The Use of Complementary and Alternative Medicine in Pediatrics

The American Academy of Pediatrics is dedicated to optimizing the well-being of children and advancing family-centered health care. Related to these goals, the American Academy of Pediatrics recognizes the increasing use of complementary and alternative medicine in children and, as a result, the need to provide information and support for pediatricians. From 2000 to 2002, the American Academy of Pediatrics convened and charged the Task Force on Complementary and Alternative Medicine to address issues related to the use of complementary and alternative medicine in children and to develop resources to educate physicians, patients, and families. One of these resources is this report describing complementary and alternative medicine services, current levels of utilization and financial expenditures, and associated legal and ethical considerations. The subject of complementary and alternative medicine is large and diverse, and consequently, an in-depth discussion of each method of complementary and alternative medicine is beyond the scope of this report. Instead, this report will define terms; describe epidemiology; outline common types of complementary and alternative medicine therapies; review medicolegal, ethical, and research implications; review education and training for complementary and alternative medicine providers; provide resources for learning more about complementary and alternative medicine; and suggest communication strategies to use when discussing complementary and alternative medicine with patients and families. Pediatrics 2008;122:1374–1386 INTRODUCTION The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (NIH) defines complementary and alternative medicine (CAM) as a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional Western medicine.1 Complementary medicine is used in conjunction with conventional medicine; for example, massage, guided imagery, and acupuncture may be used in addition to analgesic medications to help decrease pain. Alternative medicine is used in place of conventional Western medicine; for example, some adolescents use herbs rather than antidepressant medications to treat depression. The distinction between CAM and mainstream medicine has lessened as many practices have undergone rigorous research and have been integrated increasingly into mainstream care. For example, guided imagery and massage have been proven to be effective in the treatment of pain and are now included in many tertiary care settings.2–5 Since the American Academy of Pediatrics (AAP) convened the Task Force on Complementary and Alternative Medicine in 2000 and since the creation of the NCCAM, these complexities inherent in the definition of CAM have become more problematic. Given the wide usage and general understanding of the term “CAM,” it will be used throughout this report. However, the term “CAM” has been replaced increasingly with “holistic” or “integrative” medicine. Holistic medicine refers to patient-centered care that includes consideration of biological, psychological, spiritual, social, and environmental aspects of health. Integrative medicine is relationship-based care that combines mainstream and complementary therapies for which there is some high-quality scientific evidence of safety and effectiveness to promote health for the whole person in the context of his or her family and community.1 Integrative medicine also reaffirms the importance of the relationship between the practitioner and the patient, emphasizes wellness and the inherent drive toward healing, and focuses on the whole person, using all appropriate therapies to achieve the patient’s goals for health and healing.6 www.pediatrics.org/cgi/doi/10.1542/ peds.2008-2173 doi:10.1542/peds.2008-2173 All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time. The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.