The Remedy Revolution
Herbs, hypnosis, and other alternative therapies are growing popular with families and doctors. But what does the research reveal?
A Rise in Alternative Medicine
From the time she was 6 months old, Dominique Entwistle suffered from severe pain near her nose and mouth. "During the day she was manic, edgy, and unable to focus. At night she would frequently wake up screaming. We were frazzled and exhausted," says mom Leigh Johnson, 48, of Los Angeles. An endocrinologist suspected Dominique's small and easily infected sinuses were the cause, but the antibiotics and steroids that an ear-nose-and-throat specialist prescribed failed to stop the pain -- which would strike when she was exposed to cold, wind, or strong smells. "I was worried about the long-term consequences of the multiple prescriptions she took in a year, and I was also frustrated that none of the physicians thought this was anything more than an overly sensitive child with a dramatic middle-aged mother," Johnson recalls.
Finally, when Dominique was 5, her pediatrician referred her to the Pediatric Pain Program at Mattel Children's Hospital at the University of California, Los Angeles. There, director Lonnie Zeltzer, M.D., combined a traditional workup with a recommendation for hypnotherapy. It took only five one-hour sessions with the center's hypnosis specialist, during which Dominique envisioned squeezing through a tiny gap in a fence to a magic garden -- a hole too small for the pain to follow -- for a significant amount of her agony to subside. (Not everyone gets results this quickly.) The sinus infections remain, says Johnson, "but controlling it through hypnosis has changed Dominique's outlook. She can turn the pain's volume down and cope so much better."
It wasn't long ago when most pediatricians in the U.S. were hostile to the notion of turning kids on to non-Western remedies. But now, parents' interest in blending conventional care with complementary or alternative medicine (known as CAM) has risen sharply, and doctors' once-icy response is thawing. A 2004 survey conducted at Wayne State University in Detroit revealed that 71% of pediatricians would consider referring patients to CAM practitioners -- up from 50% in 1998. "Mainstream physicians are increasingly open to additional alternative tools that may help when conventional approaches can't," says Lawrence Rosen, M.D., director of the integrative pediatrics service at Maria Fareri Children's Hospital in Valhalla, N.Y.
Of course, many doctors remain wary. The American Academy of Pediatrics (AAP) urged its members to use caution in a 2001 policy statement on children with chronic illness, warning, "there may be evidence of the possibility of direct harm, unknown risks, or concerns about indirect harm to the child [from using alternative approaches]." Since doctors are unfamiliar with most therapies -- and because studies on alternative approaches usually involve research on adults, not children -- "some doctors also fret about liability if they prescribe them," says Kathi J. Kemper, M.D., professor of pediatrics at Wake Forest University in Winston-Salem, NC, and author of The Holistic Pediatrician.
Nevertheless, more than 80% of the top 25 children's hospitals identified by Child in February 2005 now use some form of alternative medicine. Medical centers that deal with children's pain or other chronic conditions -- which often defy conventional cures -- are especially likely to employ these therapies. "Pediatricians are frequently requesting consultations for acupuncture; it's now one of the first-line methods for treating children's pain or nausea," says Elliot Krane, M.D., chief of pediatric pain management at Stanford University Medical Center and author of the book Relieve Your Child's Chronic Pain.
Reason for Hope
Driving this trend are parents who experiment with these therapies on themselves. In May 2004, the National Center for Health Statistics and the National Center for Complementary and Alternative Medicine reported that 36% of U.S. adults use some form of CAM. "When parents get more comfortable with them, and perhaps find some success, it makes them more likely to want them for their children," says Tim Culbert, M.D., medical director of the integrative medicine and cultural care group at Children's Hospitals and Clinics of Minnesota.
At the same time, many parents are frustrated with the shortcomings of conventional medicine. "Recent news about the dangers of several classes of drugs for adults [notably Cox-2 inhibitors, such as the painkiller Vioxx] have led parents to look more at non-pharmacological approaches," Dr. Culbert observes. Plus, some parents, upon sensing that a doctor is taking a disease-oriented approach to care, "look for treatments that they feel consider the whole person," says Edward Cox, M.D., director of pediatric primary care at DeVos Children's Hospital in Grand Rapids, MI, and former chairman of the AAP Task Force on Complementary and Alternative Medicine.
Phyllis Lombardi turned to an integrative approach soon after her son Joseph was diagnosed as autistic at 22 months. Concerned that the watchful waiting advised by Joseph's doctor was costing her son valuable time, she looked for other options and found a chiropractor for regular spinal adjustments and a physician who suggested that Joseph, now 8, change his diet and take $150 worth of supplements a month (including primrose oil, B-12, magnesium, and fish oil).
"He's much calmer now, gets sick less, and understands a lot more of what we say," reports Lombardi.
