Complementary/alternative medicine use in a pediatric oncology unit in Turkey

BACKGROUND: Important in the cancer therapy is the increasingly use of complementary/alternative medicine (CAM). The current study aims to establish the extent of use, the types of therapies employed, factors influencing, the reasons for choosing and the cost of CAM used in pediatric cancer patients in our clinic in Ankara, Turkey. PROCEDURE: A detailed questionnaire regarding demographic data and information about the use of CAM was completed by 95 patients who have attended the clinic between 1999 and 2000. RESULTS: Forty-nine patients (51.6%) had used one or more than one type of CAM. The most frequent (71.4%) was herbal medicine and biologic intake (stinging nettle, plant essence, honey of Anzer). The second one was religious therapy (40.8%). No correlation could be found between the use of CAM and parents education status, the level of income, number of siblings, the prognosis of the disease, the rate of satisfaction with the level of information given by the doctor at the time of diagnosis or the belief in the information given by the doctor about the prognosis (P > 0.05). All patients used CAM in addition to conventional therapy. CONCLUSIONS: More than half of the patients used CAM, with stinging nettle being the most common agent. Our patients place a high level of trust in their physicians and the conventional therapies offered by them; however, they also believe that the complementary therapies are harmless and, therefore, worth trying.     

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

OBJECTIVES: The use of complementary and alternative medicines (CAM) is increasing in the general population. Attention deficit hyperactivity disorder (ADHD) is a chronic condition that has a major impact on children's functioning and has no cure, therefore many families may try CAM at some stage. We aimed to determine (i) the lifetime incidence of CAM use in a clinical sample of children with ADHD; (ii) parents' perceptions of the effectiveness of CAM for ADHD; and (iii) the proportion who informed their paediatrician. METHODS: The sample was drawn from patients aged 5-17 years with ADHD attending Royal Children's Hospital, Melbourne outpatient clinics from May to September 2003. A 20-item survey was posted to consenting families. RESULTS: From 105 surveys, 75 were returned (response rate 71.4%). Mean child age was 11.1 (SD 2.9, range 5.0-16.9) years; 65 (86.7%) were boys. Fifty (67.6%) families reported current or past CAM use. Of the 23 different therapies reported, the most common were modified diet (33 families), vitamins and/or minerals (16), dietary supplements (12), aromatherapy (12) and chiropractics (10). Reported effectiveness was variable. The factors most frequently rated as important in choosing CAM were minimizing symptoms (40 families), adding to the benefit of conventional treatment (30) and avoiding side-effects (29). Thirty-two (64%) of 50 families reported that they informed their paediatrician of their CAM use. CONCLUSION: Complementary and alternative medicines are commonly used in children with ADHD. Paediatricians should inquire about the use of CAM, and use available resources to help guide families in their therapeutic choices.     

Managing paediatric death in the emergency department

Death of a child in an emergency department is a rare occurrence, but one with significant impact on the family and staff involved. The rarity means few emergency department clinicians feel ‘expert’ in the overall management process. However, most have some knowledge and experience which can be augmented by collaborating with other health professionals. By exploring some of the main management issues and challenges for the emergency department, key aspects of care are identified for emergency department clinicians to consider in reviewing local procedures and guidelines.     

Survey of complementary and alternative medicine use at a tertiary children's hospital

OBJECTIVE: The use of complementary and alternative medicine (CAM) within the Australian community is common. The objective of this study was to determine the prevalence and pattern of CAM usage in children attending a tertiary children's hospital. METHODS: We conducted a cross-sectional survey of children attending the Royal Children's Hospital, Melbourne. Children were identified by consecutive acute admissions and attendance at outpatient clinics. A structured questionnaire with items about the use of CAM in the preceding year was administered by means of a face-to-face interview. RESULTS: Based on the 503 children surveyed, 51% reported CAM use in the preceding year. Forty-three percent had used at least one CAM medication. The most common medicinal CAM used were multivitamins, vitamin C, herbal remedies and homeopathic treatments. Non-medicinal CAM was used by 23% of the participants. The most commonly used therapies were chiropractic, naturopathy, aromatherapy, therapeutic massage and dietary restriction. The main reasons stated for CAM usage included promotion of general health and treatment of colds. Sixty-three percent of those reporting CAM use had not discussed this with their treating doctor. CONCLUSION: The use of CAM by children is common. Complementary and alternative medicine is particularly used for the treatment of common illnesses and conditions of childhood. Importantly, use is not always conveyed to treating physicians. Given the potential risk of adverse events associated with the use of CAM or interactions with conventional management, doctors should ask about their use as a part of routine history taking.     

