Integrative Medicine for Children

530 Pages·2008·8.27 MB·English

by  May Loo MD

11830 Westline Industrial Drive
St. Louis, Missouri 63146
INTEGRATIVE MEDICINE FOR CHILDREN ISBN: 978-1-4160-2299-2
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
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Notice
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our
knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers are advised
to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product
to be administered, to verify the recommended dose or formula, the method and duration of administration, and
contraindications. It is the responsibility of the practitioner, relying on their own experience and knowledge of the
patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all
appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Editors assume any liability
for any injury and/or damage to persons or property arising out of or related to any use of the material contained in this
book.
The Publisher
Library of Congress Cataloging-in-Publication Data
Integrative medicine for children / [edited by] May Loo.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4160-2299-2 (hardcover : alk. paper) 1.
Children--Diseases--Alternative treatment. 2. Integrative medicine.
I. Loo, May, 1946-
[DNLM: 1. Complementary Therapies--methods. 2. Adolescent. 3.
Child. 4. Infant. WB 890 I6084 2009]
RJ53.A48I58 2009
618.92--dc22
2008020998
Vice President and Publisher: Linda Duncan
Senior Editor: Kellie White
Senior Developmental Editor: Jennifer Watrous
Editorial Assistant: April Falast
Publishing Services Manager: Patricia Tannian
Project Manager: Jonathan M. Taylor
Designer: Amy Buxton
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
This book is dedicated to all the healthcare professionals who wish to broaden
their knowledge for the well-being of children, to all the loving parents who seek
safe and comprehensive care for their children, and especially to all children
throughout the world who deserve to live healthy and happy lives.
Contributors
Matthew I. Baral, ND Stephen Cowan MD, FAAP
Naturopathic Physician Clinical Instructor
Assistant Professor, Pediatrics Department of Pediatrics
Southwest College of Naturopathic Medicine New York Medical College
Tempe, Arizona Valhalla, New York
Founder
Jane Carreiro, DO The Holistic Developmental Center for Children
Associate Professor and Chair Mt. Kisco, New York
Department of Osteopathic Manipulative Medicine Cofounder
College of Osteopathic Medicine Riverside Pediatrics
University of New England Croton, New York
Biddeford, Maine
Timothy Culbert, MD
Maria Choy, MD, FAAN Medical Director, Integrative Medicine Program
Attending Physician, Neurology Children’s Hospitals and Clinics of Minnesota
CentraState Medical Center, Minneapolis, Minnesota
Affiliate of Rutgers University
Freehold, New Jersey Lana Dvorkin-Camiel, PharmD
Attending Physician, Neurology Associate Professor of Pharmacy Practice Director
Bayshore Community Hospital Applied Natural Products Programs Natural
Holmdel, New Jersey Products Division
Vice President Coordinator
New Jersey Chapter of the American Academy Center for Drug Information and Natural Products
of Medical Acupuncture Massachusetts College of Pharmacy and Health Sciences
Morganville, New Jersey Boston, Massachusetts
Effie Poy Yew Chow, PhD, RN, LicAc(CA), Lynda Richtsmeier Cyr, PhD, LP
DiplAc(NCCAOM), Qigong Grandmaster Program Lead, Pediatric Psychologist
Founder and President Integrative Medicine
East West Academy of Healing Arts Children’s Hospitals and Clinics of Minnesota
San Francisco, California Clinical Instructor
Behavioral Pediatrics Program
Agatha P. Colbert, MD Department of Pediatrics
Senior Investigator University of Minnesota
Helfgott Research Institute Minneapolis, Minnesota
National College of Natural Medicine
Clinical Research Assistant Professor Maura A. Fitzgerald, RN, MS, MA, PCNS-BC
Family Medicine Clinical Nurse Specialist
Oregon Health and Science University Integrative Medicine Program
Portland, Oregon Children’s Hospitals and Clinics
Minneapolis, Minnesota
Paula M. Gardiner, MD, MPH
Assistant Professor
Department of Family Medicine
Boston University Medical Center
Boston, Massachusetts
vii
viii  Contributors
Russell H. Greenfield, MD David Rindge, DOM, LAc, RN
Director Center for Cooperative Medicine, PA
Greenfield Integrative Healthcare Healing Light Seminars, Inc.
