Volume 54, Issue 6, Pages xv-xviii (December 2007)

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Preface

Article Outline

• References

• Copyright

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Lawrence D. Rosen, MD, FAAP

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David S. Riley, MD Guest Editors

Complementary and alternative medicine (CAM) is defined by the National Center for Complementary and Alternative Medicine as “a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine” [1]. This is changing. Patient interest and use of CAM continues to grow, the pool of licensed healthcare providers specializing in CAM is increasing, and the interest in CAM research and therapies continues to expand in conventional medical centers.

The increasing prevalence of CAM use in adults has been widely publicized [2], [3], whereas the use of such therapies in children has been underreported [4]. In fact, CAM use in pediatric populations has been increasing over the past decade, in both well and chronically ill children, according to numerous publications [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18]. Safety and efficacy issues in the pediatric population for conventional therapies have been front and center for some time, as there has been increasing recognition that extrapolation from adult treatments is often not justified. These same questions are important in the pediatric usage of CAM. What is safe and what is not? What works and what does not? What sort of evidence-based practice guidelines do we need and how should they be developed? What is the role for the categories of evidence [19] used by the World Health Organization (WHO) (Table 1)?

Table 1.

World Health Organization categories of evidence


	Category	Source of evidence
	Ia	Systematic review of randomized controlled trials
	Ib	At least one randomized controlled trial
	IIa	At least one well-designed quasi-experimental trial
	IIb	At least one other type of well-designed quasi-experimental study
	III	Well-designed nonexperimental descriptive studies (eg, comparative, correlation, or case control studies)
	IV	Expert committee reports or opinions, and clinical experience of respected authorities

Recent surveys indicate that pediatricians want evidence-based guidance on how to safely and effectively integrate CAM therapies in their practices [20], [21]. Educational efforts to address this need include the inclusion of more CAM topics at the American Academy of Pediatrics (AAP) National Convention and Exhibition [22], and the growth of the international Pediatric Integrative Medicine Conference, Pangea [23]. In this spirit, this issue is the first in the history of the Pediatric Clinics of North America dedicated to reviewing the principles and practices of CAM use.

The growing practice of pediatric integrative medicine, which advocates for an examined integration of conventional and CAM therapies in the holistic care of children, is evidenced by the burgeoning number of professional groups supporting pediatric CAM education [24]. These include the AAP Provisional Section on Complementary, Holistic, and Integrative Medicine (PSOCHIM) [25], the Ambulatory Pediatric Association's Special Interest Group in Integrative Pediatrics [26], and the Integrative Pediatrics Council [27]. Many of the leaders of this movement serve as authors in this remarkable issue dedicated to pediatric integrative medicine. Articles included in this issue review current hot topics such as integrative approaches to obesity, mood disorders, autism and asthma, the ethics of CAM use in children, and how to integrate therapies such as acupuncture, herbals, massage, and mind-body medicine. These subjects should be relevant for all primary care practitioners and specialists who care for children. We thank our colleagues for their contributions to this important work.

References

[1]. [1]What is CAM? NCCAM CAM Basics. Available at: http://nccam.nih.gov/health/whatiscam/. Accessed September 4, 2007.

[2]. [2]Eisenberg DM, Kessler RC, Foster C, et al. Unconventional medicine in the United States: prevalence, costs, and patterns of use. N Engl J Med. 1993;328:246–252. MEDLINE | CrossRef

[3]. [3]Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey. JAMA. 1998;280:1569–1575. MEDLINE | CrossRef

[4]. [4]Rosen LD. Complementary and alternative medicine use in children is underestimated. Arch Pediatr Adolesc Med. 2004;158:291. MEDLINE | CrossRef

[5]. [5]Spigelblatt L, Laine-Ammara G, Pless IB, et al. The use of alternative medicine by children. Pediatrics. 1994;94:811–814.

[6]. [6]Braganza S, Ozuah PO, Sharif I. The use of complementary therapies in inner-city asthmatic children. J Asthma. 2003;40:823–827.

[7]. [7]Braun CA, Bearinger LH, Halcon LL, et al. Adolescent use of complementary therapies. J Adolesc Health. 2003;37:76e.1–76e.9.

