most pediatricians wrongly believe fewer than 10% of their patients were being given alternatives.

The most popular types of CAM being given to the children in this study were homeopathy, chiropractic remedies, and naturopathy. The authors acknowledged that their study had found greater use of alternatives than other studies and attempted to learn why parents were using alternatives. In questionnaires, they measured the parents’ satisfaction with medical care and discovered one factor that may make their results not entirely transferable to U.S. pediatricians. A full 21% of parents had resorted to alternatives because of a lack of medical resources in the traditional medical system there. Selection and recall bias and small sample size should also be considered when interpreting this study.

Other factors that had influenced the parents to seek CAM were word of mouth (36%), personal experiences and beliefs of the parents (28%), with many perceiving the therapies as more natural, and an amazing 28% had been referred to alternatives by doctors. The majority of parents giving their children CAM modalities were college-educated, married and employed. These study authors urged parents and pediatricians to communicate more openly about CAM use.

The second study examined the practices of naturopaths in Washington state and the care they provided to children. For those unfamiliar with the training, accreditation and scope of practice of naturopaths, Dr. Stephen Barrett, M.D., wrote a critical overview here.

Naturopaths, who obtain ND degrees from one of five schools in North America, have long concerned the medical profession. As Dr. Kimball C. Attwood, associate editor of the Scientific Review of Alternative Medicine, and Dr. Carl Bartecchi, clinical professor of medicine at the University of Colorado School of Medicine, wrote:

Naturopathic schools... don't teach a recognizable form of medicine. NDs claim that diseases are caused by toxins, allergies, systemic yeast infections, “energy imbalances," dietary sugar, fat, and gluten, spinal misalignments, "craniosacral rhythm" disturbances, and a few other fanciful notions. To diagnose these, they use “applied kinesiology," “iridology," “hair analysis," “electrodermal skin testing," “pulse and tongue diagnosis," and other methods that lack any basis in science or medicine. Treatments include “detoxification" by enemas, fasting, vitamin injections, homeopathy, “craniosacral therapy," inflating balloons in the nostrils to “release tensions stored in the connective tissue and return the body to its original design," arduous dietary regimens, “natural remedies" sold by the ND for a profit, and more. There is a time-honored term for such practices: quackery.

Dr. Morris Fishbein, M.D., who edited the Journal of the American Medical Association and spearheaded the AMA's antiquackery campaign for several decades, equated NDs with faith healers.

This Pediatrics study was conducted by naturopaths and led by Wendy Weber of the School of Naturopathic Medicine in Kenmore, Washington. It sought to examine the practices of NDs caring for children. They found substantiation for some of the concerns of the medical profession.

Weber and colleagues collected 251 surveys from naturopathic physicians (a response rate of 50.3% of the 499 questionnaires mailed out). Only 15% of the NDs they surveyed cared for 5 or more children each week, and many of them were midwives. Pediatric care made up a substantial part of their practice and “based on the ages of children seen and the conditions treated, pediatric NDs may provide the majority of care for some children,” said the authors.

The most common reasons for visiting a pediatric ND included well child visits, upper respiratory tract infections, allergies, skin disorders, and mental health conditions. Of the pediatric ND visits, 24% were for treatment of chronic disorders, especially for care seen by the medical profession as controversial, such as for ADHD, or of limited benefit, as with autism.

Among the office visits by children under 2 years of age, only 18.6% of the children were provided childhood immunizations, and only 27.3% of children 2 to 5 years of age.

“Based on the recommended periodicity for health supervision visits to pediatricians and the current immunization schedule, it is likely that vaccines are provided at greater than 50% of health supervision visits for children under 2 years old to conventional providers. This suggests that there may be ambivalence regarding vaccinations among pediatric NDs and/or the parents of their patients,” said the authors. Previous surveys have found 12 out of 15 NDs do not actively make recommendations for immunizations, they noted.

And, while NDs are licensed to prescribe antibiotics in Washington state, the authors found no antibiotics were prescribed for any of the 65 children presenting with upper respiratory infection symptoms. This compared to another study of Washington pediatricians which found antibiotics prescribed for 46% of patients under 3 years of age presenting with URI symptoms, although some argue antibiotics are overused.

Both studies published in Pediatrics were small surveys, with the inherent precautions of such methodologies, but parents and pediatricians may find them a helpful segue to talk and explore the use of alternatives for the protection of children in their care.