Alternative medicines popular among pediatric outpatients

Use of complementary and alternative medicines such as vitamins, homeopathy and chiropractic therapy is common among children with chronic conditions, say Canadian researchers who suggest doctors should routinely be asking about their use.

Researchers surveyed parents about the use of complementary and alternative medicines (CAM) at five specialty clinics at both Stollery Children's Hospital in Edmonton and Children's Hospital of Eastern Ontario in Ottawa.

"CAM use is high among pediatric cardiology, gastroenterology, neurology, oncology, and respiratory patients, most of whom use CAM concurrently with conventional care," Dr. Sunita Vohra, of the pediatrics department at the University of Alberta and her co-authors, said in Monday's issue of the journal Pediatrics.

"Many patients, using CAM alongside their conventional medicines, are still not discussing their CAM use with their physicians and are increasing the likelihood for potential interactions and preventable harms."

Among those who said their child currently uses CAM with prescription medications, nearly 20 per cent didn't consult with a doctor or pharmacist, the researchers said.

Of the parents surveyed in Western Canada, 71 per cent reported their child had at some point used CAM compared with 42 per cent in central Canada.

The most common CAM products for both cities were:

• Vitamins and minerals, 91.2 per cent.
• Herbals, 29.2 per cent.
• Homeopathics, 37 per cent.
• Others, including food and hormone-based products, probiotics and fish oil, 38.9 per cent.

The most common therapies were:

• Massage, 42.5 per cent.
• Chiropractic, 38.2 per cent.
• Relaxation, 13.1 per cent.

The average age of the children was 8.8 years, most gave their overall health status as excellent, very good or good and the time since diagnosis was mainly more than a year.

Avoiding herbal and drug interactions

Parents rated most CAM products (84.2 per cent) and practices (76.2 per cent) as helpful or may have been helpful.

Parents also reported 80 adverse events. Of these, they considered 55 or 69 per cent to be minor.

Clinical herbologist Robert Rogers, who was not involved in the study, has published a book for doctors that details the possible interactions between drugs and herbal products.

"It can be very dangerous," Rogers said. "Particularly if you're talking about cardiovascular events, for example bleeding,  blood thinning, but also for blood pressure."

The researchers said families trust health-care providers but are more likely to disclose use of alternative medicines if an open, nonjudgmental approach is used.

Dr. Gideon Koren is a pediatrician and toxicologist at Toronto's Hospital for Sick Children, where he runs a program on what can go wrong with both drugs and herbal alternatives.

Koren said physicians need to understand why parents are using alternative medicines, because it may be a sign that the child isn't doing well. 

His hospital takes the approach that all treatments, both conventional and alternative, need to be tested to check they are safe and effective, Koren said.

The study's authors urged clinicians to inquire about CAM use when routinely taking a history during every patient visit, suggested points to cover and resources on interactions between CAM and drugs.

The study was supported by the SickKids Foundation.