Pediatricians group urges doctors to study up on herbs, supplements, yoga

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Pediatricians should be familiar with evidence-based non-Western treatments parents are using for their children so they can offer advice about safe, effective and age-appropriate use of such things as herbal medicines, acupuncture and yoga, the American Academy of Pediatrics is recommending.

The recommendations are in a new Academy clinical report that aims to help doctors navigate the popular but sometimes murky world of "complementary therapies." These treatments are used alone or in combination with mainstream treatments; the Academy makes a distinction between these therapies and "alternative" medicine, which it describes as not evidence-based.

The report also lists probiotics, osteopathic or chiropractic manipulation, tai chi and qigong as the complementary therapies used most frequently on children, according to the 2007 and 2012 National Health Interview Surveys.

The report suggests doctors bring the topic up by asking parents if they are using any vitamins, herbs, supplements or home remedies to enhance their kids' health. 

The guidelines come as consumer interest in, and use of, complementary medicine has outpaced training options for pediatricians.

More than one in every 10 children used a form of complementary medicine in the previous year, according to the 2012 national health survey. Meanwhile, 50 percent of medical schools in the country listed at least one course or clerkship in complementary and alternative medicine on their websites as of 2015, the Academy report says.  

The Academy says pediatricians must be vigilant about assessing the quality of natural health products, including dietary supplements, herbal medicines and homeopathic remedies.

It says there is convincing evidence that fish oil, one of the natural products most commonly given to kids, supports full-term gestation and is integral in the development of the brain, nervous system and retina, with minimal adverse effects.

The report says research has found that some probiotic strains shorten the duration of acute infectious diarrhea. And it says there is strong and growing evidence supporting the use of probiotics for late-onset sepsis in preterm infants.

There are few long-term studies on the safety and efficacy of pediatric use of melatonin, a supplement commonly used in kids with sleep disorders, the report adds.

"Despite the fact that natural health products may be perceived as safe because of their natural origins, researchers have demonstrated the potential for serious toxicity and possible adverse reactions or events, especially in patients taking prescription medications concurrently," the report says.

"Compounding this risk is the fact that safety standards that specifically address the pediatric population are lacking, and parents may be reluctant to disclose the use of natural products for fear of censure or ridicule," it adds.

The report says studies have found that yoga has a positive effect on children's psychological functioning. 

There's less proof supporting the use of chiropractic manipulation for problems unrelated to the musculoskeletal system. The report says high-quality evidence supporting such treatments is "lacking, especially in infants and children, for whom the risks of adverse events may be the highest because of immature stability of the spine."

Dr. Lisa Stern, a pediatrician at Tenth Street Pediatric Medical Group in Santa Monica, says she's open to many complementary medical treatments, adding, "I don't think Western medicine has all the answers."

Stern says she'll occasionally recommend complementary medicine, such as when children develop fluid in their ears. She says there's not a good treatment for it, so when the problem is unrelated to an infection or allergies, she will recommend the child see an acupuncturist or an osteopath, who could do some manipulations to help the middle ear drain.

She's less supportive of using homeopathic remedies to treat fussy newborns. "I don't really know what the manufacturing process was," she says, explaining that babies are especially vulnerable to product contamination.

Stern says she stays current on complementary medicine through pediatric publications; she says she sometimes hears about treatments or providers directly from patients' families.

"I think it's worth a try, before we escalate and do more medical testing," Stern says of complementary treatments. "Medical testing makes children really anxious, so I think if they can do less invasive things, I think it's better for the child."

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