Pediatric Updates
Counseling Families Regarding Complementary/Alternative Medicine for Their Child

The use of complementary and alternative medicine (CAM) to treat chronic illness or disability is increasing in the United States. CAM is especially used among children with autism and related disorders. Access to the Internet has greatly expanded families' exposure to CAM.

Alternative therapies usually have not been subjected to clinical research. Most are supported by anecdotal evidence, although some have proven effectiveness. While some alternative therapies lack proof of effectiveness, these therapies may in the future prove to be effective. In addition, CAM may have placebo effects that are useful and enhance the quality of life.

CAM is often times used when families become frustrated with biomedical therapies because of complexity, discomfort, bewildering technology, or uncertainty of cure. And, for some conditions, biomedicine has little or nothing to offer. Many families try alternative therapies, believing that any approach that does no harm is worth a trial. For most families, the use of CAM is an attempt to gain a sense of control over the child's chronic illness or disability and to improve quality of life (American Academy of Pediatrics, 2001).

The American Academy of Pediatrics (2001) has the following recommendations when discussing alternative, complementary, and unproven therapies:

1. Seek information for yourself and be prepared to share it with families.
2. Evaluate the scientific merits of specific therapeutic approaches.
3. Identify risks or potential harmful effects.
4. Provide families with information on treatment options.
5. Educate families to evaluate information and treatment approaches.
6. Avoid dismissal of CAM in ways that indicate a lack of sensitivity or concern.
7. Recognize feeling threatened and guard against becoming defensive.
8. If the CAM approach is endorsed, offer to provide monitoring and evaluating the response.
9. Actively listen to the family and child with chronic illness or disability.

These recommendations can be used by nurses when discussing CAM with families. However, introducing the subject of CAM requires tactful communication skills. A statement such as, "I am very interested in how nontraditional or alternative therapies can be used to help children. What things have your tried?" is a positive and nonthreatening entree to a discussion with the family. If families are using an unfamiliar intervention, ask for their sources of information and review them before giving advice. In general if a therapy produces no adverse effect, including significant financial burden, do not discourage its use. Preserving a trusting, supportive relationship with the family generally outweighs any benefit from trying to disprove the value of nonconventional therapy.

Reference

1. American Academy of Pediatrics, Committee on Children with Disabilities: Counseling Families Who Choose Complementary and Alternative Medicine for Their Child with Chronic Illness or Disability, Pediatrics: 107 (3): 598-601, 2001.

Additional Information

• An excellent comprehensive resource is: DerMarderosian A (Editor): The Review of Natural Products, Facts and Comparisons, St. Louis, 1996 (with monthly updates).
• University of Texas Center for Alternative Medicine Research
• The National Institutes of Health Office of Alternative Medicine
• The National Council for Reliable Health Information
• The Consumer Federation of America
• See Chapter 22 in Nursing Care of Infants and Children, 6th edition.
• See Chapter 18 in Essentials of Pediatric Nursing, 6th edition.

March 15, 2002

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