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Natural Approaches to Children's Health: Herbals and Complementary and Alternative Medicine.

Complementary and alternative medicine (CAM) practices are widely used with pediatric populations. An overview of herbal medicines, use of common therapies with children, and advisory information is discussed.

Our ancestors relied heavily on herbs and other natural remedies for treating childhood ailments. Their belief in these remedies was rooted in tradition and that they seemed efficacious. Indeed, chamomile tea was soothing and aloe relieved minor burn pain. Although such remedies were supplanted in the mid-20th century by modern medicine, they are now experiencing a resurgence in popularity. Today, parents and children are increasingly turning to complementary and alternative medicine (CAM) for health promotion and disease management.

While the return to CAM may seem paradoxical in today's highly technological health care arena with its ever-increasing array of pharmaceuticals, individuals have numerous motivations for embracing CAM as a viable treatment alternative. Some individuals are becoming increasingly suspicious of the pharmaceutical industry and the chemical products they produce. Dissatisfaction with allopathic (conventional western) medicine, unsatisfactory treatment results, and greater personalized attention from CAM practitioners are other reasons given (Spigelblatt, Laine-Ammara, Pless, & Guyver, 1994). Claims of better health, symptom relief, and cures by using CAM abound, both validated and otherwise. CAM is gaining wider respect among the U.S. health care community as well, with more providers recommending CAM and health care plans reimbursing selected interventions.

The number of American children using CAM therapies is unknown. It is estimated that over 40% of Americans now use some form of CAM, spending upwards of $27 billion per year. Despite their widespread use, information about CAM has not traditionally been integrated into nursing curricula. Such knowledge is important if nurses are to provide holistic care to children and their families. In order to facilitate an understanding of these therapies, this article will provide an overview of CAM care, focusing on herbal medicine.

Overview of CAM and Herbal Therapies

CAM encompasses a broad array of healing philosophies and therapies that seek to treat the whole individual, mind-body-soul, through the application of selected therapies (National Center for Complementary and Alternative Medicine [NCCAM], 2000). An overview of the most common care systems is presented in Table 1. Each care system uses specific treatment modalities that are derived from its philosophy. While many care systems may, for example, use herbs, they are not necessarily used in the same way. Common treatment modalities are biological supplements (e.g., herbs, orthomolecular therapies, bee pollen, shark cartilage), manual healing/physical therapy (e.g., massage, spinal manipulation, ultrasound), mind-body control (e.g., hypnosis, meditation, yoga), bio-electromagnetic field manipulation (e.g., therapeutic touch), or nutritional modifications (Nemours Foundation, 2000). Historically, CAM has not been embraced by allopathic medicine although some therapies, such as acupuncture and hypnosis, are now being adopted. Others are under investigation by the NCCAM, a division of the National Institutes of Health (NCCAM, 2000).
Table 1. Selected Alternative Care Systems

Oriental Medicine   A holistic approach that emphasizes
                    proper balance of qi, or vital
                    energy. Imbalance of yin and
                    yang lead to disharmony in qi.
                    Treatment is geared towards the
                    patient, not the disease.

Ayurveda (India)    Literally means the "science of
                    life." Strives to restore harmony
                    among body, mind, and spirit.
                    Care is highly personalized using
                    a holistic approach.

Native American     Incorporates ceremonial rituals
Medicine            with various botanical and animal
                    medicines that are drawn from
                    the "alive world." Practices are
                    handed down to new generations
                    by oral tradition. Features differ
                    among tribes.

Homeopathy          Is based on "like cures like." Uses
                    minute or highly diluted doses of
                    substances from plants, animals,
                    or minerals for treatment.
                    Treatments specifically designed
                    to match symptom profiles.

Naturopathy         A holistic, individualized system
                    that seeks to correct alternatives
                    in body processes, allowing
                    health to be restored.


Note: From American Botanical Council (www.herbalgram.org/) and Nemours Foundation (http://kidshealth.org)

Arguably, herbal preparations are one of the most commonly used therapies by families for their children. Herbs, sometimes known as botanicals, are plants that are cultivated for culinary and medicinal use. Any plant part (e.g., leaf, flower, stem, seed, and root) that is used for medicinal purposes may be considered an herb. The active ingredients of many herbs are the phytochemicals that are formed in response to a plant's normal metabolic processes. Classes of phytochemicals include alkaloids, anthraquinones, coumarins, pytoestrogens, tannins, and many more. If such phytochemicals are isolated, purified, and processed, such as in the case of digoxin from foxglove, they are considered pharmaceutical drugs (American Botanical Council, 2000). When whole plants, parts of plants, or their extracts are used for medicinal reasons, they may be referred to as phytomedicinals.