Charlotte, North Carolina Melbourne, Florida
Clinical Assistant Professor
University of North Carolina–Chapel Hill School of Medicine Deborah Risotti, RN
Chapel Hill, North Carolina Private Consultation
Visiting Assistant Professor Pediatric Medical Education and Advocacy
The University of Arizona College of Medicine North Reading, Massachusetts
Tucson, Arizona
Detlef Schikora, DR.sc.nat.
Tobin Hart, PhD Faculty of Science
Professor Institut for Biophotonics
Department of Psychology University of Paderborn
University of West Georgia Paderborn, Germany
Carrollton, Georgia
Anne Spicer, DC, DACCP
Janet L. Levatin, MD Associate Professor, Clinical Mentor
Clinical Instructor Bloomington Natural Care Center
Department of Pediatrics Northwestern Health Sciences University
Harvard Medical School Bloomington, Minnesota
Boston, Massachusetts
Private Practice Anna Tobia, PhD
Brookline, Massachusetts Psychologist
Jefferson Myrna-Brind Center for Integrative Medicine
Gerhard Litscher, MSc, PhD, MDsc Thomas Jefferson University Hospital
Professor Philadelphia, Pennsylvania
Research Unit of Biomedical Engineering in Anesthesia and
Intensive Care Medicine and TCM Research Center Graz Catherine Ulbricht, PharmD
Medical University of Graz Founder
Graz, Austria Natural Standard Research Collaboration
Cambridge, Massachusetts
Jack Maypole, MD Senior Attending Pharmacist
Director of Pediatrics Massachusetts General Hospital
South End Community Health Center Boston, Massachusetts
Boston, Massachusetts
Assistant Professor of Pediatrics Jennifer Woods, BS
Boston Medical Center Editorial Assistant
Boston University School of Medicine Natural Standard Research Collaboration
Boston, Massachusetts Cambridge, Massachusetts
Mary C. McLellan, BSN, RN, CMT, CPN Alan D. Woolf, MD, MPH
Massage Therapy Director Associate Professor
Integrative Therapies Team Pediatrics
Staff Nurse III, Education Coordinator Harvard Medical School
Inpatient Cardiology Boston, Massachusetts
Cardiovascular Program Director, Pediatric Environmental Health Center
Children’s Hospital General Pediatrics
Boston, Massachusetts Children’s Hospital
Boston, Massachusetts
Randall Neustaedter, OMD, LAc, CCH
Classical Medicine Center Joy A. Weydert, MD, FAAP
Redwood City, California Integrative Medicine and Pain Management
Department of Pediatrics
Karen Olness, MD, FAAP Children’s Mercy Hospital
Professor of Pediatrics Assistant Professor
Family Medicine and Global Health University of Missouri–Kansas City School of Medicine
Case Western Reserve University Kansas City, Missouri
Cleveland, Ohio
Contributors ix 
Mark Wright
Contributing Author
Natural Standard Research Collaboration
Cambridge, Massachusetts
Chinese Herb Consultants
Harriet Beinfield, LAc
San Francisco, California
Jake Paul Fratkin, OMD, LAc
Boulder, Colorado
Efrem Korngold, OMD, LAc
San Francisco, California
Preface
A powerful reference tool for pediatricians and complemen- As CAM therapies become more acceptable in mainstream
tary and alternative medicine (CAM) practitioners, Integrative medicine, Integrative Medicine for Children can be used as
Medicine for Children accumulates the best practices of experts a textbook to provide a wider breadth of training for future
in the field, offering conventional medical treatment blended practitioners.
with appropriate CAM therapies. Parents can also use this
versatile guide for practical recommendations on using CAM Why Is This Book Important to Healthcare 
therapies for specific childhood conditions. Professionals?
