The two most powerful arguments in favour of complementary/alternative medicine (CAM) are that of freedom of choice and the notion of a cure without any risk of side effects. Of course, people should be allowed to use the therapy they like. But what about young children?
Surveys suggest that 99% of parents are prepared to administer CAM to their kids, and 33% of all children suffering from asthma, 34% of kids affected by arthritis and up to 84% of youngsters with cancer receive "alternative" treatments. Special diets, herbal medicines, homeopathy, massage, high-dose vitamins, spiritual healing, naturopathy, acupuncture and chiropractic are all popular. Parents' preference for CAM is clearly the deciding factor. With conventional healthcare, the decisions usually involve experts, typically GPs. With CAM it is normally the mother who determines what is best.
The mother choosing CAM for her child may assume that there is no risk at all. Yet changing a child's diet and administering herbal remedies or megavitamins are measures which clearly have a potential to cause harm. In a recent study into the adverse effects of herbal medicines, Gail Mahady from the University of Illinois writes: "Parents need to recognise that treatment of any disease with a herbal medicine is really drug therapy, not dietary supplementation." When I recently tried to get this point across to an audience of paediatricians, one questioned me: "Are you saying that a little peppermint tea can be harmful?" Yes. One study showed that, in animals, peppermint tea significantly alters the hormonal balance.
The list of serious side effects associated with herbal medicine for children is long and includes popular remedies such as eucalyptus or valerian. Some traditional Chinese and Indian herbal preparations have been found to be contaminated with poisonous heavy metals or powerful prescription drugs. In such cases, children are more prone than adults to suffer harm. Acupuncture, spinal manipulation, massage and cupping have also been implicated in having the potential to cause harm to children. In 2001, the case of a three-month-old German girl was reported. She had been treated with spinal manipulation of her upper spine. As a result, both arteries in her neck were damaged, causing bleeding in the brain. Tragically, the child died shortly after.
Serious dangers can also arise when conventional therapies are abandoned in favour of CAM. Many childhood cancers are curable - with conventional methods - but not with "alternative cancer cures", yet children with cancer are particularly likely to use CAM. And the problem is not confined to cancer. In a case reported in the medical press in 2001, a diabetic child in Germany was taken to see a CAM practitioner who advised the mother to stop the child's insulin treatment. She followed this recommendation. Two days later, the child was dead.
I know of seven similar cases. And then there is, of course, the big issue of immunisation. Some chiropractors, homeopaths and naturopaths advise parents irresponsibly against vaccinating their children. In view of all this, the notion that CAM for kids is without risk is clearly misguided.
Do any of these therapies work for kids? Far too often, the assumption that medical treatments are effective in children is based on little more than extrapolation. If a therapy works in adults, we assume that it also works for kids. But this is not always true. Consequently, there is a considerable element of uncertainty in relation to many medical treatments for kids - and, of course, this applies to CAM as well.
There is some positive news as well. Clinical trials have demonstrated that massage therapy can improve the development of preterm infants. Other studies showed that a herbal remedy called Andrographis paniculata can help children to get rid of a common cold. Some treatments have little potential to directly cause harm. But be sure to use them alongside with, rather than as a substitute for, conventional treatments.
In general, parents tempted to try CAM on their kids should be cautious. Toddlers can neither choose nor give informed consent. The uncertainty over whether or not any given therapy generates more good than harm is even greater than it is for adults. So, be sensible, consider all aspects carefully and discuss them with your physician - and if he doesn't want to know, change doctor.
· Edzard Ernst is professor of complementary medicine at the Peninsula medical school at the universities of Exeter and Plymouth.
