ARTICLE Complementary and Alternative Medicine Use by Pediatric Specialty Outpatients AUTHORS: Denise Adams, PhD,a,b Simon Dagenais, DC, WHAT’S KNOWN ON THIS SUBJECT: Complementary and PhD,c Tammy Clifford, PhD,d,e,f Lola Baydala, MD, MSc, alternative medicine (CAM) use is common among children, FRCP,b W. James King, MD, FRCPC, MSc,g,h Marilou Hervas- especially those with chronic, recurrent, or incurable conditions. Malo, MSc,i David Moher, PhD,d,j,k and Sunita Vohra, MD, Concurrent use of CAM with conventional medications is of , FRCPC, MSca b concern and needs to be assessed, especially in vulnerable aCARE Program, and bDepartment of Pediatrics, Faculty of patient populations. Medicine and Dentistry, University of Alberta, Edmonton, Canada; cDepartment of Social and Preventive Medicine, University at WHAT THIS STUDY ADDS: Buffalo, Buffalo, New York; dDepartments of Pediatrics and CAM use is high among pediatric eEpidemiology & Community Medicine, University of Ottawa, cardiology, gastroenterology, neurology, oncology, and respiratory Ottawa, Canada; fCanadian Agency for Drugs and Technologies in patients, most of whom use CAM concurrently with conventional Health, Ottawa, Canada; gDivision of Pediatric Medicine, care. This study provides additional evidence to suggest the use of Department of Pediatrics, University of Ottawa, Ottawa, Canada; CAM be included in routine patient history taking. hChildren’s Hospital of Eastern Ontario, Ottawa, Canada; iEpidemiology Coordinating and Research (EPICORE) Centre, Edmonton, Canada; jOttawa Hospital Research Institute, Ottawa, Canada; and kUniversity of Ottawa Evidence-based Practice Centre, Ottawa, Canada KEY WORDS abstract complementary medicine, pediatric, data collection OBJECTIVE: ABBREVIATIONS Complementary and alternative medicine (CAM) use is CAM—complementary and alternative medicine high among children and youth with chronic illnesses. The objective CI—confidence interval of this study was to assess the prevalence and patterns of CAM use in RA—research assistant 10 subspecialty clinics in Canada and to compare CAM use between 2 Dr Adams was substantially involved in analysis and geographically diverse locations. interpretation of data, drafting and revising the article, and final approval of the version to be published; Drs Dagenais, Clifford, METHODS: This survey was carried out at 1 Children’s Hospital in and Moher were substantially involved in design and conduct of western Canada (Edmonton) and 1 Children’s Hospital in central Can- the study, revising the article, and final approval of the version ada (Ottawa). Questionnaires were completed by parents in either to be published; Drs Baydala and King were substantially involved in design of the study, revising the article, and final French or English. approval of the version to be published; Ms Hervas-Malo was RESULTS: Although demographic characteristics of the 2 populations substantially involved in analysis and interpretation of data, drafting and revising the article, and final approval of the were similar, CAM use at the western hospital was 71% (n = 704) version to be published; and Dr Vohra was substantially involved compared with 42% (n = 222) at the central hospital (P , .0001). Most in design and conduct of the study, interpretation of the data, respondents agreed or strongly agreed that they feel comfortable drafting and revising the article, and final approval of the version to be published. discussing CAM in their clinic. The most common CAM products cur- rently used were multivitamins/minerals, herbal products, and www.pediatrics.org/cgi/doi/10.1542/peds.2012-1220 homeopathic remedies. The most common CAM practices currently doi:10.1542/peds.2012-1220 used were massage, chiropractic, relaxation, and aromatherapy. Accepted for publication Sep 24, 2012 Eighty adverse effects were reported, and 55 (68.8%) of these were Address correspondence to Sunita Vohra, MD, FRCPC, MSc, self-assessed as minor. Department of Pediatrics, Faculty of Medicine & Dentistry and School of Public Health, University of Alberta, 8B19-11111 Jasper CONCLUSIONS: Results of this study indicate that CAM use is high Ave; Edmonton General Hospital, Edmonton, AB, Canada; T5K 0L4. among pediatric specialty clinic outpatients and is much greater E-mail: [email protected] in the western than in the central hospital. Most respondents felt that PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). their CAM use was helpful with few or no harms associated. Many Copyright © 2013 by the American Academy of Pediatrics patients, using CAM alongside their conventional medicines, are still (Continued on last page) not discussing their CAM use with their physicians and are increasing the likelihood for potential interactions and preventable