Herbal Supplements and Children

Herbal treatments are becoming popular. These treatments come from plants and can either be pills, powders, shampoos, salves, or ointments.  Herbal supplements are not just utilized by adults. Many parents are giving their children these supplements.  These parents face the daily decision whether or not to medicate their children for everything from simple fevers, to ADHD, to psychosis.

Alternative medicine is being used on children as young as infants. US Food and Drug Administration (FDA) conducted a study in which 9 percent of mothers stated they give their infants herbal teas or supplements (Voelker, 2009).  Neither are regulated by the FDA.  If using alternative medications parents must keep this in mind.  They must also keep in mind that children absorb these chemicals differently than adults, and therefore could have a different, perhaps adverse, reaction (Kapalka, 2010).

As more parents begin to utilize dietary supplements with their children, more studies need to be conducted to show the efficacy of these different supplements and alternative treatments (Science Letter, 2005). Until studies are completed to show the safety of these herbs and supplements parents should take into consideration the  American Academy of Pediatrics Committee on Children with Disabilities  guidelines for parents whose children have chronic diseases (Woolfe, 2003).

Parents and doctors must take certain things into consideration before giving children any non prescribed or unregulated supplements.

* Parents should not equate “natural” with “safe.”
* Parents should seek expert guidance when considering the use of CAM practices, including herbal remedies, and avoid self-medication.
* Herbs and plants (just like drugs) may have beneficial effects as well as expected and sometimes unanticipated toxicity.
* Unlike drugs, herbal products have not been scrutinized by the FDA, so it is truly a case of “buyer beware.” Variable and unpredictable concentrations, ingredients, and contaminants are of concern, especially when such products are used in children.
* Parents should inform clinicians of any herb or dietary supplement that they are giving their children  (Woolfe, 2003).

Related Blogs:

http://en.wordpress.com/tag/herbal-supplements/

http://agelessherbs.org/2010/04/27/what-herbs-are-safe-for-children-with-asthma/

References

“How effective are herbal supplements in reducing illnesses in children?” Science Letter  Academic OneFile.  Retrieved from http://go.galegroup.com.proxy1.ncu.edu/ps/i.do?&id=GALE%7CA267760670&v=2.1&u=pres1571&it=r&p=AONE&sw=w

Kapalka, G. M. (2010). Nutritional and herbal therapies for children and adolescents: A handbook for mental health clinicians. San Diego, CA US: Elsevier Academic Press. Retrieved from EBSCOhost.

Voelker, R. (2011). Study: Up to 1 in 10 infants given herbal supplements, teas by their mother. The Journal of the American Medical Association,305 (21),2161.doi:10-1001/jama.2011.717Woolf, A.D. (2003). Herbal remedies and children: do they work? Are they harmful?.    Pediatrics, 112 (1), 240-246.

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Cultural Competency in Care

Cultural competent care has many definitions. Cultural competency is the ability “to provide high-quality effective health care to patients from diverse sociocultural backgrounds” (Green p, 1071). One of the most important aspects of providing cultural competent care is to have basic knowledge about different patient’s cultures.  It is important to understand how the culture looks at different aspects such as pain, death, diet, and who usually makes the medical decisions within a family. Dr. Camphinah-Bacote, an authority on cultural competence, considers cultural competence as an ongoing process.  “Cultural competence is not the mere acquisition of knowledge, skills and attitudes- it requires a genuine desire to work with culturally diverse clients” (Berg,n.d.)  Simply put cultural competency is the understanding of the areas of people identities that are important to them, both in the areas in “which they seek treatment and those that inform that distress in terms of its etiology, its expression, and its treatment” (Brown, 2009).