Survey of paediatric complementary and alternative medicine use in health and chronic illness

Groups of 25 children with cerebral palsy (CP), inflammatory bowel disease (IBD), and cancer were compared to 25 healthy children to establish use of complementary or alternative medicine (CAM). Children with chronic disease were greater than three times more likely to use CAM, usually without paediatricians' knowledge.     

Use of complementary and alternative medicine by patients presenting to a paediatric Emergency Department

Although the popularity of complementary and alternative medicine (CAM) has risen in the last decade, information about its use by paediatric patients presenting to an Emergency Department is still sparse. We report here the results of a cross-sectional survey of paediatric patients presenting to an urban, tertiary paediatric Emergency Department between October 2006 and March 2007. In total, 1143 questionnaires (68% of those distributed) were completed and available for analysis. Of these, 58% (n = 665) of all respondents admitted that their child had received some form of CAM therapy, while 25% (n = 291) admitted that their child was receiving CAM for the present illness. In 31% of the respondents (n = 354), CAM had been prescribed by a physician, while 50% (n = 575) used CAM as self-medication. Patients presented to the Emergency Department mostly because of an infection (42% of total; 29% of these used CAM) or a trauma (38% of total; 19% of these used CAM). Parents of CAM-users were significantly older, more often born in Switzerland and had significantly higher school education than those of the non-users. Nearly two-thirds of the administered CAM therapies were not prescribed by a physician, and 50% of the families using CAM did not discuss this with their general practitioner. Parental requirements implied that medical professionals on a paediatric Emergency Department should know the effects and side-effects of CAM therapies and even be able to recommend them. The study population, even trauma patients, frequently used CAM. The use of CAM is characterised by a high rate of self-medication and the exclusion of the physicians from the decision-making process. The parents of paediatric patients frequently demand that CAM be considered as a possible treatment option and wish to have an open discussion with the medical professionals on this topic. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Complementary and alternative medicine for autism spectrum disorders: Rationale,safety and efficacy

Complementary and alternative medicine is widely used for children with autism spectrum disorder, despite uncertainty regarding efficacy. This review describes complementary and alternative practices commonly used among this population, the rationale for the use of each practice, as well as the side‐effect profile and evidence for efficacy. The existing evidence base indicates that melatonin can be recommended as a treatment for sleeping disturbances associated with autism spectrum disorder, while secretin can be rejected as an efficacious treatment for broader autistic symptoms. There is insufficient evidence to draw conclusions on the efficacy of modified diets, hyperbaric oxygen therapy, immune therapy, and vitamin and fatty acid supplementation. There is a clear need for methodologically rigorous studies to provide evidence‐based guidance to families and clinicians regarding complementary and alternative practices for individuals with autism spectrum disorders.     

Complementary and alternative medicine in children attending gastroenterology clinics: usage patterns and reasons for use

Background: The use of complementary and alternative medicines (CAM) appears to be increasing. This cross‐sectional study aimed to assess the use of CAM in children, investigate factors influencing their use and attitudes towards them and to contrast to previous usage patterns. Methods: Parents of children attending gastroenterology outpatient clinics at a tertiary paediatric hospital completed a questionnaire providing details of CAM usage, awareness and attitudes. Results: Sixty‐nine percent of the 98 respondents were using or had used CAM (n= 66). Nutritional supplements (n= 37, 56% of CAM users) and probiotics (n= 33, 50%) were most commonly used. Most CAM users sought complementary therapy to help a chronic problem (n= 43, 69.4%) and had been referred by a friend or family member (n= 33, 53.2%). Self‐reported well‐being was associated with CAM use (P= 0.0009) and CAM were described as partially effective by 40 parents (67.8%). Forty‐six parents (75.4%) expressed that they would use CAM again. Seventy‐two respondents (80%) believed that doctors should support the use of CAM. Conclusion: Children attending this gastroenterology clinic are commonly given CAM. Awareness and acceptance of CAM by carers of children with gastroenterology conditions is high.     

Seizures in the paediatric emergency department

Seizures are a common presentation to emergency departments. Early intervention improves treatment response. Use of consensus guidelines is highly recommended to decrease drug side effects and reduce intensive care requirements. Benzodiazepines remain the mainstay of first‐line treatment. Choice of drugs for second‐line treatment is expanding and some important studies are currently underway to determine which of these agents has the best safety and effectiveness profile in children.     

