Herbs to Homeopathy—Medicinal Products for Children

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Many pediatric patients and their families use dietary supplements and homeopathy. They do not always disclose this information to their health care practitioners. It is important that health care practitioners are aware of the research available in these areas and discuss the use of these products openly with their patients. As part of that dialogue, clinicians need to consider what level of effectiveness is acceptable to support the use of these products by their patients. This risk–benefit appraisal should consider safety, effectiveness, the medical condition being treated, and the personal beliefs and preferences of patients and their families.

Section snippets

Regulation of dietary supplements

Dietary supplements, regulated under the DSHEA, are products designed to “supplement the diet” and include herbal and other botanical products, vitamins, minerals, amino acids, and other dietary substances for use.” The DSHEA allows dietary supplements that were on the market before 1994 to be marketed without the approval of efficacy and safety that the FDA requires for prescription medications. Manufacturers are permitted to claim that the product affects the structure or function of the

Regulation of homeopathy

Homeopathic remedies, on the other hand, have been regulated as drugs since the 1938 Food Drug and Cosmetic Act that defines the term “drug” to mean “articles recognized in … the official Homeopathic Pharmacopeia of the United States … and articles intended for use in the diagnosis, cure, mitigation, treatment, or the prevention of disease in man …. Whether or not they are official homeopathic remedies, those products offered for the cure, mitigation, prevention, or treatment of disease

Trends in pediatric use of dietary supplements

Many children and adolescents use dietary supplements and homeopathy. The prevalence of use of these products depends on population characteristics (healthy versus sick), the age of the child or adolescent, race/ethnicity, and other factors such as methods of data collection (interviews versus surveys) and the extent of the survey (national versus regional).

Recent national surveys indicate that more than 20% to 40% of all young children and 20% to 30% of adolescents in the United States have

Patient use of dietary supplements and homeopathy

In 1996, Vincent [29] identified reasons that patients seek complementary therapies, including dietary supplements and homeopathy. These reasons included a positive value associated with complementary treatment, the ineffectiveness of orthodox treatment for a patient's complaint, concern about the adverse effects of orthodox medicine, concerns about communication with doctors, and, finally, the availability of complementary medicine. Homeopathy patients were most strongly influenced by the

Homeopathy—what is it?

Homeopathy is a popular form of CAM globally and is part of the official health care systems in a number of countries. It is 200 years old, and its core is based on the idea of “treating like with like” (Similia similibus curentur), aiming to stimulate self-healing processes. This principle also is applied in some areas of conventional medicine, such as allergy desensitization. The doses used in homeopathy range from those that are similar in concentration to conventional medicines to very high

Research background

Hierarchies for the evaluation of evidence of clinical research usually give the greatest weight to systematic reviews of controlled trials, followed by randomized, controlled trials. Other forms of evidence also are used to establish the effectiveness and safety of a therapy. The World Health Organization and many regulatory agencies use the hierarchy in Box 1 for evaluating evidence [38].

Research in homeopathy

Currently more than 130 randomized, controlled clinical trials of homeopathy have been published in the peer-reviewed medical literature. Of those, more than 15 have focused on the pediatric population.

Dietary supplement research

This section gives examples of commonly used pediatric dietary supplements. Vitamins and minerals that can be obtained from food or supplements include vitamin A, B, C, D, E, calcium, and iron. Survey data clearly indicate that multivitamins are the most commonly used supplements. The question arises: should all children take a vitamins and minerals, and, if so, at what age do they begin? There are numerous different opinions and recommendations about vitamins and minerals, but there is no

Patient preference

The use of dietary supplements and homeopathy, particularly in clinical research, often is associated with strong issues of patient preference. When subjects refuse to be randomized, it sometimes is possible to compensate for the challenges of recruitment by using of quasi-experimental designs, but then other methodologic challenges emerge. On the other side of the spectrum of patient preference is parental concern about the safety of nonpharmaceutical and pharmaceutical medicinal products for

Summary

Many pediatric patients and their families, especially those who have chronic or recurrent conditions, use dietary supplements and homeopathy. Families do not always disclose this information to their health care professionals. It is critical that health care practitioners have an open a dialogue with their patients about the use of dietary supplements and homeopathic medicinal products. As part of that dialogue, clinicians must consider what level of evidence or efficacy is acceptable to

References (96)

  • P.W. Geissler et al.

    Medicinal plants used by Luo mothers and children in Bondo district, Kenya

    J Ethnopharmacol

    (2002)
  • F. Dantas et al.

    Do homeopathic medicines provoke adverse effects? A systematic review

    Br Homeopath J

    (2000)
  • K. Linde

    Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials

    Lancet

    (1997)
  • W.B. Jonas et al.

    Homeopathy and rheumatic disease

    Rheum Dis Clin North Am

    (2000)
  • R. Papp

    Oscillococcinum® in patients with influenza-like syndromes: a placebo controlled double-blind evaluation

    Br Homeopath J

    (1998)
  • B. Idindili et al.

