To describe the use of dietary botanical supplements and teas among infants, the characteristics of mothers who give them the specific botanical supplements and teas used, reasons for use, and sources of information.
We used data from the Infant Feeding Practices Study II, a longitudinal survey of women studied from late pregnancy through their infant's first year of life conducted by the US Food and Drug Administration and the Centers for Disease Control and Prevention between 2005 and 2007. The sample was drawn from a nationally distributed consumer opinion panel and was limited to healthy mothers with healthy term or near-term singleton infants. The final analytical sample included 2653 mothers. Statistical techniques include frequencies, χ2 tests, and ordered logit models.
Nine percent of infants were given dietary botanical supplements or teas in their first year of life, including infants as young as 1 month. Maternal herbal use (P < .0001), longer breastfeeding (P < .0001), and being Hispanic (P = .016) were significantly associated with giving infants dietary botanical supplements or teas in the multivariate model. Many supplements and teas used were marketed and sold specifically for infants. Commonly mentioned information sources included friends or family, health professionals, and the media.
A substantial proportion of infants in this sample was given a wide variety of supplements and teas. Because some supplements given to infants may pose health risks, health care providers need to recognize that infants under their care may be receiving supplements or teas.
Zhang et. al's article states that there is a potential danger of infants using botanical supplements such as chamomile tea, or, sambuca syrup (elderberry), but this remains highly speculative, as they failed to cite a single study noting even mild infant harm from such supplements. One citation was noted regarding the passage of lead from maternal breast milk of mother's taking Chinese Herbs, but this was not the subject of the study.
Empirically speaking, the greatest risk of harm to infants with gastrointestinal and respiratory complaints (as were cited as the most common reasons for using supplements) has come from FDA-approved pharmaceutical products.
To wit, the same issue of Pediatrics published two articles of note. The first cited the unnecessary prescription of antibiotics for wheezing episodes due to viral infections of the lower respiratory tract, which can create a state of dysbiosis, diarrhea and dehydration.(De Boeck K, Vermeulen F, Meyts I, Hutsebaut L, Franckaert D, Proesmans M. Coprescription of antibiotics and asthma drugs in children. Pediatrics. Jun;127(6):1022-1026)
The second article is a meta-analysis noting increased risk of developing asthma in children given antibiotics early in life (Murk W, Risnes KR, Bracken MB. Prenatal or early-life exposure to antibiotics and risk of childhood asthma: a systematic review. Pediatrics. Jun;127(6):1125 -1138).
With respect to GI disorders, one need only consider the recall of Cisapride due to reports of prolonged QT syndrome and fatal arrhythmia, or the recent meta-analysis questioning the efficacy of proton pump inhibitors in infantile GERD in the face of certain side effects (van der Pol RJ, Smits MJ, van Wijk MP, Omari TI, Tabbers MM, Benninga MA. Efficacy of proton-pump inhibitors in children with gastroesophageal reflux disease: a systematic review. Pediatrics. May;127(5):925-935).
The Zhang study noted that the highest use of medicinal teas was in Hispanic families. Traditionally, Hispanic families use unprocessed teas purchased bulk from a local store. This is a far cry from the processed supplements that have been noted to contain small amounts of contaminants.
Future studies should attempt to obtain samples of the actual treatments used and empirically evaluate both their efficacy in infants, as well as the presence or absence of contaminants. These medicinal teas have been the mainstay of treatment for hundreds of years and are likely beneficial or at worst benign.
Rather than assuming that parents don't know how to take care of their children and that it is our job to prevent them from harming them with chamomile tea, we as pediatricians and researchers, should be open to learning and studying what parents have used for hundreds of years to treat mild disorders.
Conflict of Interest:
None declared
The article "Feeding of Dietary Botanical Supplements and Teas to Infants in the United States" concludes that doctors should ask mothers ( and fathers) about the use of herbal teas to their infants. I agree completely. What the article fails to mention is that many so called all natural products contain a number of contaminants such as lead and other heavy metals. Since there is no law that requires the manufacturers of dietary supplements to test these and other products for safety let alone efficacy, no parent should be treating their infant or any child with a product that might contain ingredients never approved by the FDA, the manufacturer or anyone else as safe.
Given the remaining mystery of the cause of sudden infant death coupled with the fact that medical examiners never test for ingredients and contaminants in dietary supplements that could play a role, any parent who uses these products on a another human being who can not object, should, if anything happened, be charged with depraved indifference.
Any doubts about the findings concerning contaminated herbal ingredeints can be verified by doing just a little research on the subject. For example, Consumer Lab. has tested a number of dietary supplements and found that many are contaminated with heavy metals and other ingredients that could pose a health risk to adults. Imagine the risk to infants if they are given the same products.
In fact, since most doctors know little about dietary supplements and the potential risks they present, asking them is no guarantee that using these products on children, especially infants, is safe.
Conflict of Interest:
None declared