Since there's been some discussion and attempted discreditation around CAM on this forum lately, it seemed serendipitous that this article appeared to day on MedScape:
http://www.medscape.com/viewarticle/584824
AAP Addresses Use of Complementary and Alternative Medicine CME/CE
News Author: Laurie Barclay, MD
CME Author: Penny Murata, MD
Disclosures
Release Date: December 5, 2008;
Learning Objectives
Upon completion of this activity, participants will be able to:
Identify common types of complementary and alternative medicine therapies used in children.
Report strategies to discuss complementary and alternative medicine with children and families.
Authors and Disclosures
Laurie Barclay, MD
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
Penny Murata, MD
Disclosure: Penny Murata, MD, has disclosed no relevant financial relationships.
Laurie Scudder, MS, NP-C
Disclosure: Laurie Scudder, MS, NP-C, has disclosed no relevant financial information.
Brande Nicole Martin
Disclosure: Brande Nicole Martin has disclosed no relevant financial information.
December 5, 2008 — The American Academy of Pediatrics (AAP) has issued a clinical report that addresses the use of complementary and alternative medicine (CAM) in children and has published it in the December issue of Pediatrics.
"The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (NIH) defines...CAM as a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional Western medicine," write Kathi J. Kemper, MD, MPH, and colleagues from the Task Force on Complementary and Alternative Medicine and the Provisional Section on Complementary, Holistic, and Integrative Medicine. "Complementary medicine is used in conjunction with conventional medicine; for example, massage, guided imagery, and acupuncture may be used in addition to analgesic medications to help decrease pain. Alternative medicine is used in place of conventional Western medicine; for example, some adolescents use herbs rather than antidepressant medications to treat depression."
Recognizing the increasing use of CAM in children, the AAP also saw the need to provide information and support for pediatricians regarding this field of practice. From 2000 to 2002, the AAP convened the Task Force on Complementary and Alternative Medicine to address issues related to the pediatric use of CAM and to develop resources to educate clinicians, patients, and families.
The present AAP clinical report describes CAM services, current levels of utilization and costs, and related legal and ethical issues. Given the breadth and range of CAM, the task force concluded that an in-depth review of each modality was beyond the scope of this report.
The aims of the report were therefore to define terms; to review the epidemiology; to list frequently used CAM modalities; to discuss medicolegal, ethical, and research implications; to describe education and training for CAM providers; to offer resources for additional learning regarding CAM; and to suggest communication strategies that clinicians may find helpful when discussing CAM with patients and families.
Now that many CAM modalities, such as guided imagery and massage for pain treatment, have been formally tested and integrated into standard practice, the distinction between CAM and mainstream medicine has become less apparent. The terms holistic medicine or integrative medicine is being increasingly substituted for CAM.
"Holistic medicine refers to patient-centered care that includes consideration of biological, psychological, spiritual, social, and environmental aspects of health," the Task Force writes. "Integrative medicine is relationship-based care that combines mainstream and complementary therapies for which there is some high-quality scientific evidence of safety and effectiveness to promote health for the whole person in the context of his or her family and community. Integrative medicine also reaffirms the importance of the relationship between the practitioner and the patient, emphasizes wellness and the inherent drive toward healing, and focuses on the whole person, using all appropriate therapies to achieve the patient's goals for health and healing."
The Kemper model of holistic care recognizes 4 main components of therapy. Biochemical components include medications, dietary supplements, vitamins, minerals, and herbal remedies. Lifestyle and nutritional interventions include recommendations for exercise and/or rest; environmental therapies including heat, ice, music, vibration, and light; and mind-body treatments such as behavior management, meditation, hypnosis, biofeedback, and counseling.
Biomechanical components include massage and bodywork, chiropractic and osteopathic adjustment, and surgery. Bioenergetic therapies may include acupuncture, radiation therapy, magnets, Reiki, healing touch, qi gong, therapeutic touch, prayer, and homeopathy.
Clinicians caring for children need to advise and counsel patients and their families about appropriate, safe, and effective health services and treatments regardless of whether they are considered mainstream or CAM. Clinicians should specifically ask about all treatments the family is administering to the child because most families use CAM services without spontaneously notifying their clinician.
To provide useful counsel regarding use of CAM and integrating these therapies into the child's treatment plan, pediatricians should stay informed and updated regarding therapeutic options available to their patients. Clinicians should address and counsel their patients' families regarding the safety, appropriateness, and advisability of specific CAM services used by individual patients.
A common-sense approach to advising families regarding use of CAM modalities is that those treatments shown to be safe and effective should be encouraged, those treatments that are safe but ineffective may be tolerated, those modalities that are effective but raise safety issues should be closely monitored or discouraged, and those therapies that are neither safe nor effective should be discouraged.
For patients being treated by a CAM provider, the pediatrician should seek permission of the patient and family to include the CAM provider in the overall management plan.
Helpful communication strategies may include asking about different therapies the patient is using; recognizing and respecting the family's perspectives, values, and cultural beliefs; working together with the parents as a team; and actively listening to families and patients.
The patient's response to treatment should be monitored with use of measurable outcomes, such as specific goals for symptom relief and remembering to "first do no harm."
"A growing number of pediatric generalists and subspecialists have begun to offer complementary therapies and advice as part of their practice," the task force concludes. "In addition, there is a growing number of academic pediatric integrative medicine programs and new initiatives to promote systematic sharing, support, and dissemination of information to improve collaborative and comprehensive care."
All AAP clinical reports automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time. Coauthor Sunita Vohra, MD, has received salary support from the Alberta Heritage Foundation for Medical Research and the Canadian Institutes of Health Research.
Pediatrics. 2008;122:1374-1386.
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