    Randomized controlled safety and efficacy trial of 2 vitamin A supplementation schedules in Tanzanian infants

    Am J Clin Nutr

    (2007)
  • P. Menon et al.

    Micronutrient Sprinkles reduce anemia among 9- to 24-mo-old children when delivered through an integrated health and nutrition program in rural Haiti

    J Nutr

    (2007)
  • M. Salman

    Systematic review of the effect of therapeutic dietary supplements and drugs on cognitive function in subjects with Down syndrome

    Eur J Paediatr Neurol

    (2002)
  • W. Sichert-Hellert et al.

    Vitamin intakes from supplements and fortified food in German children and adolescents: results from the DONALD study

    J Nutr

    (2006)
  • J.L. Varma et al.

    Community-level micronutrient fortification of a food supplement in India: a controlled trial in preschool children aged 36–66 mo

    Am J Clin Nutr

    (2007)
  • D.J. Raiten et al.

    Vitamin D and health in the 21st century: bone and beyond. Executive summary

    Am J Clin Nutr

    (2004)
  • C.J. Antalis et al.

    Omega-3 fatty acid status in attention-deficit/hyperactivity disorder

    Prostaglandins Leukot Essent Fatty Acids

    (2006)
  • A. Hrastinger et al.

    Is there clinical evidence supporting the use of botanical dietary supplements in children?

    J Pediatr

    (2005)
  • Z. Weizman et al.

    Efficacy of herbal tea preparation in infantile colic

    J Pediatr

    (1993)
  • S. Bent et al.

    Valerian for sleep: a systematic review and meta-analysis

    Am J Med

    (2006)
  • S.F. Muller et al.

    A combination of valerian and lemon balm is effective in the treatment of restlessness and dyssomnia in children

    Phytomedicine

    (2006)
  • R.R. Briefel et al.

    Secular trends in dietary intake in the United States

    Annu Rev Nutr

    (2004)
  • R.B. Ervin et al.

    Use of dietary supplements in the United States, 1988–94

    Vital Health Stat

    (1999)
  • R.B. Ervin et al.

    Prevalence of leading types of dietary supplements used in the Third National Health and Nutrition Examination Survey, 1988–94

    Adv Data

    (2004)
  • R.B. Ervin et al.

    Dietary intake of selected vitamins for the United States population: 1999–2000

    Adv Data

    (2004)
  • S.L. Lanski et al.

    Herbal therapy use in a pediatric emergency department population: expect the unexpected

    Pediatrics

    (2003)
  • J.M. Angsten

    Use of complementary and alternative medicine in the treatment of asthma

    Adolesc Med

    (2000)
  • S. Cala et al.

    A survey of herbal use in children with attention-deficit-hyperactivity disorder or depression

    Pharmacotherapy

    (2003)
  • E. Chan et al.

    Complementary and alternative therapies in childhood attention and hyperactivity problems

    J Dev Behav Pediatr

    (2003)
  • P. Gardiner et al.

    Supplement use growing among children and adolescents

    Pediatr Ann

    (2004)
  • P. Gardiner et al.

    Recent review of complementary and alternative medicine used by adolescents

    Curr Opin Pediatr

    (2000)
  • G. Johnston

    The use of complementary medicine in children with atopic dermatitis in secondary care in Leicester

    Br J Dermatol

    (2003)
  • L.J. Mazur et al.

    Use of alternative and complementary therapies for pediatric asthma

    Tex Med

    (2001)
  • D. Sinha et al.

    Complementary and alternative medicine use in children with attention deficit hyperactivity disorder

    J Paediatr Child Health

    (2005)
  • C.A. Slader et al.

    Complementary and alternative medicine use in asthma: who is using what?

    Respirology

    (2006)
  • K.J. Kemper et al.

    Consultations for holistic pediatric services for inpatients and outpatient oncology patients at a children's hospital

    Arch Pediatr Adolesc Med

    (2001)
  • J.M. Braun et al.

    Therapeutic use, efficiency and safety of the proteolytic pineapple enzyme Bromelain-POS in children with acute sinusitis in Germany

    In Vivo

    (2005)
  • P. Gardiner et al.

    Factors associated with dietary supplement use among prescription medication users

    Arch Intern Med

    (2006)
  • L.L. Everett et al.

    Herbal and homeopathic medication use in pediatric surgical patients

    Paediatr Anaesth

    (2005)
  • C. Vincent et al.

    Why do patients turn to complementary medicine? An empirical study

    Br J Clin Psychol

    (1996)
  • N. Jain et al.

    Barriers to acceptance: an exploratory study of complementary/alternative medicine disuse

    J Altern Complement Med

    (2001)
  • D.J. Bearison et al.

    Medical management of asthma and folk medicine in a Hispanic community

    J Pediatr Psychol

    (2002)
  • G. Flores et al.

    Barriers to health care access for Latino children: a review

    Fam Med

    (1998)

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