[8]. [8]Day AS, Whitten KE, Bohane TD. Use of complementary and alternative medicines by children and adolescents with inflammatory bowel disease. J Paediatr Child Health. 2003;40:681–684. MEDLINE | CrossRef

[9]. [9]Harrington JW, Rosen L, Garnecho A, et al. Parental perceptions and use of complementary and alternative medicine practices for children with autistic spectrum disorders in private practice. J Dev Behav Pediatr. 2006;27:S156–S161.

[10]. [10]Loman DG. The use of complementary and alternative health care practices among children. J Pediatr Health Care. 2003;17:58–63.

[11]. [11]Losier A, Taylor B, Fernandez CV, et al. Use of alternative therapies by patients presenting to a pediatric emergency department. J Emerg Med. 2005;28:267–271. Abstract | Full Text | Full-Text PDF (121 KB) | CrossRef

[12]. [12]Ottolini MC, Hamburger EK, Loprieato JO, et al. Complementary and alternative medicine use among children in the Washington, D.C. area. Ambul Pediatr. 2001;1:122–125. Abstract | Full Text | Full-Text PDF (43 KB) | CrossRef

[13]. [13]Pitetti R, Singh S, Hornyak D, et al. Complementary and alternative medicine use in children. Pediatr Emerg Care. 2001;17:165–169. MEDLINE | CrossRef

[14]. [14]Reznick M, Ozuah PO, Franco K, et al. Use of complementary therapy by adolescents with asthma. Arch Pediatr Adolesc Med. 2002;156:1042–1044. MEDLINE

[15]. [15]Sanders H, Davis MF, Duncan B, et al. Use of complementary and alternative medical therapies among children with special health care needs in southern Arizona. Pediatrics. 2003;111:584–587.

[16]. [16]Sawni A, Ragothaman R, Thomas RL, et al. The use of complementary/alternative therapies among children attending an urban pediatric emergency department. Clin Pediatr (Phila). 2007;46:36–41. MEDLINE | CrossRef

[17]. [17]Sawni-Sikand A, Schubiner H, Thomas RL. Use of complementary/alternative therapies among children in primary care pediatrics. Ambul Pediatr. 2002;2:99–103. Abstract | Full Text | Full-Text PDF (59 KB) | CrossRef

[18]. [18]Sinha D, Efron D. Complementary and alternative medicine use in children with attention deficit hyperactivity disorder. J Paediatr Child Health. 2005;41:23–26. MEDLINE | CrossRef

[19]. [19]WHO Division of Traditional Medicine . General guidelines for methodologies on research and evaluation of traditional medicine. Geneva (Switzerland): World Health Organization; 2000;.

[20]. [20]Sikand A, Laken M. Pediatricians' experience with and attitudes toward complementary/alternative medicine. Arch Pediatr Adolesc Med. 1998;152:1059–1064. MEDLINE

[21]. [21]Periodic Survey of Fellows #49, American Academy of Pediatrics Division of Health Policy Research: Complementary and Alternative Medicine (CAM) Therapies in Pediatric Practices, October 2002. Available at: http://www.aap.org/research/periodicsurvey/ps49bexs.htm. Accessed September 4, 2007.

[22]. [22]American Academy of Pediatrics National Conference and Exhibition. Available at: http://www.aap.org/nce. Accessed September 4, 2007.

[23]. [23]Pangea: a conference for the future of pediatric wellness. Available at: http://www.pangeaconference.com. Accessed September 4, 2007.

[24]. [24]Rosen LD. Integrative pediatrics: past, present, and future. Explore. 2006;2:455–456. Full Text | Full-Text PDF (46 KB) | CrossRef

[25]. [25]American Academy of Pediatrics Provisional Section on Complementary, Holistic and Integrative Medicine. Available at: http://www.aap.org/sections/CHIM. Accessed September 4, 2007.

[26]. [26]Ambulatory Pediatrics Association Special Interest Group in Integrative Pediatrics. Available at: http://www.ambpeds.org/Site/sp_int_groups/sig_comp_alt_peds.htm. Accessed September 4, 2007.

[27]. [27]The Integrative Pediatrics Council. Available at: http://www.integrativepeds.org. Accessed September 4, 2007.

Integrative Pediatrics Council, Pediatric Integrative Medicine, Department of Pediatrics, Hackensack University Medical Center, Hackensack, NJ 07601, USA

University of New Mexico Medical School, Santa Fe, NM 87508, USA, EXPLORE–The Journal of Science and Healing

PII: S0031-3955(07)00138-1

doi:10.1016/j.pcl.2007.09.003

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