It is important for any medical or mental health provider to be culturally competent while working with Complementary and Alternative Medicine because the patients may have values different from the practitioner’s own. One of the major issues in today’s health care system is the disparity of health and health care among minorities and lower socioeconomic classes. The disparities between White and racial/ethnic minority clients have been a newsworthy topic in recent years.  There have been some studies on showing this disparity but minimal studies on determining why this has occurred in the first place.  Due to these disparities some have argued that providing culturally competent care is ethically essential (Imel, Baldwin, Atkins, Owen, Baarseth, & Wampold, 2011).  Medical and mental health practitioners should be aware of the disparities and recognize their own values.  Practitioners should be patients centered and they should understand the patient’s needs.  They should also be sensitive to the patient’s culture and use this culture and beliefs into the patient care plan (Westberg,  Bumgardner,  & Lin, 2005).

Cultural competence is not something that can be taught in a seminar or class. As there are an infinite amount of cultures and cultural combinations throughout the world it is impossible to learn about how everyone interprets their culture and which aspects they generally adhere to. Culturally and Linguistically Appropriate Services (CLAS) are the first comprehensive set of standards of cultural and/or linguistic competence in healthcare service delivery ever developed by a national organization. The standard began when the U.S. Department of Health and Human Services and Office of Minority Health reviewed the existing standards. The CLAS were created after this review. The CLAS Standards are guided by 3 themes: culturally competent care, language access services; and organization supports for cultural competence (Berg,n.d.).

In addition to the changing of cultures, we as individuals are constantly growing and changing, thus changing how we look at other’s cultures.  As humans we learn and grow throughout our lifetimes and this is the same for our understanding of cultures and hence our cultural competence.

References:

Berg,D. (n.d.) Culture, faith traditions, and health. Retrieved from http://www.csh.umn.edu/modules/culture/intro/in01.html.

Brown, L.S. (2009) Cultural competence: A new way of thinking about integration in therapy. Journal of Psychotherapy Integration,19(4),340-353.

Green, A.R., Betancourt, J.R. Park, E.R., Greer, J.A., Donahue, E.J., & Weissman, J.S. (11/01/2008). “Providing culturally competent care: Residents in HRSA Title VII funded residency programs feel better prepared.”. Academic medicine (1040-2446), 83 (11),  1071.

Westberg, S. M., Bumgardner, M. A., & Lind, P. R. (2005). Enhancing cultural competency in a college of pharmacy curriculum. American Journal of Pharmaceutical Education, 69(1-5), AA1-AA1-AA9.

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Chiropractic Care for Colicky Infants

Infant colic may be harmless to a baby but the excessive crying can be very stressful for the parents, can affect the bond between parent and child, and could be considered a risk factor for child abuse (Kingston, 2007). There is some speculation that a misalignment of the spine and neck can contribute to the colicky symptoms.

Chiropractic care has been used to treat infant colic. Chiropractic is  a field that manipulates the muscoloskeletal system. The main emphasis of chiropractic care is working on a misaligned spine and its effects on the nervous system (Freeman, 2009). Chiropractic care is a hands on, medication free alternative practice for certain medical problems. Chiropractic care is considered a highly skilled treatment and for children it must be gentle. Chiropractors offer a drug free treatment to typical childhood illnesses and they complement traditional pediatric services.

The American Chiropractic Association (2009) stated that a survey indicated that chiropractic care in minors had increased 8.5 percent since 1991. The American Chiropractic Association’s site reported that a study by the Center for Disease Control and Prevention indicated that nearly 3 percent of children in the US had been treated by chiropractors or osteopathic manipulation  in 2007.   

One study compared two groups of children, one group of infant/toddlers who had received chiropractic care  for colic, and the other group was a non- treatment group. The non-treatment group was post-colicky children who had not received chiropractic care while colicky as infants.  The results of the study showed that infants treated with chiropractic care for colic were less likely to not experience long term colic.  The study also looked at long term effects as well. The study determined that infants treated with chiropractic care for colic were also less likely to have temper tantrums and nocturnal walking when compared to the non treatment group (Miller & Phillip,2009).

More studies need to be conducted to show the efficacy of chiropractic care for infants. Studies so far have should benefits however it is still an underused method of medical care for children in general.