Current trends favor enhanced cooperation among various
Conceptual Approach healthcare professionals and the integration of CAM therapies
Following the success of Pediatric Acupuncture (Churchill Liv- into conventional medical treatments. However, the reality is
ingstone, 2002), a reference integrating Western medicine with that it is difficult for any one conventional or CAM practition-
acupuncture, Integrative Medicine for Children answers the call er to comprehensively learn the nuances of other disciplines.
for a manual that addresses the broader scope of CAM thera- Providers now can turn to this book for a single, concise vol-
pies in relation to conventional treatments. As more practition- ume covering the basics of major CAM fields and applicable
ers and parents look to CAM to treat pediatric conditions, modalities.
the need for an authoritative reference encompassing both The significance of this unique, encyclopedic, and integra-
conventional Western medicine and major CAM therapies is tive reference book is evident as pediatricians and parents seek
evident. more collaborative treatment plans for children, especially dif-
ficult conditions that are not responsive to one particular type
Organization of treatment. Integrative Medicine for Children will hopefully
lead to increased communication among practitioners.
The first section of Integrative Medicine for Children presents
Integrative Medicine for Children is based on the cooperative
the history, theory, current evidence-based information, appli-
and diligent efforts of more than 30 expert contributors, who
cations, and contraindications on various CAM therapies.
provide erudite information and share their personal, clinical
The second section serves as a focused reference for 55
experiences for the enhancement of healthcare for children.
chronic and acute pediatric conditions, featuring:
• Conventional medical diagnosis and treatment
• Appropriate CAM therapies, including condition-specific,
evidence-based information May Loo, MD
• Treatment recommendations based on clinical experience
• Contraindications and potential adverse effects June 2008
xi
Acknowledgments
With thanks to all the contributors and their assistants whose Thanks also to my family, Bill, Alyssa, and Alexandra, for their
expertise, hard work, and thoughtfulness have made this book love and support through the innumerable, long, and arduous
possible. Thanks to the Elsevier staff: Kellie White, Jennifer hours.
Watrous, and Jonathan Taylor, whose patience, persistence,
and encouragement were invaluable for carrying this task to
completion.
xii
1
S E C T I O N CAM THERAPIES
�
C H A P T E R 1
Introduction
Book Organization|May Loo
Integrative Medicine for Children is intended as a reference conventional care of their children.44 Five of the most common
book that provides pediatricians with evidence-based informa- CAM modalities for children are homeopathy, naturopathy,
tion on complementary and alternative medicines (CAM) and acupuncture, chiropractic, and massage.45 The motivation to
practical CAM treatment recommendations from prominent seek CAM is so strong that patients are willing to pay billions
CAM practitioners. At the same time, it provides CAM prac- of dollars out of pocket.2-4,8,18,46
titioners with information on conventional pediatric diagno- Parents give numerous reasons for seeking CAM for their
ses and management. It is hoped that this book will promote children: dissatisfaction with allopathic medicine*; concern
communication among pediatric disciplines so that various about side effects18,40; desire for a more holistic, more natu-
modalities can be integrated to provide comprehensive, safe, ral, and safer form of healing6,25,28,40; parental satisfaction with
and effective treatments for children. self-use of CAM8,26; and a belief that CAM works25,28 and is
The National Center for Complementary and Alternative more compatible with their personal beliefs about health.25
Medicine (NCCAM) at the National Institutes of Health defines In addition, parents of children with chronic conditions often
CAM as “those treatments and health care practices not taught express the frustration that their children are unresponsive to
widely in medical schools, not generally used in hospitals, and conventional therapy6; that biomedicine has little or nothing
not usually reimbursed by medical insurance companies” and to offer28,43; that the conventional treatments are complex,
further indicates that “some approaches are consistent with uncomfortable, too technological, and unnatural43; or that
physiologic principles of Western medicine, while others con- they are not sufficiently involved in the planning and manage-
stitute healing systems with a different origin . . . [some] are ment of their child’s care.17 Some parents even view hospitals
becoming established in mainstream medicine.”1 as dangerous places.47
In recent years the use of CAM has exploded,2,3 with adult CAM offers these parents a sense of control and auton-
usage as high as 62%4,5 and pediatric usage ranging from omy over their child’s chronic illness or disability and in