It is estimated that over 5,000 herbs, both singularly and in combination, are used for medicinal purposes (Glossapedia, 2000). Herbs are prepared for internal use by extracting the essential oils, brewing plant material into teas, or extracting and compounding specific plant parts into pills or lozenges. When used topically, herbs may be prepared as tinctures, liniments, or poultices (American Botanical Council, 2000). Lastly, the essential oils extracted from herbs are used in aromatherapy. Common herbal medicines are available commercially, while knowledgeable CAM practitioners prepare individualized therapies.

CAM and herbal therapies are widely used by parents to treat common childhood problems such as constipation, coughs and colds, and selected chronic conditions. Such medicinals also are appealing when a child's condition, such as asthma, is not completely ameliorated by allopathic therapies (Spigelblatt et al., 1994), which often are costly and have strict prescribing regimens. For other conditions, such as attention deficit hyperactivity disorder, undue fear of psychoactive medicines (e.g., methylphenidate or amphetamine) have parents choosing other treatment modalities that appear to be safe alternatives (Chan, Gardiner, & Kemper, 2000). Although a full accounting of herbal preparations used with children is impossible to provide, a list of common pediatric concerns and their herbal treatments are summarized in Table 2.

[TABULAR DATA 2 NOT REPRODUCIBLE IN ASCII]

Herbal remedies are ubiquitous and promoted through mass marketing. They can easily be acquired from grocery stores, pharmacies, major retailers, and health food stores. Some products such as Rhino Pops (e.g., echinacea) or Body Zoomer fruit smoothies (e.g., St. John's wort) are being specifically targeted to children (Gugliotta, 2000). Teens are using herbal medicines as well, especially for complaints such as dysmenorrhea and migraine. As no prescription is needed and most come with a range of dosing instructions, consumers determine the therapy they feel is most appropriate. Herbal medicines are not inexpensive and often are comparable with the price of over-the-counter and/or prescription drugs. For interested individuals, instructions for cultivating and compounding herbs to treat one's own symptomatology are readily available through commercial books and over the Internet.

Cautions and Concerns

The majority of herbal medicines are relatively safe when used judiciously, causing only mild and infrequent side effects (Rotblatt, 1999). Because they are "natural," however, many consumers equate them to be "safe," especially as the number of recalls for prescription medicines increases. Parents are becoming increasingly concerned about medicines that are prescribed for their children but have not been tested with pediatric populations (Starr, 2000). However, to assume that all herbal medicines are safe is a fallacy. Most herbal medicines, although containing phytochemicals and other active ingredients, generally lack scientific study, and there are virtually no investigations of their safety or efficacy in children. There also is no oversight of herbal therapies by the Federal Food and Drug Administration. Because dosage recommendations have not been clearly established, harm can occur. Children are at greater risk because of differences in the way drugs are absorbed, metabolized, and excreted (Starr, 2000). For example, ephedra has been linked to cardiac problems, and lemon balm may inhibit selected thyroid hormones (Chan et al., 2000).

Studies have shown that herbs vary in potency and quality, and because they are natural, purity may be difficult to achieve. Herbal preparations are derived from plants that have other natural components or phytochemicals (e.g., steroids) that are hard to eliminate during processing. Herbals from developing countries may contain pesticides or heavy metals, both of which can be toxic in children (Davis, 2000; Nemours Foundation, 1998). Allergies are possible, but it may be difficult to determine to what component of a preparation the child is reacting. The combination of some herbal therapies with allopathic medicines may be contraindicated. Lastly, when herbal or other CAM therapies are the primary intervention, delays in seeking needed allopathic medical care for children with conditions that cannot be treated appropriately with CAM may occur. This may result in unnecessary morbidity and mortality.