 

Chiropractic Organizations

http://www.acatoday.org

References
American Chiropractic Association (2009). Increasing number of children receive pediatric chiropractic care. Retrieved from http://www.acatoday.org/press_css.cfm?CID=3247
Kingston,H. (2007). Effectiveness of chiropractic treatment for infantile. Paediatric Nursing,19 (8), 26.

Miller, J., & Phillips, H. (2009). Long-term effects of infant colic: A survey comparison of chiropractic treatment and nontreatment groups. Journal Of Manipulative And Physiological Therapeutics, 32(8), 635-638.

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Psychoneuroimmunology and Children

Alternative approaches to medical practices have been increases in recent years.  Some of these changes have been fueled by the study of how the body reacts and interacts to psychological process, the nervous system and the immune system.  This study known as psychoneuroimmunology incorporates a multiple disciplinary approach to how these bodily functions interact with one another.  The studies concentrate on how the immune system reacts when other aspects of the body are stressed or relaxed.

Beginnings of Psychoneuroimmunology

Similar to the conditioning responses of Pavlov’s dogs experiments Robert Ader began to experiment with illness-induced taster-aversion paradigm. Unaware of the Russian Pavlov’s experiments Ader utilized rats and a combination of saccharin mixed in water and a drug Cytoxan.  Cytoxan was known to cause nausea and taste aversion.  Ader had hypothesized that the different amounts of saccharin would affect taste aversion (Freeman, 2009).  His results showed that the rats that had been given larger amounts of Cytoxan ended up with suppressed immune systems.  He later joined with immunologist Nicholas Cohen to test new hypothesis about immunity.  The two conducted larger experiences with the conclusion that the immune system can be enhanced by a “consistent environmental event” (Freeman, 2009, p. 72).  Their studies were the beginning of other researchers questioning the link between conditioning and treatment for diseases.  The field of psychoneuroimmunology was then born and has continued to grow to present day, raising thoughts to how the body and mind are connected.

Current Areas of Interest in Psychoneuroimmunology

The field of psychoneuroimmunology has progressed and evolved from its original intentions. One of the current areas of research involves social research.  According to Freeman (2009) there are four social research areas: “social interaction and social support, effects of relationship passages, health effects of chronic stressors not directly related to relationships, and health effects of short-term stressors” (p. 88).  Research involving social interaction and social support exams the effects of human interaction or lack thereof.  This research looks at how these interactions correlate with physical and mental health. Research involving relationship passages looks at the changes in relationship statuses are effected by or are the cause of stress. Health effects of chronic stressors not directly related to relationships can occur when there are non relationship stressors such as environmental threats. Health effects of short-term stressors include life events such as traumatic event, health issues, or stress for a short lived period of time.

 There have been studies on children to look at the effects of stress and disease on their immune system. In one study researchers assessed the connection between child abuse, traumatic events and objective health indicators and alcohol use. The researchers recruited 668 adolescents from community and clinical sources. The adolescents were grouped according to trauma classes, whether they were a witness to violence or a victim of said violence. The researchers documented health-related systems, alcohol use disorders, physical findings, and blood tests. They reviewed health outcomes one year after the initial study and then again as a young adult. Within the blood tests examined the researchers looked at immunoglobulin levels, although these were not conducted during the young adult portion. The immunoglobulin levels were higher with the subjects that had a higher or more severe level of traumatic history. More health related symptoms were linked to those who had experienced a high level of trauma.  The higher level of trauma experiences was also found to be related to more weight gain, and stress-response immune system problems.   The study concluded that that child abuse was a predictor of poorer health related symptoms and attributed these to anxiety issues (Clark, Thatcher, & Martin, 2010).

Another area that can affect a child’s immune system is peer victimization and bullying. According to a study (Vernbert, Nelson, Fonagy, & Twemlow, 2011) repeated involvement as a target or perpetrator of aggression could compromise a child’s immune system over time though physiologic processes associated with stress” (p 843).  The study looked at the nursing logs to determine behavioral indictors of the children’s health needs. The study only looked at children whose visits to the nursing office were coded as being somatic, illness, or injury. Victimization of Self Scales were given to the children.  This five point likert scale questioned students about the last three months and any victimization that took place during that time period.   The study suggests that “chronic victimization may, in turn, increase the risk for immune compromise over time, leading to more frequent illnesses” (p. 846).

