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Q: As a parent I have been using complementary medicines for the past three years. I feel healthier as a result and would like to know more about the safety and benefits of these treatments for children.

A: The use of complementary and alternative medicine (CAM) in pediatrics has become more and more popular during the past decade.

In December the American Academy of Pediatrics published a clinical report on this topic, stating that CAM cannot be ignored any longer by pediatricians.

The report says "pediatricians and other clinicians who care for children have the responsibility to advise and counsel patients and families about relevant, safe, effective and age-appropriate health services and therapies, regardless of whether they are considered mainstream or CAM."

(The Canadian Paediatric Society does not have a section dealing with this topic.)

There are definite trends in the education of medical students and pediatricians toward a better awareness of what CAM involves. Recent data show that in the United States, 64 per cent of medical schools reported having CAM curricula. That number is lower for pediatric training programs in Canada and the U. S., but the Canadian Paediatric Society has offered workshops for pediatricians at recent educational events.

By definition, complementary medicine is used in conjunction with conventional medicine. When a child experiences chronic pain, for example, the parents may, in addition to traditional X-rays and other medical tests, take the child in for massage, guided imagery or acupuncture.

Alternative medicine is used in place of conventional western medicine. For example, in an adolescent with depression, herbs may be used instead of an antidepressant.

Some experts in the field suggest the distinction between CAM and mainstream medicine has lessened over the past few years as many practices have undergone rigorous research. For that reason, the CAM terminology has been replaced increasingly with terms such as "holistic" or "integrative" medicine.

To fully understand the scope of the different treatments, Dr. Kathi Kemper wrote The Holistic Pediatrician (Harper Collins, 2002). This model of holistic care defines four main areas: - Biochemical--the use of dietary supplements, vitamins, minerals and herbal remedies. - Lifestyle--nutrition, exercise/ rest, therapies such as heat, ice, music, vibration, light, meditation, hypnosis and biofeedback. - Biomechanical--massage, chiropractic and osteopathic adjustments. - Bioenergetic--acupuncture, magnets, healing touch, prayer and homoeopathy.

A negative perception among the majority of pediatricians is still seen as a major concern for proponents of CAM use in children. Even though more and more robust data from prestigious centres such as Harvard and Yale have been published, most pediatricians remain skeptical--and in some cases passionately hostile --toward CAM.

However, according to the clinical report in Pediatrics, one-third of pediatricians reported they or their families used some type of CAM therapy. Massage therapy was used by 70 per cent; chiropractic care by 21 per cent and acupuncture by 13 per cent.

A Canadian study showed that 11 per cent of children used care such as chiropractic, homoeopathy, naturopathy and acupuncture (that percentage may actually be higher than reported, given that the majority of patients who use CAM fail to inform their pediatricians about it, mostly out of fear that they will be judged negatively).

Parents' reasons for seeking care from CAM providers included: word of mouth, the particular treatment was considered effective, fear of drug adverse effects, dissatisfaction with conventional medicine and the need for more personal attention.
The latter probably gets compounded when pediatricians are not open to having a respectful and clear communication style with families in their practices who seek CAM care.

The use of CAM is most common in patients with chronic conditions such as asthma, attention deficit/hyperactivity, autism, cancer, cerebral palsy, cystic fibrosis, inflammatory bowel disease and juvenile arthritis.

In all fairness to pediatricians who are highly critical of CAM, there is little or insufficient research on the effectiveness of most CAM therapies for many of these conditions. Yet according to a Provisional Section on Complementary, Holistic and Integrative Medicine of the American Academy of Pediatrics, more and more data are showing that although CAM use is increasingly common in children, there have been few reports of serious side-effects.

Many pediatricians are becoming aware of the importance of asking families about their use of CAM--as opposed to waiting for the patients to report it spontaneously. This has become critically important, because some of the therapies (such as herbal remedies) may have bad interactions with conventional medications if used simultaneously.

A major concern regarding some biochemical products used in CAM is that labelling is not always and consistently subject to a high standard. Since regulations differ from those governing pharmaceuticals, there may be concerns about the purity and potency of herbal products and dietary supplements.

Which portion of the plant is used determines its potency--the root, stem, leaves or flowers all deliver different amounts and the time of harvest may lead to inconsistent levels.

Adolescents, desiring independence, autonomy and privacy are more likely to use the Internet as a source for obtaining dietary supplements, which promise relief for conditions such as acne, obesity or enhanced energy and sports performance.

The take-home message on all of this is that CAM use is on the increase and that more research is needed to reduce skepticism among pediatricians. For more information on complementary and alternative medicine, see nccam. nih.gov