harms. Pediatrics 2013;131:225–232 PEDIATRICS Volume 131, Number 2, February 2013 225 Downloaded from www.aappublications.org/news by guest on October 1, 2021 The use of complementary and alterna- pediatric outpatient clinics in 2 geo- use, and so to facilitate comparisons tive medicine (CAM) is common and in- graphically diverse locations. By con- between study populations and study creasing among children.1 Often our ducting the survey in 2 locations over locations, a survey was developed for most vulnerable pediatric populations, the same period of time, we hoped to use by all participants regardless of particularly those with chronic, re- make meaningful comparisons about specialty or setting. The final survey current, or incurable conditions, turn to CAM usage between 2 geographically was composed of 19 questions that CAM. Rates vary depending on how CAM diverse populations with chronic ill- addressed patient and family demo- is defined and how sampling is done, ness. Because utilization rates can vary graphics, general health, use of specific with some rates reaching .75%.1–4 according to how the information is CAM products and therapies (both Furthermore, it is not uncommon for sampled (ie, current use vs lifetime current and lifetime use), reasons for children to be given .1typeofCAMat exposure), this issue was explored, as use, concurrent use with conventional a time. A 2003 study found that of the well as the perceived helpfulness and medicine, satisfaction with care, ad- 64% of children attending a rheumatol- possible adverse events associated verse effects, and disclosure about use. ogy clinic in Toronto who were currently with CAM use. The survey was developed according using CAM, 50% were using .1type.5 to established methodology.10–12 CAM Concurrent use of CAM with conven- METHODS products and practices commonly used fi tional medications is also common. For The target populations in this study by children were identi ed through 13,14 example, 20% of pediatric patients in were children with chronic illnesses a literature review and previous – a Canadian emergency department seeking care at 2 participating tertiary published surveys of CAM use.5,15 17 used conventional medicines and CAM care centers, 1 Children’s Hospital in Questions were developed by the in- 6 concurrently. western Canada (the Stollery Child- vestigative team to address gaps Difficulties in studying pediatric CAM ren’s Hospital in Edmonton, Alberta) in our knowledge of CAM use in chil- use have been identified and include and the other in central Canada (the dren. Draft questions were reviewed variation in definitions of both CAM (ie, Children’s Hospital of Eastern Ontario in by experts in CAM and pediatrics does CAM include vitamins or prayer) Ottawa, Ontario). Five specialty clinics and revised accordingly. The survey and pediatric as well as lack of re- were chosen for the study (cardiology, was subjected to pilot testing to es- porting of period of assessment, costs, gastroenterology, neurology, oncology, tablish concept validity in a conve- insurance coverage, occurrence of ad- and respiratory), and patients in these nience sample of Children’s Hospital verseevents,sourceofCAMinformation, clinics were surveyed at each location of Eastern Ontario staff and patients and discussion of CAM use with a con- (10 clinics in total). These 5 specialties and revised accordingly. When the En- ventional health care provider.7 were chosen because they see many glish language survey was finalized, Despite the popularity of CAM, rates of patients with chronic conditions the questionnaire was translated into disclosure of CAM use to physicians are Surveys were carried out in the waiting French by a professional translator often poor, with rates as low as 23%. room of each participating clinic before and then back translated into English Reasons for lack of disclosure include the clinic appointment. Children and/or to ensure the veracity of the trans- concerns about a negative response their families were eligible to partici- lation. The French version of the survey by the physician, belief that the phy- pateinthisstudyifthey were,18years was also pilot tested. (For a copy of the sician did not need to know about the of age, could read French or English, survey, contact the corresponding au- CAM use, and that the physician did and had not previously filled out this thor.) not ask.8 Concurrent use of CAM and survey. The research assistant (RA) Data were entered into a database prescription medications is wide- stayed in the room with the partic- (SPSS 11) and 10% were “double en- spread and poses a possible risk to ipants to answer questions as they tered” to test data entry quality; an patients who may be unaware of the completed the questionnaire