The physiological system of children can also be affected when they are abused or neglected as infants. These chronic stressors can cause dysregulation of body systems.  Katz, Sprang, and Cooke (2011) describe allostatic load as a “dynamic, interactive process in which multiple physiological systems regulate metabolic activities to adapt to changing environmental demands” (p. 160).   In one case records were reviewed of a child who has been severely neglected as an infant. The child had been diagnosed as failure to thrive as infant and also exhibited symptoms of reactive attachment disorder.  The child was placed in foster care as an infant.  She began to have respiratory problems including distress, high fever, pneumonia, and apnea.  She was subsequently placed in pediatric intensive care. Within the following six months the child regressed in developmental areas and continued to be sick, including another upper respiratory infection.  The child died shortly after this infection was diagnosed.

The authors of the article questions whether the “severe, frequent, and chronic challenges that Casey endured in her young life likely led to cumulative strain overtime on multiple organs and tissues, which can be conceptualized as allostatic load” ( p. 165). The authors suggest that this chronic stress may have led to immunosuppression issues as speculated in adults with extreme stress.   The study had several limitations including its limit to one case, and a lack of medical testing to show changes in the immune system.  Although the article speculated that the child’s cortisol levels had probably changed, there was no testing of the levels while the child was alive.  Although this article was simply based on one case, and case worker notes, it brings to light the effects of neglect on infant children and the physiological changes that may occur because of this neglect.  Further studies with a larger population and medical testing would be needed to offer any concrete conclusions to the correlations between child neglect and allostatic load.

References

Clark, D.B., Thatcher, D. L., & Martin, C.S.  (2010) .Child abuse and other traumatic

experiences, alcohol use disorders and health problems in adolescence and young

adulthood. Journal of Pediatric Psychology, 35(5), 499-510.

Freeman, L. (2009). Mosby’s complementary and alternative medicine: A research based

approach (3rd ed.). St. Louis, MO: Mosby Elsevier.

Katz, D. A., Sprang, G. & Cooke, C. (2011). Allostatic load and child maltreatment in infancy.

Clinical Case Studies, 10 (2), 159-172. doi.10.1177/1534650111399121

Vernberg, E. M., Nelson, T. D, Fonagy, P. & Twemlow, S.W. (2011). Victimization, aggression, and visits to the school nurse for somatic complaints, illnesses, and physical injuries. Pediatrics, 127, 842-848. doi: 10.1542/ped.2009-3415

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Massage for Infants

Massage is utilized for different reasons, including increasing health and healing. The characteristics of massage include utilizing and touch and movement, usually by the hands but other parts of the body can be used.  Typically in western society massage has been used for adults; however there has been an increase infant massage in the United States (Freeman, 2009).  “The sensitivity of early interactions conveyed through eye contact, voice tone, facial expression and gentle touch plays a crucial role in healthy infant development. Infant massage has been adopted as an early intervention because touch offers a unique opportunity to support early interaction” (Barlow & Underdown, 2011, p. 21)

Massage can have many benefits for both the infant and the caregiver.

 Benefits of Infant Massage

For the baby:

Aids in the infant-parent bonding experience

Helps in relaxation

Promotes better sleep

Boosts immune system

Helps digestion, circulation, and sensory development

Benefits for the parent

Assists parents in feeling more comfortable and bonded to their baby

Helps parents understands their infants sounds and cues

Parents learn ways to calm their baby

 Overall infant massage stimulates, relaxes, bonds and relieves.

 Infant massage is often used with pre-term infants to increase stimulation and growth.  One study conducted showed that 60 minutes of massage each day assisted infants in sleeping better than compared to premature infants that did not receive massages.                         (Guzzetta, D’Acunto, Carotenuto, Berardi, Bancale, Biagioni, 2011).

