Complementary and Alternative Medicine for Developmental-Behavioral Problems in Children

Educational Objectives

The goal of this program is to improve patient guidance on complementary and alternative medicine (CAM) for developmental behavioral problems (DBP) in children. After hearing and assimilating this program, the clinician will be better able to:

1. Identify the various CAM agents used for DBPs in children.
2. Analyze the evidence for CAM use for specific DBPs in children.

Summary

Complementary and alternative medicine (CAM): families often resist expertise, and pediatricians must guide them toward safe and effective agents; >30% of adults and a growing number of children are using CAM; the National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health is a reliable resource; terminology — CAM encompasses practices outside mainstream medicine; complementary approaches are used alongside conventional medicine, and alternative approaches replace standard (ie, guideline- and evidence-based) treatments; complementary approaches are more common; CAM use has been increasing and is now seen in ≈40% in adults and >12% of children; categories — therapies fall into 2 broad categories, ie, natural products and mind-body practices; the most common complementary approaches in children include natural products (≈5%) and mind-body techniques, eg, chiropractic care, osteopathic manipulation, yoga, tai chi, qi gong, deep breathing, homeopathy, meditation, diet, and massage

CAM for children: between 2012 and 2017, there was a large increase in yoga and meditation; families are seeking symptom relief and addressing treatment adverse effects; some families desire more control over their child’s treatment or a preference for “natural” remedies; social media anecdotes are also a factor; the biomedical rationale for CAM use may seem intuitive to some parents; CAM use is more common with higher parental education and income; there is a lot of misinformation and disinformation around developmental and behavioral conditions, eg, autism spectrum disorder (ASD)

Common modalities: natural products include herbs, vitamins, minerals, probiotics, and dietary supplements (eg, fish oil); mind-body techniques include acupuncture, guided imagery, and progressive muscle relaxation; other options include Ayurvedic medicine and other traditional Eastern medicine disciplines (eg, Chinese)

CAM use for specific conditions: patients may seek out CAM for, eg, pain, musculoskeletal issues, colds, anxiety, stress, and insomnia; ASD — there is no evidence (and some evidence of harm) for, eg, secretin, chelation, antifungal agents; hyperbaric oxygen and cannabidiol (CBD) oil are being studied; however, some evidence support special diets (eg, ketogenic, omega-3 fatty acids), acupuncture, mindfulness practices, massage, qi gong, oxytocin, and music therapy; there is better evidence for melatonin for sleep; attention-deficit/hyperactivity disorder (ADHD) — there is no evidence for carnitine, herbs, elimination diets (eg, red dye, chocolate), or homeopathic products; there is weak evidence for acupuncture, chiropractic, meditation, and yoga; there is more evidence for neurofeedback, omega-3 fatty acids, and external trigeminal nerve stimulation (a US Food and Drug Administration-approved device); anxiety — there is no evidence for lavender, chamomile, passionflower, or Reiki; there is some evidence for acupuncture, hypnosis, massage, meditation, and movement therapies; there is better evidence (weak effects) for relaxation techniques, particularly when integrated with CBT; there is some evidence for kava and melatonin as preprocedural anxiety relievers

Challenges of CAM: families may not inform their physicians about CAM use due to assumptions about their knowledge, lack of time, perceptions about necessity, or fear of disapproval; physicians must ask about and discuss CAM use and promote shared decision-making; NCCIH is a reliable resource for evidence-based information on CAM and can guide use; risks of CAM — kava can cause liver toxicity, chelation can cause electrolyte imbalances, and St. John’s wort can interact with drugs (eg, selective serotonin reuptake inhibitors) through the cytochrome P450 system; supplements, eg, melatonin, are not regulated, may contain contaminants, and often vary in dosage; allergies, drug interactions, and accidental ingestion may occur; spinal manipulations might exacerbate, eg, cervical instability in trisomy 21; CAM treatments can be expensive; marijuana-derived treatments can alter senses, change mood, impair body movement, and impair memory and learning; however, CBD is useful for 2 rare seizure disorders and is being studied for pain, inflammation, and mental health; delta-9-tetrahydrocannabinol analogs are helpful for nausea and vomiting with chemotherapy and appetite and weight loss with AIDS, but they are not officially recommended

Placebo effect: belief in the efficacy of a treatment can lead to positive health outcomes; how a patient is treated by health care providers (trust, rapport, engagement) is equally as important as the treatment itself, especially in developmental-behavioral pediatrics

Readings

Canenguez Benitez JS, Hernandez TE, Sundararajan R, et al. Advantages and disadvantages of using St. John’s wort as a treatment for depression. Cureus. 2022;14(9):e29468. Published 2022 Sep 22. doi:10.7759/cureus.29468; Denny A, Day AS, Vernon-Roberts A. Association between paediatric complementary and alternative medicine use and parental health literacy, child health, and socio-economic variables: A prospective study. Pediatr Rep. 2024;16(2):368-384. Published 2024 May 8. doi:10.3390/pediatric16020032; Gillies D, Leach MJ, Perez Algorta G. Polyunsaturated fatty acids (PUFA) for attention deficit hyperactivity disorder (ADHD) in children and adolescents. Cochrane Database Syst Rev. 2023;4(4):CD007986. Published 2023 Apr 14. doi:10.1002/14651858.CD007986.pub3; Repova K, Baka T, Krajcirovicova K, et al. Melatonin as a potential approach to anxiety treatment. Int J Mol Sci. 2022;23(24):16187. Published 2022 Dec 19. doi:10.3390/ijms232416187; Soares RB, Dinis-Oliveira RJ, Oliveira NG. An updated review on the psychoactive, toxic and anticancer properties of kava. J Clin Med. 2022;11(14):4039. Published 2022 Jul 12. doi:10.3390/jcm11144039; Shuai B, Jin H, Lin Y, et al. Safety and efficacy of complementary and alternative medicine in the treatment of autism spectrum disorder: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2020;99(45):e23128. doi:10.1097/MD.0000000000023128; Teschke R, Sarris J, Glass X, et al. Kava, the anxiolytic herb: back to basics to prevent liver injury?. Br J Clin Pharmacol. 2011;71(3):445-448. doi:10.1111/j.1365-2125.2010.03775.x; Zisman CR, Patti MA, Kalb LG, et al. Complementary and alternative medicine use in children with a developmental disability and co-occurring medical conditions. Complement Ther Med. 2020;53:102527. doi:10.1016/j.ctim.2020.102527.

Disclosures

For this program, members of the faculty and planning committee reported nothing relevant to disclose.

Acknowledgements

Dr. Vanderbilt was recorded at the 40th Annual Current Advances in Pediatrics, held October 18-20, 2024, in Irvine, CA, and presented by The American Academy of Pediatrics, Orange County Chapter. For information about upcoming CME activities from this presenter, please visit https://www.aap-oc.org. Audio Digest thanks the speakers and presenters for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0.75 CE contact hours.

Lecture ID:

PD710602

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.