estimates of 10% to 15% to as high as 40%.6-16 improving quality of life.6,40,43 Children also appear to
The escalation in pediatric CAM is global and is most readily accept CAM therapies and report positively on their
prevalent in the Western world, especially in the United States, experiences.13,21,49-51
Canada, Australia, and Western Europe.6,17-23 Usually children The abundance of resources—the media, the Internet,
who see CAM practitioners have educated parents who also condition-specific publications, parent groups, health food
use CAM.8,14,16,21,24-26 stores, and even family members and friends who have used
Pediatric CAM is being used to treat a wide variety of CAM—has contributed to the swaying of parents toward
acute and chronic physical and emotional conditions. The CAM.6,19,25,43 Even the American Academy of Pediatrics (AAP)
acute conditions can be common, routine outpatient prob- recognizes failure of biomedicine as the reason for parents to
lems,14,16,24,27-29 such as gastrointestinal complaints,22,30 skin turn to CAM.43
disorders,20,22 and musculoskeletal complaints.8 As many as Although the majority of pediatric CAM is used in conjunc-
50% to 70% of the parents of children with chronic, recur- tion with conventional therapies,5,19 parents have been reluc-
rent, or incurable conditions seek CAM.11,15,31-34 The most tant to discuss CAM treatments with pediatricians.† Reasons
common chronic conditions are asthma, arthritis, cystic fibro- for this hesitancy include fear of ridicule and the belief that
sis, cancer, inflammatory bowel disease (IBD), and cerebral the pediatrician has little information about CAM practices.
palsy.17,19,26,28,36-40 Parents may seek CAM even when their A U.S. survey of 348 pediatricians revealed a marked dis-
children are in tertiary children’s hospitals.29,41 CAM therapy crepancy between the pediatricians’ perceptions of use and
is also increasingly used for psychoemotional and behavioral actual CAM use by children.53 As pediatric CAM treatments
pediatric disorders.22 For example, studies indicate that as become more accepted and as pediatricians become less judg-
many as 50% of children with autism in the United States may mental and more knowledgeable about CAM, parents will be
be using CAM therapies.42,43
Although some families incorporate CAM into their bio- *References 18, 25, 28, 40, 43, 47, 48.
medical regimen, other families completely substitute CAM for †References 2, 3, 5, 14, 16, 29, 45, 52.
1
 CAM Therapies
more comfortable discussing CAM therapy with their child’s to fatal hypermagnesemia.67-78 The Federation of Medical
physician.24,27,28,43,53 Boards specifies that the selected CAM therapies should provide
Pediatricians, like most of the conventional medical com- “a favorable risk/benefit ratio compared with other treatments
munity, have traditionally regarded CAM as being unscientific for the same condition.”65
and supported mainly by anecdotal evidence. The AAP criti- The current trend is in favor of integration of mainstream
cizes CAM because of the paucity of randomized, controlled, medicine with CAM therapies, with a majority of medical
double-blinded clinical trials to prove its safety and efficacy in centers offering educational programs in CAM.72-86 In March
children.43,45 However, it is important to realize that the lack 2002, the White House Commission on Complementary and
of data does not signify a lack of CAM efficacy, but rather is Alternative Medicine Policy (WHCCAMP) issued a lengthy
a reflection of multiple difficulties in applying strict scientific report recommending across-the-board “integration” of CAM
research standards and evidence-based practice guidelines into government health agencies and the nation’s medical,
to CAM disciplines. Recognizing this problem in funding medical education, and insurance systems, which suggests that
research, NCCAM issued a statement that “CAM has divergent CAM is close to the mainstream.87 In 1998, Children’s Hos-
belief systems and theories about health and illness, focuses on pital Boston successfully established the first integrated CAM
individualized care, and has varied measures of effectiveness.”54 medical education and clinical services into an urban pediatric
The placebo response in CAM is strong and ever present, as it teaching hospital, where 2100 CAM consultations were pro-
is generated simply by the close, more “hands-on” relationship vided over 5.5 years, and acupuncture and massage therapies
between the practitioner and the patient.55 Gradually, scientifi- were eventually incorporated into a Clinical Practice Guide-
cally acceptable data in children are emerging, such as the use of line.7 By tapping into the wealth of knowledge and experience
acupuncture to treat pain,13 massage therapy to lower anxiety of biomedicine and CAM modalities, this book hopes to con-
and stress hormones,57 herbs to treat colic,58 and homeopathic tribute in some way to the integration of various modalities for
remedies to reduce the duration of acute childhood diarrhea.32 treating children.