Preparation Tips

Timing: find a time when you have enough time to devote to the massage. Do not do an infant massage when the baby is extremely hungry or has a full stomach

Position: Make sure you are comfortable. You can sit on the floor, the bed, or place the baby in your lap.

Massage Oils: oils can be used. Natural oils are preferred. Only a few drops are needed and should never be used on the infants head or face.

Baby’s readiness: Make sure your baby is ready. If the baby becomes over stimulated it is important to stop.

Video on infant massage

Find trainings near you

http://www.infantmassageusa.org/become-an-educator/training-locations/

Find a certified infant massage specialist in your area

http://www.infantmassageusa.org/learn-to-massage-your-baby/educator-directory/

Websites of interest

http://www.infantmassageusa.org/

Books:

Baby Massage: The Calming Power of Touch by Alan Heath and Nicki Bainbridge

Baby Massage: Soothing Strokes for Healthy Growth by Suzanne Reese

An Infant Massage Guidebook: For Well, Premature, and Special Needs Babies by Mary Ardy

Blogs on infant massage: http://www.babytata.wordpress.com

References

Barlow, J. & Underdown, A. (2011). Interventions to support early relationships: Mechanisms identified within infant massage programmes. Community Practitioner, 84 (4) 21-27.

Freeman, L. (2009). Mosby’s complementary and alternative medicine: A research based approach (3rd ed.). St. Louis, MO: Mosby Elsevier

Guzzetta, A., D’Acunto, M.,G., Carotenuto, M., Berardi, N., Bancale, A., Biagioni, E., . . . . (2011). The effects of preterm infant massage on brain electrical activity. Developmental Medicine and Child Neurology, 53(00121622), 46-46-51. Retrieved from http://search.proquest.com/docview/896272401?accountid=28180

http://www.massageforchildren.com/

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Hypnosis with Children

Anxiety, stress, and trauma are common in adult life.  They are also common disorders experienced by children and adolescents. Ignored, these disorders may lead to more complicated psychopathologies in adulthood.

The goal of hypnotherapy is to teach the patient an attitude of hope in the context of master. The patient learns to be an active participant in his or her own behalf, to focus on creating a solution rather than on enduring a problem, and to discover and use resources for inner control as much as possible.

Leaders in pediatric hypnosis, Kohen and Olness (2011), suggest the following things to be considered for pediatricians and others working with children:

How can pediatric professionals help these young children shift from their typical vulnerable self-view to one of mastery and resilience?

How might clinicians design hypnosis encounters that enhances children’s resources to more accurately discriminate real danger from imagined danger, increase their capacity to better cope, and influence what happens?

How might hypnosis facilitate goals of fostering children and teenagers’ self-regulation of their psychophysiological and negative emotional arousal and over reactivity, catastrophic thinking, and avoidant behaviors?

How might clinicians use spontaneous trance states of highly anxious children and teenagers during assessment and treatment? (Kaiser, p. 17)

There are different uses of hypnosis with children.  Some of the post common are for pain, anxiety disorders, OCD, and behavior disorders. When child experience pain they may not understand the pain and become anxious.  Hypnosis can help both the pain and anxiety associated with the pain. For other anxiety disorder issues hypnosis can complement traditional therapies.  Hypnosis along with cognitive psychotherapy can be beneficial for children who suffer from obsessive compulsive disorder. With behavioral problems, hypnosis may help the child by suggesting a better behavior (Watkins, 2011).

 

Specific Goals and Suggestions for Self-regulation of the Cognitive Process

Shift attention STOP sign in your head, then GO on to something more pleasant
Discriminate: Realistic risk appraisal Metaphors for “things aren’t always as they seem”, be a detective; judge and jury: what’s the evidence?; dark versus clear glasses
Aware of resources to Cope Age of progression (imagine managing the situation with calm, comfort, and control)
Cognitive restructuring Computer control panel in brain: download good thoughts, delete unhelpful thoughts (worries), empty trash can, open “Super-Control file”
Compartmentalize and minimize Use metaphors such a magnifying glass, binoculars, telescope, dimmer switch
Internal locus of control Use child’s interest, activities, and ideas focused on empowerment, master, being in charge.