In 2005, researchers at The Children's Hospital of Philadelphia found that some autistic kids show an improvement in symptoms due to the natural progression of the disease. Still, Lombardi believes in the supplements. "My regular pediatric practice pooh-poohs some of what we do, but they have nothing to offer me. With this treatment, I have hope."
Concern and Caution
In the realm of alternative approaches, herbs are Dr. Kemper's biggest concern. More than 45% of parents have given their child an herbal product, according to a study she published in 2004. "We thought parents would be more hesitant to give these to their kids, but they're not," she says. Many of those parents received some disheartening news in July when echinacea, on which Americans spent $153 million last year, was found to be useless as a prevention or cure for colds, according to a rigorous study by the National Center for Complementary and Alternative Medicine.
Because natural does not mean neutral, says Dr. Kemper, it's crucial for parents to discuss methods they're considering with their child's doctor. Last May researchers at Johns Hopkins Children's Center in Baltimore found that only 36% of parents are informing pediatricians of the alternative therapies their children are using. Doctors need to know so they can watch for side effects that may result from the use of certain supplements and also ensure that a child isn't taking two medicines that negatively interact with each other.
As you discuss options with your child's doctor, consider the medical evidence -- or lack of evidence -- for the following four treatments now being used in some pediatric-care facilities. While some herbal remedies may be experiencing a backlash, alternative therapies that don't require children to ingest any potentially harmful supplements are quietly offering optimism for children with chronic illnesses.
Treating Headaches and Other Pain With Acupuncture
Treatment: AcupunctureTarget: Headaches and Other Pain
Ten-year-old Max Farber knows what he likes, and surprisingly, needles are near the top of his list. The Encino, CA, boy began to suffer crippling migraines when he was 6; he was given medications and even had surgery to shave a bone malformation obstructing blood flow to the head. But the throbbing pain -- complete with dizziness and vomiting -- remained. His mother, Rebekah Farber, 46, suffers from migraines herself and found relief with an alternative medicine regimen that included acupuncture. When Max was 8, she decided to take him to her acupuncturist.
Not surprisingly, Max initially balked. "The first time I saw the needles, they seemed scary. But then I thought about how my head feels like someone is smashing me with a hammer, and I was willing to try," he says. After 18 months of biweekly treatments, Max still gets migraines, Rebekah says, but they're much less intense.
Growing research has documented acupuncture's effectiveness. A study last year in England by researchers from Memorial Sloan-Kettering Cancer Center in New York City compared acupuncture with traditional care in 401 adults with migraines. Those who had received up to 12 acupuncture sessions had nearly two fewer headaches per month over the course of three months -- the equivalent of 22 fewer headache days per year. Another, of 22 Israeli children by scientists there, found that acupuncture reduced the kids' migraine frequency and also increased painkilling endorphins.
Exactly how the method works remains a mystery. "The Chinese say you are moving stagnant chi, or energy. Western studies have shown that it resolves local inflammation and also produces chemicals that suppress pain receptors in the brain," says Mike Waterhouse, a Beverly Hills, CA, acupuncturist. Typical treatments for children involve eight to 12 needles, inserted for 20 minutes. Side effects, such as occasional slight bruising around the needle area, are mild and rare.
"Although the AAP offers no guidelines on this, we recommend acupuncture to our pediatric pain patients who have not had success with medication or other standard treatment," says Santhanam Suresh, M.D., associate professor of anesthesia and pediatrics at Northwestern University in Chicago and a member of the AAP Section on Anesthesiology and Pain. "I have seen it work, but because it lacks enough large, double-blind studies we use other methods first."
Treating Asthma With Biofeedback
Treatment: BiofeedbackTarget: Asthma
Dai Logan, 38, of Allen, TX, had her life turn upside down when daughter Winnie was diagnosed with asthma as an infant, following in the footsteps of her older sister, Sigourney, now 10. For nearly a month last December, Winnie's chest became so tight she couldn't fully catch her breath, a situation that brought fatigue -- and panic. Her pulmonologist diagnosed vocal cord dysfunction, a tightening of the cords around the airway, and suggested biofeedback.
At the office of Dan Smith, a certified biofeedback therapist at Medical City Children's Hospital in Dallas, Winnie watched monitors revealing the muscle tension in her neck and chest. As she relaxed these muscles under Smith's direction, the pattern on the monitor changed. By the end of the session, Winnie used the feedback from those monitors to control her muscles enough to bring her breaths down from 30 per minute to 12. A second appointment reduced it to four, and the vocal cord dysfunction has recurred only once (although Winnie has had several asthma attacks since).
Some doctors refer to biofeedback as "Nintendo for the body" and say today's tech-savvy kids are using it to get results, especially for stress-triggered conditions like asthma. Dr. Culbert believes the method helps asthmatic children learn to balance their autonomic nervous system (which may prevent attacks) and keeps them more relaxed when asthma does strike (panic makes the airways tighter).