Alcohol use by parents who present their child to a paediatric emergency department

OBJECTIVES: Parental alcohol misuse exposes children to risk, but is poorly identified in paediatric settings. We aimed to (i) measure the alcohol use in parents of a sample of children attending emergency and (ii) assess the quality of documentation of this alcohol use by paediatric residents. METHOD: Parents of children presenting to the Emergency Department of a children's hospital were interviewed regarding their alcohol use, and each completed an AUDIT CORE questionnaire. The child's case notes were reviewed for documentation of parental alcohol use. RESULTS: One hundred and ninety-three parents were interviewed. Although per capita alcohol use for both sexes, and hazardous drinking for females were found to be significantly less than general population figures, rates of hazardous drinking were high for fathers. Yet only 1% of case notes reviewed contained any documentation of parental alcohol use. CONCLUSION: This small study suggests that although average alcohol intake amongst parents presenting their children to a paediatric emergency department may be lower than for the general population, there is a significant prevalence of undetected hazardous drinking amongst parents.     

Infective endocarditis: experience of a paediatric emergency department

OBJECTIVES: To determine the clinical features at presentation of children with infective endocarditis to a tertiary centre and review the role of the emergency department in these cases. The subsequent course and outcomes are briefly discussed. METHODS: Retrospective audit of children with endocarditis presenting to a tertiary children's hospital over a 16-year period. RESULTS: Twenty-three cases of infective endocarditis were identified. Initial presentation via the paediatric emergency department occurred in 78% of cases and was associated with the least delay to commencement of appropriate treatment. The average duration of illness at the time of presentation was 6 days. Prior medical care had been sought in 65% of the cases, with antibiotics prescribed for an alternate diagnosis in 73%. Children with and without cardiac anomalies were equally represented. Of the group with normal cardiac anatomy, 45% presented without a murmur. Staphylococcus aureus was the most frequent causative organism (43%) and accounted for 64% of cases in children with no pre-existing cardiac abnormalities. Permanent sequelae were more likely to occur with S. aureus. The overall mortality rate was 9%. CONCLUSIONS: Infective endocarditis is a rare illness in children and represents a diagnostic challenge. The majority of cases will present via the paediatric emergency department with a non-specific febrile illness, having frequently commenced antibiotics for an alternate diagnosis. Specific expertise in paediatric emergency care can assist in early diagnosis and management. Morbidity remains significant, particularly in cases caused by S. aureus.     

Improving asthma documentation in a paediatric emergency department

Objectives: To improve documentation for children presenting to the Emergency Department (ED) of The Children's Hospital with acute asthma.
Methodology: In phase I, the documentation process was analysed using a standard total quality management (TQM) approach to identify specific problems leading to poor documentation. Fifty-two medical records of children presenting over a 3 week period were reviewed for nursing and medical documentation. A set of minimum criteria, consistent with the Paediatric Asthma Management Plan, were established for documentation by both medical and nursing staff. Following dissemination and education, compliance with documentation was evaluated and compared to an asthma survey performed in the ED in 1991. In phase II, a specific proforma for medical assessment was developed and 80 medical records of children presenting over a 3 week period were reviewed. Fifty-two (65%) with completed proformas were evaluated. The outcome measure was the documentation rate for minimum criteria established by TQM process.
Results In phase I, nursing compliance with documentation ranged from 46% for signs of respiratory distress to 83% for a past history of asthma and 100% for pulse rate. Doctors were similarly poor at documenting essential elements such as severity (31%), palpable pulsus paradoxus (29%), the child's usual doctor (46%) and follow-up arrangements (21–56%). In phase II, the documentation of the severity of acute asthma (42%) and of the child's usual doctor (42%) remained poor but there were statistically significant improvements in documentation of interval medications, palpable pulsus paradoxus, respiratory rate, pre-treatment oximetry, education, follow-up arrangements and communication letters.
Conclusion The process of TQM has proved valuable in improving some aspects of documentation of children presenting to ED with acute asthma. It remains to be shown whether improved documentation will result in improved outcome.     

Complementary and alternative medicine use in children and adolescents with type 1 diabetes

BACKGROUND:

The use of complementary and alternative medicine (CAM) in paediatric patients varies between 11% and 68%. There are limited reports of its use in children with type 1 diabetes mellitus (T1DM).

OBJECTIVE:

To describe the use of CAM in children with T1DM, and the perceptions of both users and nonusers regarding the effect of CAM on diabetes management.

DESIGN/METHODS:

A cross-sectional, anonymous questionnaire survey was mailed to a randomly selected subgroup of patients with T1DM. Each patient’s main caregiver was asked to complete the questionnaire.

