CAM therapies are commonly used across a broad spectrum of pediatric patients. The percentage of American adults in the general population using CAM increased from 34% in 1990 to 42% in 1997; out-of-pocket expenditures increased 45% during this same period. Certain racial and cultural groups, age, gender, and socioeconomic status groups may have even higher use of certain kinds of CAM therapies. For example, in the general public, CAM is most commonly used by middle-aged, white women with above-average income and education. Parental CAM use is one of the strongest predictors of pediatric CAM use. Overall, CAM use in children is least common in healthy community populations, ranging from 2% to 7%; intermediate in clinic patients, ranging from 11% to 20%; and highest in clinics and inpatient settings serving patients with chronic or incurable conditions such as allergies, asthma, attention deficit-hyperactivity disorder (ADHD), autism, cystic fibrosis, cancer, inflammatory bowel disease, rheumatoid arthritis, or complex psychosocial problems, ranging from 25% to more than 70% of children. The use of CAM therapies is more common among patients with worse quality of life and poor prognosis. Fewer than 50% discuss their CAM use with physician.

The most common reasons that parents seek CAM therapies for their children is to relieve symptoms and to be assured that they have tried every reasonable, safe option. Many CAM therapies also are perceived as less expensive and safer than conventional medications and surgical treatments. Patients prefer therapies that are consistent with their values (such as being natural, safe, and empowering), and seek care from therapists who respect them. CAM therapies may be sought because of frustration with modern medicine’s inability to cure chronic illnesses, fear of the adverse effects of medications, interest in traditional beliefs and cultural practices, a desire for more natural therapies and more time for discussion with the clinician, a desire to decrease reliance on external, technical solutions, and a desire to enhance one’s resilience and natural ability to respond effectively to challenges. Implicitly or explicitly then, the goals many patients seek in CAM are global goals such as connection, respect, support, meaning, harmony, presence, and peace of mind (Box 8.1).

Whether CAM works depends largely on the patient and condition being treated, the specific treatment in question, and the therapeutic goals. Western, mainstream medicine and medical research has largely focused on specific treatment goals related to specific conditions. Goals such as achieving a cure, reducing or managing symptoms, preventing specific diseases, or eliminating specific toxins (e.g., lead) are readily measured objectively. However, patients and families may also hold global goals that are difficult to measure using typical outcomes-based research.

The model displayed in Figure 8.1 helps clinicians appreciate the similarities and differences between a wide variety of complementary and mainstream therapies. The model contains four major domains of therapeutic options. Each domain (biochemical, lifestyle, biomechanical, bioenergetic) contains both mainstream and CAM therapies. The arrows reflect the
similarities and continuum of adjacent therapies in different domains, such as dietary supplements (Biochemical domain) and diet (Lifestyle domain). CAM therapies are not a cure for cancer, cystic fibrosis, autism, fractured femurs, appendicitis, and congenital or genetic defects. Nor do CAM therapies prevent polio, measles, lead poisoning, substance abuse, child abuse, or anthrax. However, CAM therapies may help with symptoms that trouble many children. Massage has proven helpful in promoting growth in preterm infants, relieving muscle spasm, pain, anxiety, depression, and insomnia, and enhancing lymphatic drainage. Acupuncture has proven effective in treating pain and nausea. Hypnosis, biofeedback, guided imagery, and meditation offer assistance with a variety of behavioral problems, dermatologic disorders, insomnia, and anxiety as well as chronic pain. Certain herbs and dietary supplements may enhance relaxation (chamomile), promote sleep (lavender), reduce gastrointestinal spasms (peppermint), relieve rashes (aloe), and prevent osteoporosis (calcium and vitamin D). Osteopathic manipulation can help prevent recurrent otitis media. Substantial additional research is necessary to define the optimal, cost-effective integration of complementary therapies into conventional practice.

In general, complementary therapies are substantially safer than conventional medications and surgery. Although patients can have minor bleeding or bruising at needle insertion sites, the serious adverse effects of acupuncture are exceedingly rare. Between the years 1981 and 1994, only 193 patients worldwide had reported adverse events from acupuncture. Despite a few well-publicized case reports of serious complications, chiropractic and osteopathic treatments are also very safe, even for young children. Similarly, massage is very safe when common-sense precautions are followed (e.g., no firm pressure in patients with low platelet counts, no massage over indwelling catheter sites or open wounds). Music, guided imagery, Healing Touch, and prayer are practically without side effects. The most serious risk from most professionally provided CAM therapies is that families will forego effective conventional care and rely solely on CAM to treat serious conditions such as cancer or diabetes. Prudent pediatricians ask a series of sensible questions prior to referring patients to CAM providers (Box 8.2).