Integrating Alternative Medicine and Traditional Treatments

When it comes to health-care services and products for children, there are myriad choices in this country. Even a simple trip to the store for toothpaste can result in excessive time spent scanning hundreds of tubes to find the unique blend that will indeed create whiter, brighter, cavity-free oral health. But the toothpaste aisle pales in comparison to the infinitely more perplexing shelves of herbal supplements, where multi-colored bottles bear pictures of the perhaps unfamiliar, and hopefully beneficial, plants from which they are derived.

In 2003, Nutrition Business Journal estimated the global nutrition market alone to be about $172 billion, and the United States is a primary consumer of these products. Consider that the figure does not include dollars spent on alternative therapies, such as acupuncture, massage and chiropractic, and the implications are staggering. Faced with this glut of complementary health-care products and services, how does the average parent decide what is safe and effective?

“Probably the biggest thing for consumers to realize is that natural does not always mean safe,” says Michelle Bailey, M.D., a pediatrician at Duke University Medical Center and co-director of education for Duke Integrative Medicine. “These botanicals and supplements sometimes do come with side effects people need to be aware of, and there can be interactions with other medicines.”

For example, the herb Gingko biloba can extend bleeding time in patients, so it should be discontinued before surgery. Bailey prefers to use natural remedies whenever possible, and says she hopes that one day all children will have access to care that combines the best of complementary and conventional medicines.

Natural Medicine for Children is a Growing Trend

As consumers in this country take more ownership of their health, they are pursuing complementary and alternative medicine (CAM), not only for themselves, but for their children, too. A 2001 survey of 745 members of the American Academy of Pediatrics found that 87 percent had been asked about CAM therapies by a patient or a parent in the three months prior to the survey. Pediatricians were most often asked about Echinacea, an herbal remedy touted as way to reduce symptoms of the common cold. Other questions concerned dietary supplements such as St. John’s Wort, vitamins and fish oil.

Because CAM is not incorporated into mainstream medicine, parents often navigate health choices with little guidance. “We are acutely aware that parents are using these products and very often do not mention their use to primary care physicians because they are uncertain about the response they will get,” says Hilary McClafferty, a pediatrician and director of the Center for Children’s Integrative Medicine located at the Integrative Health Center of Chapel Hill.

McClafferty also serves on the steering committee of the American Academy of Pediatrics’ Provisional Section on Complementary, Holistic and Integrative Medicine. This section was formed in 2005 to respond to public demand for holistic therapies and to build a body of evidence-based research in the field. As a pediatrician with several decades of experience and a parent who has provided care to her own children, McClafferty is excited about the opportunity to educate families and physicians while also providing integrative health care to families.

Educating Physicians

Most pediatricians (72.8 percent) agree they should offer patients information about all treatment options but report they have little in-depth knowledge of CAM therapies, according to the AAP survey. McClafferty and Bailey both studied under Andrew Weil, M.D., the founder and director of the Program in Integrative Medicine at the College of Medicine, University of Arizona. Weil is at the forefront of the movement to educate consumers and physicians about CAM and incorporate this type of care into the mainstream. Established in 1994, the program trains physicians, medical students, nurse practitioners, pharmacists and allied health professionals on the philosophy and practice of integrative medicine.

At Duke, a pilot program for second-year pediatric residents includes a newly added rotation through pediatric integrative medicine. “If residents understand the importance of having this conversation (about CAM) with families, it will start to break down barriers in the communication gap, and physicians will feel more comfortable with their knowledge-base and be able to counsel families,” Bailey says.

Bridging the Gap

Both McClafferty and Bailey wish to complement care received from a primary pediatrician. McClafferty says she is creating a model that allows time to explore the whole patient and take an in-depth look at nutrition, life stressors and lifestyle issues that contribute to, or impede, good health.

The Integrative Health Center of Chapel Hill offers movement and meditation classes, educational seminars, stress-reduction programs and individualized health programs. A wide variety of clinical services are available, including acupuncture, massage, counseling, integrative medicine consultations and mind-body therapies. The Integrative Health Center has offered mindful meditation through cooperation with the UNC Program on Integrative Medicine (PIM) and also is conducting an ongoing scientific study with the program. The UNC PIM is housed in the Department of Physical Medicine and Rehabilitation at the UNC School of Medicine.

The Duke Center for Integrative Medicine is a 27,000-square-foot building near Duke Forest that includes therapeutic treatment rooms, conference space, fitness facilities, meditation spaces and a kitchen for healthy cooking demonstrations. It also offers a wide variety of therapeutic and educational services.

Both pediatricians aim to bring integrative medicine strategies into the mainstream of pediatric care, and since the Triangle is fertile ground for medicine and research, families here have access to state-of-the-art facilities in this emerging field.

For More Information
Integrative Pediatrics Council * www.integrativepeds.org
National Center for Complementary and Alternative Medicine, National Institutes of Health * http://nccam.nih.gov

Carol McGarrahan is a Triangle-area writer and frequent contributor.Purchasing Quality Nutritional Supplements

Parents take note: All supplements are not created equal. Some companies are more reputable than others. A qualified health professional can offer specific advice on dosage and brand.

General suggestions for purchasing nutritional supplements include looking on the label for:
– The letters GMP (Good Manufacturing Practices);
– Company contact information;
– Expiration date and lot number; and
– A USP (United States Pharmacopoeia’s) seal, which indicates a company has voluntarily agreed to use good manufacturing processes and have some type of quality assurance testing.

When considering dosage, remember that children are not just small adults and talk to your health care provider.FDA Gives Children’s Cold Medicines a Thumbs-Down

Experts suggest natural alternatives A U.S. Food and Drug Administration panel recommended that over-the-counter cold and cough medicines not be used by children younger than 6 because they were found to be ineffective and sometimes harmful. Furthermore, The FDA recommends not using cold and cough medicines in children under 2 years of age unless a health care provider gives specific directions to do so. In response, many companies have voluntarily recalled these products.

At least 45 children died in the United States between 1969 and 2006 after taking decongestants commonly found in cold medications, and 69 died after taking antihistamines, according to the FDA. Reports for 2004-2005 from the U.S. Centers from Disease Control and Prevention show an estimated 1,519 children younger than 2 were treated in emergency rooms for adverse effects associated with cough and cold medications.

Because cold medicines arrived on the scene in the early 1970s, they did not undergo today’s regulatory standards. In light of these dangers, health experts offer the following advice for preventing and treating colds naturally and safely.

Illness prevention:
– Effective hand-washing practices.
– Nutrition that is heavy on antioxidants like those found in citrus fruits, green tea and vegetables
– Adequate rest.
– Good hydration.

Natural care for symptom relief:
– Aromatherapy oils like lavender and chamomile to soothe a child or eucalyptus to relieve congestion. These oils can be added to bathwater.
– A cool-mist humidifier.
– Irrigating sinus passages with a nasal bulb aspirator (for infants).
– Nasal saline drops.
– A teaspoon of buckwheat honey before bed can help calm coughs and enable children to sleep. Honey isn’t recommended for children younger than 1 year old since it may contain toxins that cause botulism.
– Echinacea taken at the first sign of a cold. The dosage should be repeated every two to four hours. Echinacea is a member of the Astor family, so children with allergies should not be exposed to it. Ask your health care provider about proper dosages for children and adults.