RESULTS:

Of 403 questionnaires mailed, 195 (48%) were completed. The mean (± SD) age of the children was 12.2±4.0 years (56% boys). Use of CAM was reported in 110 children (56%) (vitamins/minerals [n=99], herbal medicine [n=22], dietary supplement [n=13]). When excluding the use of vitamins/minerals, the CAM number dropped to 47 children (24%). Only the current age of the child was significantly different between users and nonusers of CAM. In users, reasons cited for using CAM were to minimize symptoms, improve control, prevent complications and add benefits to insulin. Only 30% of CAM users stated that CAM improved diabetes control. Nonusers cited satisfaction with current diabetes treatment and lack of knowledge as reasons for not using CAM.

CONCLUSIONS:

CAM use in children with T1DM was frequent, and appeared to be an attempt to improve control or prevent diabetes complications. However, improved control was not reported as a benefit. Diabetes care teams should assess the use of CAM in children with T1DM, and monitor for any potential positive or negative effects.     

Comparison of complementary and alternative medicine use: reasons and motivations between two tertiary children's hospitals

Aims

To compare prevalence, reasons, motivations, initiation, perceived helpfulness, and communication of complementary and alternative medicine (CAM) use between two tertiary children''s hospitals.

Methodology

A study, using a face‐to‐face questionnaire, of 500 children attending the University Hospital of Wales, Cardiff, UK was compared to an identical study of 503 children attending the Royal Children''s Hospital, Melbourne, Australia.

Results

One year CAM use in Cardiff was lower than Melbourne (41% v 51%; OR = 0.67, 95% CI 0.52–0.85), reflected in non‐medicinal use (OR = 0.41, 95% CI 0.29–0.58) and general paediatric outpatients (OR = 0.38, 95% CI 0.21–0.67). Compared to Melbourne, factors associated with lower CAM use in Cardiff included families born locally (father: OR = 0.58, 95% CI 0.44–0.77) or non‐tertiary educated parents (mother: OR = 0.54, 95% CI 0.38–0.77). Cardiff participants used less vitamin C (OR = 0.31, 95% CI 0.18–0.51) and herbs (OR = 0.49, 95% CI 0.34–0.71), attended less chiropractors (OR = 0.25, 95% CI 0.06–0.37) and naturopaths (OR = 0.08, 95% CI 0.02–0.33), but saw more reflexologists (OR = 3.33, 95% CI 1.08–10.29). In Cardiff, CAM was more popular for relaxation (OR = 1.92, 95% CI 1.03–3.57) but less for colds/coughs (OR = 0.4, 95% CI 0.27–0.73). Most CAM was self‐initiated (by parent) in Cardiff and Melbourne (74% v 70%), but Cardiff CAM users perceived it less helpful (OR = 0.46, 95% CI 0.31–0.68). Non‐disclosure of CAM use was high in Cardiff and Melbourne (66% v 63%); likewise few doctors/nurses documented recent medicinal CAM use in inpatient notes (0/21 v 2/22).

Conclusions

The differences in CAM use may reflect variation in sociocultural factors influencing reasons, motivations, attitudes, and availability. The regional variation in use and poor communication highlights the importance of local policy development.     

Prevalence and parental perceptions of complementary and alternative medicine use by children with cancer in a multi-ethnic Southeast Asian population

Background

The purpose of the current study was to determine the prevalence of use of complementary and alternative medicine (CAM) by children with cancer and to compare the characteristics of CAM users and CAM nonusers.

Methods

A cross‐sectional study was performed at a pediatric oncology center in Kuala Lumpur, Malaysia. The parents of 97 children with cancer were interviewed using a structured questionnaire.

Results

Overall, 84.5% of the respondents had used CAM, and most of them believed that CAM provided a boost to the immune system, and used CAM with the intention to complement conventional treatment. The most frequently used CAM was water therapy (78%), followed by spirulina (33%), vitamin C (27%), multivitamin (23%), visit to traditional healers (22%), sea cucumber (Stichopus horrens) (15%), and Chinese traditional medicine (12%). The Malay (n = 67) were using more often (93%) CAM than non‐Malay (n = 30, use 67%, P = 0.001).

Conclusions

CAM use is common among Malaysian children with cancer. Understanding the sociocultural dimension of patients' health beliefs is important to a successful treatment, and pediatric oncologists should ask for the use of CAM. Pediatr Blood Cancer 2009;52:70–74. © 2008 Wiley‐Liss, Inc.