Only very small studies have so far been conducted, mostly on adults. The best: a 2004 randomized study of 94 adults by the University of Medicine and Dentistry of New Jersey, in Piscataway, which found that asthmatics practicing biofeedback along with their traditional treatment improved their lung function and needed less steroid medication than a control group.
"Because stress can trigger an asthma attack, I think biofeedback is a fine addition if parents want to try it," says Michael J. Welch, M.D., a physician in San Diego and editor of the AAP book Your Guide to Allergies and Asthma. Dr. Welch says he would like to see more research, however, and notes that the cost of the treatment is typically not covered by insurance. "Most important, I would not want parents to view biofeedback as a substitute for traditional medical care."
Treating Gastrointestinal Pain With Guided Imagery and Hypnosis
Treatment: Guided Imagery and HypnosisTarget: Gastrointestinal Pain
For more than a year, school mornings were the most trying times in the Moyer family's Mendham, NJ, household. Nearly every day, 10-year-old Kate and 5-year-old Emily would be ready to leave for school when 7-year-old Paul would develop an urgent need to move his bowels. His recurrent gas pains and up to a dozen bowel movements daily had his distraught mother, Pamela, 38, in repeated contact with Paul's pediatrician, who couldn't find a cause. Finally, the doctor referred Paul to pediatric gastroenterologist Nader N. Youssef, M.D., who diagnosed irritable bowel syndrome (IBS).
Western medicine has no acceptable cure for IBS, which causes symptoms such as constipation, diarrhea, and abdominal pain. "Parents are frustrated because treatment for their child primarily includes dietary changes or antispasmodic or low-dose antidepressant drugs for pain modification that are not formally approved for kids," says Dr. Youssef, director of the Center for Pediatric Irritable Bowel and Motility Disorders at Goryeb Children's Hospital in Morristown, NJ. Three years ago Dr. Youssef decided to explore guided imagery, a form of hypnosis in which patients relax and then are given specific images to visualize. He conducted a study in which 18 children with IBS were led through four to seven one-hour visualizations. Sixteen of the kids reported less abdominal pain the following year, and 10 were able to stop the antidepressive medication they had been taking to calm their digestive nerves.
Paul's experience involved two one-hour sessions with a specially trained nurse. "As part of the treatment, the nurse took Paul through a 15-minute head-to-toe relaxation. When she got to the abdomen, she talked about a vacuum sucking up the pain. She also reinforced Paul's belief that Jesus would soothe his aching belly," Pamela says. (Treatment images are typically custom-ized to a child's interests.) Each night for a month, Paul played a tape of this guided relaxation, and his bathroom urgency largely disappeared.
According to practitioners, hypnosis isn't as far out as it may seem. "Your ankle hurts and you go to a movie and don't think about it, and then the end credits roll and it hurts again," says Dr. Krane. "When you're focused, the brain creates its own painkillers, interrupting the transmission of pain the same way analgesics do."
"Guided imagery could be attractive to patients who have exhausted traditional treatments," says Robert Kramer, M.D., assistant professor of pediatric gastroenterology at the University of Miami Miller School of Medicine. "It is difficult to imagine any adverse effects on a child's health, although it would mean a parent bearing the financial cost of an unproven method."
Treating Ear Infections With Osteopathic Manipulation
Treatment: Osteopathic ManipulationTarget: Ear Infections
More than a decade after osteopathic manipulation helped cure her of whiplash following a car accident, Miriam Mills, M.D., clinical professor at the Oklahoma State University Center for Health Sciences in Tulsa, began using this method of adjustment, which involves the gentle maneuvering of joints and soft tissues around the neck and spine, on her own patients with ear infections. The procedure's dramatic effects became apparent soon after, when a surgeon asked why she had stopped referring patients for ear tubes.
In 2003, Dr. Mills published a randomized, controlled study about osteopathic manipulation as an additional therapy for children who suffer from recurrent ear infections. The 25 kids up to 6 years old who had six manipulations over six months reduced their infection rate by 68%. Only one child (compared to eight kids in the control group) needed ear tubes.
"After my son's first few appointments, congestion that was dislodged by Dr. Mills's gentle movements would come out of his nose, so I knew it was doing something," says Mara Rabinowitz, 34, of Tulsa. Four-year-old Kip cured his chronic cough and ear fluid after three monthly treatments.
Not everyone is convinced of the method's effectiveness, however. The AAP's clinical practice guidelines for middle ear infections states that "to date, there are no studies that conclusively show a beneficial effect of alternative therapies. Conclusions regarding [these methods] cannot be made until research evidence is available."
Meryl Davids Landau lives in Boca Raton, FL, and writes about health and pregnancy for Glamour and Self.