Complementary and Alternative Medicine Overview

Background

What is alternative/complementary medicine (CAM)?

The National Center for Complementary and Alternative Medicine (NCCAM) 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 medicine.” Complementary medicine augments conventional treatment, while alternative medicine is used instead of conventional treatment. For the most part, there is little scientific evidence to support the use of CAM therapies.

CAM Therapy Domains

NCCAM divides CAM therapies into several domains:

Alternative Medical Systems: entire systems of theory and practice that have evolved separately from conventional medicine (i.e. homeopathic medicine, naturopathic medicine, traditional Chinese medicine, and Ayurveda)
Mind-Body Interventions: use techniques designed to increase the mind’s ability to affect the body (i.e. meditation, prayer, mental healing, and art/music/dance therapy)
Biologically Based Therapies: use herbs, foods, and vitamins/minerals at high doses (i.e. dietary supplements and herbal products)
Manipulative and Body-Based Methods: manipulate or move parts of the body (i.e. chiropractic or osteopathic manipulation and massage)
Energy Therapies: use techniques designed to affect energy fields (i.e. Qi Gong, Reiki, Therapeutic Touch, and magnet therapy)

Prevalence of CAM Use in the Pediatric Population

General child population: 2-70% of children, depending on how CAM is defined
In children with special health care needs, it is estimated that CAM use may be as high as:
- 54% in children with attention deficit hyperactivity disorder
- 95% in children with autistic spectrum disorders
- 56% in children with cerebral palsy
- 87% in children with Down Syndrome
A survey conducted in Utah found that 35% of children with a neurobehavioral disorder (Down Syndrome, autism, ADHD) had taken a non-prescribed dietary supplement in the year before the survey

Counseling Families Who Choose CAM Therapies

Only 20% of the parents of children with a chronic illness reported non-prescribed dietary supplement use to the child’s health care provider. The reasons that parents gave for not discussing dietary supplement use with their child’s health care provider included not perceiving it as important, feeling that the doctor would react negatively, and not having the doctor ask about CAM therapies. Misinformation/unrealistic promises regarding CAM therapies are perpetuated via the internet, supplement manufacturers/distributors, and some CAM providers. Why do parents of children with chronic illness/disability choose CAM therapies?

Frustration with the complexity, discomfort, and/or uncertainty of conventional medical therapies
A lack of involvement in the development of the child’s care plan
Information from the media, condition-specific publications, other parents, and the internet
Attracted by claims that CAM therapies are “natural”
Desire to gain a sense of control over a child’s illness
Desire to improve a child’s quality of life

American Academy of Pediatrics Recommendations for Pediatricians Who Discuss Alternative, Complementary, and Unproven Therapies with Families includes:

Seek information for yourself and be prepared to share it with families.
Evaluate the scientific merits of specific therapeutic approaches.
Identify risks or potential harmful effects.
Provide families with information on a range of treatment options (avoid therapeutic nihilism).
Educate families to evaluate information about all treatment approaches.
Avoid dismissal of CAM in ways that communicate a lack of sensitivity or concern for the family’s perspective.
Recognize feeling threatened and guard against becoming defensive.
If the CAM approach is endorsed, offer to assist in monitoring safety, side effects, and evaluating the response.
Actively listen to the family and the child with chronic illness.

Continuing Medical Education in CAM Therapies

Free, online CME seminars (registration required) are available from the National Center for Complementary and Alternative Medicine at http://nccam.nih.gov/videolectures/

Reviews of CAM Therapies for Specific Developmental Disabilities

Attention Deficit Hyperactivity Disorder

Autism

Cerebral Palsy

Down Syndrome

References

Peer-reviewed Journal Articles/Academies:

National Center for Complementary and Alternative Medicine. What Is Complementary and Alternative Medicine (CAM)? Available at: http://nccam.nih.gov/health/whatiscam/. Accessed 9/27/05.

National Center for Complementary and Alternative Medicine. The Use of Complementary and Alternative Medicine in the United States. Available at: http://nccam.nih.gov/news/camsurvey_fs1.htm. Accessed 9/27/05.

Harris AB. Evidence of Increasing Dietary Supplement Use in Children with Special Health Care Needs: Strategies for Improving Parent and Professional Communication. J Amer Diet Assoc. 2005; 105 (1): 34-37.

Ball SD, Kertesz D, and Moyer-Mileur LJ. Dietary Supplement Use Is Prevalent Among Children with a Chronic Illness. J Am Diet Assoc. 2005: 105: 78-84.

Hyman SL and Levy SE. Introduction: Novel Therapies in Developmental Disabilities – Hope, Reason, and Evidence. MRDD Research Reviews. 2005; 11: 107-109.

American Academy of Pediatrics Committee on Children with Disabilities. Counseling Families Who Choose Complementary and Alternative Medicine for Their Child With Chronic Illness or Disability. Pediatrics. 2001; 107(3): 598-601.

Harrington JW, Rosen L, Garnecho A, Patrick PA. Parental perceptions and Use of Complementary and Alternative Medicine Practices for Children with Autism Spectrum Disorders in Private Practice. Journal of Developmental Behavioral Pediatrics 2006: 156-161.

ADVISORY COMMITTEE

Theodore A. Kastner, M.D., M.S.

Robin L. Hansen, M.D.

Patrick J. Maher, M.D.

Terrance D. Wardinsky, M.D.

PUBLICATION INFORMATION

Funded by a grant from the California Department of Developmental Services

For more information, contact:

Center for Health Improvement

1330 21st Street, Suite 100

Sacramento, CA 95814

(916) 901-9645

This document does not provide advice regarding medical diagnosis or treatment for any individual case, and any opinions or statements contained in this document are not intended to serve as a standard of medical care. Physicians are encouraged to view the considerations presented in this document in light of evolving scientific information. This document is not intended for use by the layperson. Reproduction of this document may be done with proper credit given to California Department of Developmental Services and the Center for Health Improvement.