Please be careful out there — supplements for sick children

Growing numbers of children and teens are taking alternative supplements and most parents and healthcare professionals believe them to be completely safe. Two recent studies of children in the hospital alert us to the need for both parents and healthcare professionals to take extra care to be aware of potentially harmful reactions with natural remedies.

The first study was conducted by physicians at a large pediatric emergency room in Toronto, Canada, led by Dr. Ran D. Goldman, M.D., at British Columbia Children’s Hospital in Vancouver. These researchers had previously found that 49% of the children visiting their emergency room used some type of alternative therapy. This had concerned them given the adverse reactions that have been identified with some, such as intracerebral hemorrhage with ginkgo biloba. For this paper, trained researchers conducted interviews of a randomized sampling of 1,804 parents of children registered in their emergency room. They obtained demographic information, chronic illnesses and the use of prescription and over-the-counter (OTC) medicines and natural health products. The average age of the children was 5.2 years.

Forty four percent of the children had been given prescription medications during the past 3 months and 26% also used OTC medications (i.e. tylenol). As many as 810 of the children had seen an alternative practitioner or used a natural remedy, with 20% of the patients using natural remedies concurrently with conventional medications, and 15% taking more than one natural remedy. Children with chronic illnesses were more likely to be taking more medications and natural remedies, increasing the risks for interactions.

Using three different medication databases and published reviews, the researchers identified potential drug interactions and found 285 children (16%) were taking natural remedies that risked potentially adverse reactions with the conventional medications they were on. These weren’t necessarily minor reactions, as a full 25% risked increased bleeding, for example, which could have serious consequences for children needing surgical procedures. Other possible adverse reactions included blood sugar abnormalities, central nervous system problems, liver toxicity, potentiate/inhibit medications or absorption of vitamins and nutrients, or affecting the accuracy of lab tests. Some potential interactions were serious and potentially life threatening, they said, such as the combination of warfarin and St. John’s Wort.

Most parents believed the natural remedies were safe, they found, with only 15% of the parents who were giving their children alternative remedies believing they could be potentially harmful.

What may be surprising is that CAM (alternative modalities) use rose with increasing education levels in both the mothers and fathers — 74% of the children receiving alternative remedies had mothers with college or advanced university educations — and the higher-educated parents represented even more of the children with potentially harmful interactions.

They also found that many medical students and doctors in New York asked their patients about their use of alternative modalities but rarely checked them in a reference text for potential adverse reactions, highlighting the need for immediate access to such reference materials. While this study was only conducted at one major pediatric emergency center and the precise prevalence may not apply to other institutions, the overall problem it identified can serve to alert parents and healthcare professionals of these risks.

But a study in Pediatrics was perhaps more worrisome as it revealed possible risks for sicker children admitted to the hospital. Little is known about the safety of supplements for children in the hospital and there are few pediatric clinical trials on their use. So, Harvard Medical School researchers examined the policies concerning in-hospital herbal and dietary supplement use in a cross-sectional sample of children’s hospitals. Only 59% of the eligible children’s institutions responded, but revealed considerable inconsistencies in policies. Only 44% had written policies in place at all on the use of over-the-counter vitamins and minerals, herbs and other supplements.

Only 2% of the hospitals included herbals on their formularies and just over a third included dietary supplements. Even so, most (84%) let patients take their home supply, two-thirds of hospital staff was allowed to make recommendations for supplements, and in 70% of the hospitals, the nurses even stored and administered the home supply of supplements. Less than a third of the surgical preoperative procedures mentioned supplement use prior to surgery. And less than half (46%) required documentation that drug or dietary supplements interactions had been checked for, with 14% having no formal or specified procedures in place for checking supplements for possible interactions.

This study, too, didn’t attempt to identify and quantify actual adverse events, but serves to caution parents and healthcare professionals that we all need to be more careful about checking the safety of supplements before administering them to sick children and to make sure healthcare providers know what each child is taking that might potentially put them at risk or complicate their care.