   (Kaiser, 2011, p. 26)

Any use of hypnotism in children should be done by trained professionals and the parents should understand what the purpose of the hypnosis is.

Website of interest

http://www.med.umich.edu/yourchild/topics/hypnosis.htm

References

Kaiser, P. (2011). Childhood anxiety, worry and fear: Individualizing hypnosis goals and suggestions for self-regulation. American Journal of Clinical Hypnosis, 54,(1) 16-31.

Kohen, D. P., & Olness, K. (2011). Hypnosis and hypnotherapy with children (4th Ed). New York, NY US: Routledge/Taylor & Francis Group. Doi:10.1080/0029157.2011.575965

Watkins, C. (2011) http://www.ncpamd.com/medical_hypnosis.htm

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Acupuncture for Children

Acupuncture is intrinsic to Chinese medicine where it has been practiced for more than  2000 years. Acupuncture began as a form of bioenergertic healing. This term refers toeh the flow of energy in living and between living things. There are different variations of acupuncture but the practice is based on the concept of someone’s Qi (chee). Qi is sent through one’s body through different channels.  Acupuncture takes specific acupoints and restore the obstructed flow.  The most common form of acupuncture is the use of dry needles placed into the skin (Gold, Nicolaou, Belmont, Katz, Benaron, & Yu ,2009)

The use of acupuncture amongst adults has been growing in popularity over the last few decades. The use of acupuncture in children is still in its infancy and research related to its efficacy in children is still sparse. Acupuncture needles have  been approved by the FDA as a medical device and some insurance companies pay for acupuncture treatment (Li, 2009).

One survey ( Lee, Highfield, Berde, & Kemper, 1999) looked at acupuncturists in the Boston, Massachusetts area. Most of the practitioners did not regularly treat children.  Those did did used different non-needle techniques to stimulate acupuncture points. These methods included using a Chinese herb called mugwort. This herb was burned to generate heat. Others used magnets or massage. Some practitioners did use electrical stimulation with the use of smaller tools instead of regular acupuncture needles. Still others used a light hammer, called a plum blossom hammer, which is a “light hammer with nine thin, short needles used to tap the skin at acupuncture points” (p.155).

One of the areas of recent research of acupuncture with children is in the treatment of childhood asthma. In a randomized controlled study researchers looked at the immediate effects of acupuncture as an adjunct treatment to children who were in an inpatient rehabilitation center. The study showed that those having acupuncture had a lower anxiety rate after treatment but there was not significant different in the lung function between the groups (Scheewe, Vogt, Minakawa, Eichmann, Welle, Stachow, & Banzer ,2011).

As with many areas of CAM the use of acupuncture, especially in children, needs to be further evaluated for its efficacy.

References

Gold, J.I., Nicolaou, C.D., Belmont, K.A., Katz, A.R., Benaron, D. M.,& Yu, W. (2009). Pediatric acupuncture: A review of clinical research. Evidence Based Complementary Alternative Medicine, 6 (4), 429-439. doi: 10.1093

Lee, A, Highfield, E, Berde, C, & Kember, K. (1999). Survey of acupuncturist: practice characteristics and pediatric care. Western Journal of Medicine, 171 (3), 153-157.

Li, X. (2009). Complementary and alternative medicine in pediatric allergic disorders. Current Opinion of Allergy and Clinical Immunology, 9(2), 161-167. doi: 10.1097/ACI.ob013e3283299226f

Scheewe, S., Vogt, L., Minakawa, S., Eichmann, D., Welle, S., Stachow, R., & Banzer, W. (2011). Acupuncture in children and adolescents with bronchial asthma: A randomised controlled study. Complementary Therapies In Medicine, 19(5), 239-246.


Additional sources of information

http://www.toyohari.org/

http://www.umm.edu/pediatrics/acupuncture.htm

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