Pediatricians need to know what alternative treatments their patients are receiving, and need to start asking parents about complementary medicine without judgment, according to a new clinical report from the American Academy of Pediatrics’ (AAP) Section on Integrative Medicine.
“The primary takeaway is the importance of clinicians being well informed. The reality is that many families are using complementary medicine, yet they hesitate to discuss this with their child's clinician for fear of censure or even ridicule,” says lead author Hilary McClafferty, MD, FAAP, associate professor in the department of medicine, co-director of the fellowship in Integrative Medicine, and director of Pediatric Integrative Medicine in Residency at the University of Arizona College of Medicine, Tucson. “A well informed clinician can steer the family towards safe and effective therapies, both conventional and complementary, and help prevent unwanted or unintended treatment interactions.”
Complementary and alternative medicine (CAM) can include a variety of approaches, but is defined as evidence-based therapies developed outside of conventional Western medicine,. Few medical schools teach this approach, with the AAP report referencing just 16 out of 143 pediatric medicine programs teaching integrative medicine. Yet parents are using these therapies, with an estimated 12% of children aged younger than 18 years using some form of CAM, according to statistics from the 2012 National Health Interview Study. Additionally, the study revealed that parents spent nearly $2 billion on CAM for their children in 2012, accounting for 9.2% of out-of-pocket healthcare costs for that year.
Complementary medicine is most often used to promote general wellbeing rather than to treat specific conditions, but it is often utilized for back or neck pain, colds, musculoskeletal conditions, anxiety or stress, and for the treatment of attention-deficit/hyperactivity disorders. Treatments can come in the form of vitamins and herbal or dietary supplements, or physical therapies like chiropractic care and yoga.
Complementary medicine use is particularly popular in children with chronic illness. More than half of children with chronic illness receive some sort of complementary therapy, and usage increases when multiple conditions are present.
Teenagers are the age group most likely to use complementary therapies. While teenagers with chronic conditions embrace these therapies, adolescents also use complementary medicine for weight loss, to increase energy, or to improve athletic performance. Supplements used may include ginseng, zinc, Echinacea, gingko, weight loss supplements, and creatine.
Children of parents who use complementary medicine for themselves are more likely to be offered these therapies, as well. Other predictors of complementary medicine use include parents with higher education levels and income, living in the Western United States, and having a high number of physician visits in the preceding year. Parents are willing to disclose CAM use when patient-centered communication is in place with their practitioner and if the clinician specifically asks.
Although usage rates of complementary medicine among minorities are low, it may be a matter of underreporting rather than low use.