Home > Alternative/Complementary Therapies (general info)

Alternative/Complementary Therapies (general info)

Complementary/alternative therapies (CAMs) pursued by parents are very common, and the Medical Home should ask specifically about them. [Kemper: 2008] In a recent study, almost half of children with inflammatory bowel disease were receiving CAMs. [Wong: 2009] In some situations such as chronic abdominal pain without obvious medical cause, where standard management has not been helpful, CAMs may be, including biofeedback and hynotherapy. [Banez: 2008] Suggestions to the Medical Home regarding controversial therapies:
  • Ensure families have access to standard services and are actively involved in all treatment decisions.
  • Attempt to determine an etiologic diagnosis. Explain current biologic understanding of the child's condition.
  • Discuss controversial therapies as part of the initial management plan and whenever asked.
  • Be knowledgeable about standard and nonstandard treatments or refer for consultation. As it is difficult to keep up to date on all the alternative therapies, the Medical Home may ask the family to schedule a follow-up appointment to allow the provider time for literature review and time to discuss the proposed therapy in depth.
  • Schedule ample time for the discussion, making certain your comments are not taken as an endorsement. Discuss the placebo effect and the importance of controlled research trials. Be ready to explain the difference between a case report and a controlled trial.
  • Provide information about the specific treatment, discuss decision making and emphasize the "red flags" – claims of a unrealistic cure or that every child will benefit.
  • Identify any confounding factors, e.g., opinions of relatives.
  • Be willing to support a trial of therapy in select situations – require clear treatment objectives and pre/post evaluation of symptoms.
  • Remain actively involved even if you do not agree with the parents' decision. If you can't do this and maintain an open therapeutic relationship, consider a referral to a Medical Home where the parents and the provider may more closely share the same philosophy.
  • If you feel that the alternative therapy and/or the declining of traditional therapeutic approaches for the alternative therapy is too risky, suggest that the family establish a new Medical Home that feels more comfortable with the family's choice.
Adapted from [Nickel: 2003].

Resources

Information & Support

For Professionals

Complementary and alternative therapies (MedlinePlus)
Information about therapies including accupuncture, herbal medicine, dietary supplements, and more.

Tools

Handout for Parents on Complementary Therapies (PDF Document 27 KB)
A list of questions to help parents consider controversial therapies.

Helpful Articles

Kemper KJ, Vohra S, Walls R.
American Academy of Pediatrics. The use of complementary and alternative medicine in pediatrics.
Pediatrics. 2008;122(6):1374-86. PubMed abstract

Samdup DZ, Smith RG, Il Song S.
The use of complementary and alternative medicine in children with chronic medical conditions.
Am J Phys Med Rehabil. 2006;85(10):842-6. PubMed abstract

Authors

Authors: Lynne M Kerr MD, PhD, 3/2009
Lisa Samson-Fang MD, 10/2008
Content Last Updated: 5/2011

Page Bibliography

Banez GA.
Chronic abdominal pain in children: what to do following the medical evaluation.
Curr Opin Pediatr. 2008;20(5):571-5. PubMed abstract

Kemper KJ, Vohra S, Walls R.
American Academy of Pediatrics. The use of complementary and alternative medicine in pediatrics.
Pediatrics. 2008;122(6):1374-86. PubMed abstract

Nickel RE, Desch LW.
The Physician's Guide to Caring for Children with Disabilities and Chronic Conditions.
Paul H. Brookes Publishing Co; 2003.

Wong AP, Clark AL, Garnett EA, Acree M, Cohen SA, Ferry GD, Heyman MB.
Use of complementary medicine in pediatric patients with inflammatory bowel disease: results from a multicenter survey.
J Pediatr Gastroenterol Nutr. 2009;48(1):55-60. PubMed abstract