Currently, the NCCAM has a budget of more than $122 mil-
lion to promote sound research in CAM. The AAP predicts Book Organization
that, in time, proven CAM therapies may come into wider use The first part of the book provides historical background of
and lose their “alternative” status.43 each CAM therapy, especially with respect to usage by children;
Parental demand for CAM, their willingness to pay out of theory behind each CAM practice; up-to-date, evidence-based
pocket, and the increasing scientific data are all factors that are information; current pediatric use; and any contraindications.
changing the role of the pediatrician and are fueling physicians’ The second part of the book discusses 55 pediatric conditions,
interest in and positive attitudes toward CAM.7,58 The pedia- beginning with conventional medical diagnosis and treatment
trician now must ask about CAM use in their patients,7,16,29,37 and followed by pertinent CAM therapies. Each discussion
be better informed about and provide parents with informa- includes available evidence-based information specific to that
tion on available CAM treatments,37,43,59 consider nontra- condition; practical treatment recommendations from the
ditional therapies when treating patients,43 and be aware of the literature (when available), from the expert’s clinical experience,
potential adverse effects of CAM or possible interactions with or both; and contraindications and potential adverse effects
conventional management.29,37,45 All of these are now incor- for use.
porated into the AAP policy recommendations for pediatri- This book is a cooperative effort by more than 30 quali-
cians.43,45 Because biomedicine expertise does not adequately fied and dedicated practitioners and took more than 4 years
prepare pediatricians to discuss CAM, the dire need to educate to be produced. It is the hope of this editor that the book will
the physicians coincides with rising physician interest in learn- serve as a helpful reference for pediatric health practitioners of
ing about CAM.7,43,58-62 Physicians themselves have turned different disciplines.
to CAM use personally and are making referrals for CAM
treatments.4,53,58 References
The increasing physician interest in CAM is counterbal- 1. National Center for Complementary and Alternative Medicine:
anced by concern about CAM therapy: the ability of CAM What is CAM? Available at http://nccam.nih.gov/heath/whatiscam.
practitioners to identify serious or complex medical con- Accessed April 2004.
ditions that require medical treatment,63 the lack of uniform 2. Eisenberg DM, Kessler RC, Foster C et al: Unconventional medi-
cine in the United States. Prevalence, costs, and patterns of use,
CAM standards for pediatric care, the appropriateness of treat-
N Engl J Med 328:246-252, 1983.
ment, legal liabilities9 (especially in the absence of evidence-
3. Eisenberg DM, Davis RB, Ettner SL et al: Trends in alternative
based studies45,64), and ethical issues.31 When advising patients
medicine use in the United States, 1990-1997: results of a follow-
concerning CAM therapies, pediatricians face two major
up national survey, J Am Med Assoc 280:1569-1575, 1998.
legal risks: medical malpractice and professional discipline.9 4. Barnes P, Powell-Griner E, McFann K et al: CDC advance
The ethical issues revolve around the possibility of causing data report #343. Complementary and alternative medicine use
harm,31,45,65 abuse and neglect in withholding proven medi- among adults: United States, 2002. May 27, 2004. Available at
cal treatments, and parental freedom of choice of therapy.9,31 http://nccam.nih.gov/news/camstats.htm. Accessed July 2004.
Although in general CAM is beneficial in pediatrics,66 specific 5. Spigelblatt LS: Alternative medicine: should it be used by chil-
adverse events have been reported in the literature, varying dren? Curr Probl Pediatr 25:180-188, 1995.
from chemical burns to exacerbation of illness to quadriplegia