NCCAM on Pediatric CAM use

The National Center for Complementary and Alternative Medicine (NCCAM) recently published a “white paper” on CAM use and children.

“CAM Use and Children” was developed based on an interview with holistic pediatric pioneer Dr. Kathi Kemper. Kathi, as some of you know, heads the American Academy of Pediatrics (AAP) provisional Section on Complementary, Holistic and Integrative Medicine, serves as the Caryl J. Guth Chair for Holistic and Integrative Medicine at Wake Forest University School of Medicine, and authored the book, “The Holistic Pediatrician.” She is probably the best source of information on the progress of the integrative pediatrics movement, period. So it is nice to see NCCAM recognize her contributions to the advancement of medicine by developing a fact sheet on CAM use in children. And it’s about time. In truth, NCCAM has not focused on children in any substantive way. The priority list for research funding opportunities NOWHERE mentions children as a special area of focus. A miniscule portion of the NCCAM budget each year goes towards pediatric research, even though children make up nearly 30% of the country’s population. One would think a focus on children’s issues would make sense for an entity charged with examining integrative therapies. Shouldn’t we be funding research in preventive strategies to reduce the incidence and prevalence of epidemic diseases like obesity, diabetes, cancer, allergies/asthma, and neurodevelopmental disorders? Or maybe simply we should continue to dump billions of dollars into trying (and failing) to fix (preventable) problems long after they’ve developed.

But I digress.

NCAAM’s fact sheet lists the following key points:

* CAM is used by American children, including adolescents.

* Children are not small adults. Their bodies can react differently from adults’ bodies to medical therapies, including CAM.

* In general, CAM therapies have not been well studied in children.

* Tell your child’s health care providers about any CAM therapy you are considering or using for your child. This helps to ensure coordinated and safe care.

To me, these first three points are kind of obvious, but hey, these fact sheets in general don’t break new ground. The rising use of CAM therapies, especially in children with chronic health conditions, has been well documented and reported. That “children are not small adults” still needs to be reported, in this day and age, is an indictment of our society’s attitude towards children. Pediatrics was developed as a specialty in the 1930’s predominantly to make this point – children need special doctors. It is not sufficient to treat them, conventionally – alternatively – however you practice, as little grown-ups. I’d like to think we’ve learned this lesson by now. Integrative practitioners DO focus on individualizing therapies more so than conventional doctors, but I would say that most pediatricians are aware of the need to tailor therapies based on size and developmental stage. The third point – that CAM has not been well studied in children – well, just re-read what I wrote above. ‘Nuff said. Or probably not.

The fourth key point highlights the crucial need for practitioners and families to communicate about the use of ALL therapies, both conventional and CAM. Surveys still indicate that a minority of parents and children disclose use of CAM therapies to their physicians. Truly holistic primary care requires open and honest dialogue, both ways, between patient and physician. To this end, the AAP has endorsed the poster below, developed by several Canadian organizations (including PedCAM), for use in pediatric offices. It’s a good start.