COMMENTARY

Integrative Medicine in Pediatrics: An Overview of What We Know

Maria R. Mascarenhas, MBBS

Disclosures

July 09, 2018

Editorial Collaboration

Medscape &

Hello. I am Dr Maria Mascarenhas, the medical director of the integrative health program at the Children's Hospital of Philadelphia. I am delighted today to talk to you about integrative therapies.

Integrative therapies are increasingly popular. Part of the popularity is due to the many benefits that we are realizing from these therapies, but also because our patients want this. As healthcare providers, it is very important that we familiarize ourselves with it so that we can provide better care.

I like this definition of integrative health provided by Dr Kathi Kemper and colleagues: "relationship-centered care that focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals, and disciplines to achieve optimal health and healing."[1]

We used to use the term "complementary and alternative medicine (CAM)." We get integrative medicine when we combine those CAM therapies that have evidence with traditional medicine.

The National Center for Complementary and Integrative Health describes three types of complementary health approaches. The first is natural products, which covers herbals, vitamins, minerals, and probiotics. The second is mind-body practices, which covers yoga, chiropractic manipulation, osteopathic manipulation, massage, acupuncture, and tai chi. The third includes traditional healers, traditional Chinese medicine, homeopathy, and naturopathy.

I would like to talk a little about how often these therapies are used. For this, we can use data from the National Health Interview Survey, conducted in 2007[2] and 2012[3]; the 2017 survey is being analyzed as we speak.

Looking at results from both 2007 and 2012, about 12% of children in the United States under the age of 18 years had used these therapies in the past preceding 5 years. The most common indications were back or neck pain, chest or head cold, other musculoskeletal conditions, anxiety, stress, attention-deficit disorder, and attention-deficit/hyperactivity disorder. In general, parents use this to treat a specific condition rather than for general well-being. This is different from adults, who use these therapies more for general well-being than to treat specific conditions.

The most common modalities used, reported in the 2012 survey, were non-vitamin, non-mineral dietary supplements like herbals and probiotics, osteopathic manipulation, chiropractic manipulation, yoga, tai chi, and Qigong.

Other studies have shown that, even in infants, the use of botanical supplements and teas in the first year of life is as high as 9%.[4] If you look at studies in children with chronic disease, the use of integrative therapies can be as high as 70%, depending on whether you look at studies from the US or from Canada.[2,3,5,6]

What are the predictors for the use of complementary medicine or integrative medicine? Parental use of these therapies definitely is a major factor.[7] If parents are more likely to use these therapies, then children will also be exposed to them. The other factors are higher parental education, higher family income, living in the Western United States, and a higher number of physician visits in the preceding year.

Specific Therapies: Who Uses What?

Next I will talk about specific therapies and [the circumstances in which they are] used most often.

Acupuncture. There is good evidence [for use] in patients with pain, nausea, and headaches, especially migraine headaches. While there is some evidence for use of this modality in pediatric patients, it is mostly emerging information. There is better information in adults. For pediatrics, more research would be great.

Aromatherapy. This therapy is very popular nowadays. The evidence would suggest that it can be used for relief of pain and anxiety, and for enhancement of energy. There are some data on use for memory, relaxation, and relief of eczema-induced itching. Lavender, peppermint, ginger, and mandarin can be used for the conditions I mentioned. Ginger and peppermint are really good for nausea.

Mind/body medicine. Modalities typically used are biofeedback, clinical hypnosis, guided imagery, mindfulness meditation, music therapy, yoga, and pet therapy. Some of the conditions treated include acute and chronic pain, anxiety, stress, dysfunctional voiding, enuresis, constipation, encopresis, sleep disorders, habit disorders, attention-deficit disorder, asthma, obesity, diabetes, inflammatory bowel disease, irritable bowel syndrome, and cancer.

Yoga. Yoga is also very popular and is now being taught in some schools with children as young as preschool age. The beauty of yoga is that it not only helps with breathing and regulation of the autonomic nervous system, but you also get the physical activity and the mindfulness components, which is also the case with tai chi. With one modality, you get more bang for your buck, so to speak. In pediatric patients we know that there are benefits primarily with pain, emotional and behavioral conditions, physical activity, and breathing. Data have shown improved academic performance, self-esteem, classroom behaviors, concentration, and emotional balance in school-age children.

Mindfulness. This therapy has many benefits. When we look at the data so far, we know that use in school-age children is linked with fewer behavior problems and [less] aggression. Children have improved happiness and ability to pay attention. Use of mindfulness therapy by teachers is associated with better hypertension control, less negative emotion, fewer symptoms of depression, and greater compassion and empathy. Parents who practice mindfulness are happier with their parenting skills and relationship with their children, who also have better social skills. Last, healthcare providers who practice mindfulness are better at coping with stress, are able to better connect with their patients, and improve their general quality of life.

Natural products. There are many benefits to herbs, vitamins, minerals, and probiotics. For probiotics, there are very specific conditions where they can be used. The hardest thing is to recognize good-quality products. Because I believe in the benefit of herbs, I encourage my patients to add it to their food. The cornerstone—the one thing that should be emphasized from the get-go—is nutrition. Nutrition is the biggest integrative therapy and the one that helps not only with all of the things we talked about, but also with growth and healthy lifestyles, which is very important for our pediatric patients. As pediatric healthcare professionals, we need to help our children establish good, healthy habits, because whatever they learn now will help them throughout their life.

Integrative Therapy for Gastric Conditions

I wanted to talk briefly about a couple of specific conditions. Since I am a pediatric gastroenterologist, we can talk about inflammatory bowel disease (IBD). Right now, the cornerstone for treatment of IBD is really medications. However, we have wonderful evidence of how diet, especially the elimination of chemicals, preservatives, emulsifiers, and dyes, can help control disease. There are great data on the use of probiotics and some herbs, especially curcumin. I think that is a very nice way of integrating [these strategies] along with cognitive-behavioral therapy to help manage your patients.

For children with irritable bowel syndrome, diet is a cornerstone. There are many studies in adults showing the benefit of the [low-]FODMAP diet, a gluten-reduced diet, lactose-reduced diet, avoidance of certain sugars, etc. There are some nice data on probiotic use, biofeedback, yoga, mindfulness, and clinical hypnosis.

You get the flavor for how you can try to manage your patients with a variety of therapies.

I hope that you have learned about some new ways to integrate these therapies into the management of your patients. Thank you for your attention. Have a wonderful day.

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