Use of complementary and alternative medicines in children Too important to ignoreAlissa Lim, Trainee Research Fellow Annette Webb, Paediatric Registrar Gill Kainey, RN, Clinical Support Services Kaye Hynes, Senior Pharmacist Noel Cranswick, Clinical Pharmacology Angela Mackenzie, Paediatrician Elizabeth Kennedy, Lawyer Liza Newby, Health Policy ConsultantMike South, Paediatrician
ComplementaryAlternativeNaturalWhackyHolisticIntegrativeUnprovenDangerousFraudulentHealing
I thought I should mention doctor, that we have been giving him a Chinese herbal tonic to build up his strength for the operation next month.
Thats OK isnt it?
The herbalist said we must keep giving it to him while he is in hospital for the operation.
Can we do that?
I wont be able to stay in overnight with him because I will need to be home for the other kids.
Would it be OK for the nurses to give him the tonic when Im not there?
AimsPresent our own research Present a new RCH policy and associated guidelines regarding CAM usage for RCH inpatients
Complementary and alternative medicine (CAM)Complementary or Alternative Medicine (CAM) is a broad domain of healing resources that encompasses all health systems, modalities and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society.Cochrane Collaboration
ExamplesMedicinesHerbal therapies NaturopathyHomeopathy Traditional Chinese MedicineMegavitamins
Other therapiesAcupuncture Aromatherapy KinesiologyChiropractic Hypnotherapy MoxibustionAyurveda Reiki Reflexology
Complementary and alternative medicine (CAM)Diverse opinion amongst orthodox health professionals regarding role of CAM in health care. (Mirrored in our group)
Complementary and alternative medicine (CAM)It is likely that some forms of CAM are good therapies with important potential roles in health care. Some will be ineffective but harmless. Others will be dangerous. Every CAM has its own combination of risk & benefit.
(Just like orthodox therapies)
Alternative therapist faces questions after boy dies The Royal Children's Hospital has asked the Justice Department to investigate an alternative health practitioner who it believes advised the family of a teenage boy with curable cancer to stop chemotherapy. The Age 21/09/2002
Special issues regarding CAM use in children
Child not competent to make own decisionsConsequences of parental choice?Balance of parental autonomy and childs wellbeingOur responsibilities as health professionals
Non-medicine CAMsConsider individually
RCH CAM Research Alissa Lim, Trainee Research Fellow Noel Cranswick, Clinical Pharmacologist Sue Skull, Clinical EpidemiologistMike South, Paediatrician
CAM use in the CommunityCross-sectional survey
Self-administered questionnaires
Random sample of 30 primary schools
Medication use in preceding two weeks
1534 questionnaires
CAM use in the CommunityTypes of CAM
CAM use in the CommunityReasons for Use
CAM use in the Community Source of CAM
RCH survey of CAM useA cross-sectional survey of inpatient and outpatients groupsQuestionnaire by face-to-face interview
CAM use in the preceding 12 months
503 patients surveyed101 inpatients and 402 outpatients (general paediatric, gastroenterology, thoracic, diabetes)
RCH survey of CAM useCAM Use
RCH survey of CAM useTypes of Medicinal CAMVitamin COther Herbal
RCH survey of CAM useReasons for CAM Use
RCH survey of CAM use
RCH survey of CAM useInpatient group:
22% had used medicinal CAM in last month
2 patients (9%) documented
partial documentation only
CAM Adverse EventsSurveillance Study via Australian Paediatric Surveillance Unit (APSU)
29 reports over 20 months (January 2001 to September 2002)
Severity : mild to severe 2 fatality
CAM Adverse EventsReport Types:
A.Adverse events associated with the use of medicinal CAM
B.Adverse events associated with failure to use conventional therapy
CAM Adverse Events
CAM
ADVERSE EVENT
Valerian
Constipation
Colloidal silver
Argyria
Ginkgo and Ginseng
Prolonged bleeding time
*Crushed Pearl
Acidosis
*Infacalm drops overdose
Hypoglycaemia, drowsiness, tachycardia
Daily IM vitamin injections
Left sciatic neuropraxia and
ongoing leg pain
Homeopathic treatment
and diet restriction
Malnutrition and sepsis
* Mechanism unknown
RCH CAM ResearchCommon in the communityVery common in patients attending RCH in last 12 months, in last monthEvidence of potential adverse effects or interactions.Families often dont tell
RCH CAM GroupDUC SubcommitteePolicyGuidelinesResource documentsDrug Information Resources
IssuesAcknowledge CAM is used for children and get it out in the openSafetyParental choiceLegalEthical DocumentationPractical issuesWard safety
RCH CAM Policy
RCH CAM Guidelines
? Child at risk
Working with families around CAMWhatever your views on CAM - it cannot be ignored, and it will not go away. If the parents of children you care for dont tell about CAM use - there is the potential for an adverse outcome.Presenting an antagonistic attitude is unlikely to be helpful.Presenting an open-minded, non-judgmental attitude is likely to improve trust and understanding.
Resourceswww.rch.org.au/genmed/camguidelines.htmThe Drug Information Service ext 5208.