Professional Interventions

First and foremost, all families must be directly asked whether they are using herbal or other CAM therapies. This must be done in an atmosphere of openness and free from disapproval, as reports indicate that individuals often withhold such information because they fear provider reprisals ("Many don't divulge alternative treatments," 2000). Where families get their information about herbal therapies is equally important to assess. Families need to be encouraged to confide in and seek advice from informed nurses, physicians, and pharmacists in conjunction with CAM practitioners before deciding on an herbal regimen for their child. Selected resources for families and providers are listed in Table 3.
Table 3. Resources for Professionals and Parents

Organizations

American Botanical Council
PO Box 144345
Austin, TX 78714-4355
(512) 926-4900
http://www.herbalgram.org

American Herbalists Guild
1931 Gaddis Road
Canton, GA 30115
(770) 751-6021
http://www.healthy.net/herbalists/

National Center for Complementary and Alternative
Medicines
PO Box 8218
Silver Spring, MD 20907-8218
http://nccam.nih.gov/
(888) 644-6226

Alternative Medicine Foundation
5411 West Cedar Lane, Suite 205-A
Bethesda, MD 20814
301-581-0116
http://www.AMFoundation.org

The Richard and Hinda Rosenthal Center for
Complementary and Alternative
Medicine
Columbia University
College of Physicians & Surgeons
630 W. 168th St., Box 75
212-543-2843
http://Cpmcnet.columbia.edu/dept/rosenthal

Web Sites

Vicus
http://www.vicus.com

Vitalcast
http://www.vitalcast.com

Books

Chandler, F. (Ed.). (2000). Herbs: Everyday reference for
health professionals. Ottawa: Canadian Pharmacists
Association and Canadian Medicine Association.

Medical Economics. (2000). PDR for nonprescription
drugs and dietary supplements. Montvale, NJ:
Author.


Allopathic providers need to become knowledgeable of, and evaluate the evidence for, common CAM therapies that their patients are using. An herbal's efficacy and quality control issues around its processing are difficult to evaluate. Since few herbals have been evaluated in controlled clinical trials, Rotblatt (1999) suggests that providers may want to recommend to their patients that they select products that are prepared and distributed by major known pharmaceutical firms. Such groups have experience with preparing medicines and can help ensure a high level of quality control. Another alternative is to choose standardized formulations that carry a certified trade group guarantee. Specific labeling information, including distributor contact information, lot number, and expiration date, is useful in case a problem arises.

Herbs do not need to be used in exclusion to conventional medicine but may be used complementarily. Many families may welcome the opportunity to use parallel interventions (Spigelblatt et al., 1994), and when appropriate, providers should suggest this possibility. Lastly, families can be helped to learn ways of getting information and claims from various sources. Evidence-based information is not yet available for many herbals, so guiding families to resources that present balanced information is beneficial.

References

American Botanical Council. (2000). Genera/ terms. [On-line]. Available: http://www.herbalgram.org/

Chan, E., Gardiner, P., & Kemper, K.J. (2000). "At least it's natural ..." Herbs and dietary supplements in ADHD. Contemporary Pediatrics, 17, 116-130.

Davis, L.E. (2000). Unregulated potions still cause mercury poisoning. Western Journal of Medicine, 173, 19.

Glossapedia: Herb. (2000) Herb. [On-line]. Retrieved October 19, 2000. Available: http://www.viscus.com/

Gugliotta, G. (2000, July 3). Aiming dietary supplements at kids. Los Angeles Times, p. S1.

Many don't divulge alternative treatments. (2000). [On-line]. Retrieved October 19, 2000. Available: http://www.viscus.com/

National Center for Complementary & Alternative Medicine. (2000). Major domains of complementary and alternative medicine. [On-line]. Retrieved October 19, 2000. Available: http://nccam.nih.gov/

Nemours Foundation. (2000). Alternative medicine and your child [On-line]. Available: http://kidshealth.org/

Rotblatt, M.D. (1999). Herbal medicines: A practical guide to safety and quality assurance. Western Journal of Medicine, 171, 172-175.

Spigelblatt, L., Laine-Ammara, G., Pless, B., & Guyver, A. (1994).The use of alternative medicine by children. Pediatrics, 94, 811-814.

Starr, C. (2000, August 15). The essentials in pediatric dosing. Patient Care, 94-114.

The Primary Care Approaches section focuses on physical and developmental assessment and other topics specific to children and their families. If you are interested in author guidelines and/or assistance, contact Judith Vessey, PhD, RNC, DPNP, FAAN; Boston College, School of Nursing, Cushing Hall, 140 Commonwealth Ave., Chestnut Hill, MA 02167-3812; (617) 552-8817; judith.vessey.1@bc.edu

Judith A. Vessey, PhD, RNC, DPNP, FAAN, is Chair, Boston College School of Nursing, Chestnut Hill, MA.

Anne Rechkemmer is a BSN student, Boston College School of Nursing, Chestnut Hill, MA.
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Author:Vessey, Judith A.; Rechkemmer, Anne
Publication:Pediatric Nursing
Geographic Code:1USA
Date:Jan 1, 2001
Words:2145
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