An updated AAP clinical report on pediatric integrative medicine (PIM) reviews complementary therapies, highlighting where research is strong and where gaps remain so clinicians can more skillfully advise patients and their families.
The report aims to raise awareness about this emerging field, improve pediatric preventive health and expand treatment options for children and adolescents living with a wide range of medical conditions.
Updated from 2008, the clinical report Pediatric Integrative Medicine from the Section on Integrative Medicine is available at https://doi.org/10.1542/peds.2017-1961 and will be published in the September issue of Pediatrics.
The report highlights resources and clinical tools. It also covers the field’s history, epidemiology, strengths and challenges, research updates, regulatory standards, medical-legal aspects, licensing considerations, and training and education initiatives.
Commonly used complementary therapies are reviewed, including biologically based practices; dietary supplements; herbal products; diet; manipulative, movement and body-based practices such as massage; mind-body therapies such as yoga; acupuncture; traditional Chinese medicine; and naturopathy.
Focus on prevention, blending of therapies
PIM describes an approach that blends complementary and evidence-informed conventional therapies with a patient-centered focus. The field is important in pediatrics for two main reasons: its high prevalence of use, especially in children with chronic illness, where one in two are estimated to use complementary therapies; and the emphasis on modern preventive health.
Children and adolescents face serious health challenges and stressors in today’s society. Integrative medicine seeks to promote a comprehensive approach to healthy nutrition, physical activity, stress management and coping skills, sleep and judicious use of complementary therapies that can help children and their families reduce risk of preventable chronic illness across the lifespan.
Patients’ use of complementary approaches
Data from the 2007 and 2012 National Health Interview Survey show complementary approaches in children were used to treat specific conditions rather than to promote general well-being. They were used most commonly for back or neck pain, head or chest colds, other musculoskeletal conditions, anxiety or stress, and attention-deficit/hyperactivity disorder. Therapies used most frequently were nonvitamin, nonmineral dietary supplements (such as herbal medicines or probiotics), osteopathic or chiropractic manipulation, and yoga, tai chi or qi gong.
While use of complementary therapies was about 12% in children under age 18 years for both 2007 and 2012, it rose to 50% in children with chronic illnesses.
Adolescents are more likely than younger children to use complementary therapies. Teens turn to them most often to help treat chronic illnesses such as inflammatory bowel syndrome and mental health conditions. They also use supplements like ginseng, zinc, Echinacea, ginkgo and creatine in hopes of reducing weight, increasing energy or improving body image or athletic performance.
Not all families feel comfortable disclosing the use of complementary therapies. The report says pediatricians can help guide families in safe use with awareness of the field and by encouraging an open exchange of information. Clinicians should respect the family’s perspectives, values and cultural beliefs while monitoring the patient’s response to treatment in case therapy needs to be re-evaluated.
- Pediatricians are encouraged to advise and counsel patients and families about relevant, safe, effective and age-appropriate health services and therapies, whether they are considered conventional or complementary.
- Pediatricians should inquire regularly about all therapies a family is using for their children.
- Pediatricians should seek continued and updated knowledge about available therapeutic options.
- Policy and health insurance coverage should evolve to provide fair coverage for patients and equitable payment for physicians.
Dr. McClafferty, a lead author of the report, is immediate past chair of the AAP Section on Integrative Medicine Executive Committee.