A mother who is nursing her two-month-old baby mentions she is taking St. John’s Wort for her post-partum blues.
A 15-year-old Internet user asks what the physician knows about acupuncture for her chronic condition.
The local neonatal intensive care unit wants a physician to speak on the effects of massage on the development of pre-term infants.
These are just some of the situations encountered in a typical day in paediatrics, as more and more questions arise regarding complementary and alternative medicine (CAM) therapies.
In response to the growing need for information in this area, The Hospital for Sick Children Foundation has launched a new grants initiative. It’s part of the Foundation’s National Grants Program, which provides up to $3.3 million each year for paediatric research, information sharing and research training, some of it focused on important but understudied areas of children’s health. The new CAM grants program will provide $1.2 million over three years for work in the area of complementary and alternative therapies, including the use of natural health products.
As a first step in determining priorities for the new program, The Hospital for Sick Children Foundation hosted Canada’s first invitational forum on paediatric CAM therapies last fall. Dozens of health-care practitioners, researchers, policy makers, and ethicists gathered for the two-day event, which was held in partnership with Health Canada’s Natural Health Products Directorate and the CIHR’s Institute of Human Development, Child and Youth Health. Discussions focused on the need for more research, training and education; health system policy and regulation; and informed decision-making.
“We’re focusing on an area where there hasn’t been a lot of attention in paediatrics, and trying to stimulate some activity,” said Gwen Burrows, director of the National Grants Program at The Hospital for Sick Children Foundation.
In 1997, the Fraser Institute estimated that up to 50 per cent of Canadians use CAM products or services each year, including 17 per cent of children. Estimates for some paediatric conditions, such as rheumatoid arthritis, are as high as 70 per cent.
Experts agree more research is needed because some CAM therapies have shown promise but require further investigation, while others may be contraindicated.
Many parents don’t tell doctors their children are using CAM therapies for fear of criticism, and children may not tell their parents about their CAM use. This poses significant risks due to potential adverse interactions.
Dr. Sunita Vohra, a clinical epidemiologist at The Hospital for Sick Children, said approximately 50 per cent of children attending three of the hospital’s subspecialty clinics use CAM therapies.
The hospital recently introduced a policy to address the potential use of such therapies. The policy proactively plans for situations where a patient or parent requests a CAM therapy or an HSC health care practitioner wants to integrate a CAM therapy into a patient’s overall plan of care.
“HSC is committed to evidence-based practice and the highest possible standards for patient care. Consequently, a preferred treatment is one that has been evaluated to be effective regardless of whether the treatment is considered ‘conventional or ‘complementary/ alternative’, the policy states.
Dr. Vohra told the forum the rules of evidence should be as important to CAM practitioners as to conventional therapy providers, and conventional care providers need to know what other treatments their patients may be pursuing. Safety, effectiveness and accountability are key issues, especially in paediatrics, where patients are more vulnerable because of their age, and parental authority is a factor.
For parents, information about different treatments can be confusing and contradictory, said Dr. Marja Verhoef, associate professor in the Department of Community Health Science at the University of Calgary. In paediatrics, decisions about care are even more complex, because children are not simply small adults, and many habits which affect health are learned early in life.
“Most of us grew up at a time when CAM and natural health products were not very important. Now we have to learn about it,” she said.
David Moher, director of the Clinical Research Division at the Children’s Hospital of Eastern Ontario Research Institute, said few people report adverse reactions or the cost-effectiveness of CAM, and he emphasized the need for randomized control trials.
Forum participants identified four funding priorities: creation of a network and/or a centre of excellence in CAM; support for learning, education and training; completion of a needs and use assessment; and the facilitation of knowledge transfer.
Forum proceedings are being widely distributed to generate further interest in this area. For copies, contact Gwen Burrows at firstname.lastname@example.org