Use of complementary and alternative medicines in children Too important to ignore

1. Use of complementary and alternative medicines in children Too important to ignore • Alissa Lim, Trainee Research Fellow • Annette Webb, Paediatric Registrar • Gill Kainey, RN, Clinical Support Services • Kaye Hynes, Senior Pharmacist • Noel Cranswick, Clinical Pharmacology • Angela Mackenzie, Paediatrician • Elizabeth Kennedy, Lawyer • Liza Newby, Health Policy Consultant • Mike South, Paediatrician

2. Complementary Natural Unproven Holistic Whacky Integrative Dangerous Healing Fraudulent Alternative

3. I thought I should mention doctor, that we have been giving him a Chinese herbal tonic to build up his strength for the operation next month. That’s OK isn’t it?

4. The herbalist said we must keep giving it to him while he is in hospital for the operation. Can we do that?

5. I won’t be able to stay in overnight with him because I will need to be home for the other kids. Would it be OK for the nurses to give him the tonic when I’m not there?

6. Aims • Present our own research • Present a new RCH policy and associated guidelines regarding CAM usage for RCH inpatients

7. Complementary and alternative medicine (CAM) Complementary or Alternative Medicine (CAM) is a broad domain of healing resources that encompasses all health systems, modalities and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society. Cochrane Collaboration

8. Examples Medicines Herbal therapies Naturopathy Homeopathy Traditional Chinese Medicine Megavitamins Other therapies Acupuncture Aromatherapy Kinesiology Chiropractic Hypnotherapy Moxibustion Ayurveda Reiki Reflexology

9. Complementary and alternative medicine (CAM) Diverse opinion amongst orthodox health professionals regarding role of CAM in health care. (Mirrored in our group)

10. Complementary and alternative medicine (CAM) • It is likely that some forms of CAM are good therapies with important potential roles in health care. • Some will be ineffective but harmless. • Others will be dangerous. • Every CAM has its own combination of risk & benefit. • (Just like orthodox therapies)

11. Alternative therapist faces questions after boy diesThe Royal Children's Hospital has asked the Justice Department to investigate an alternative health practitioner who it believes advised the family of a teenage boy with curable cancer to stop chemotherapy.The Age 21/09/2002

12. Special issues regarding CAM use in children • Child not competent to make own decisions • Consequences of parental choice • ?Balance of parental autonomy and child’s wellbeing • Our responsibilities as health professionals

13. Non-medicine CAMsConsider individually

14. RCH CAM Research • Alissa Lim, Trainee Research Fellow • Noel Cranswick, Clinical Pharmacologist • Sue Skull, Clinical Epidemiologist • Mike South, Paediatrician

15. CAM use in the Community • Cross-sectional survey • Self-administered questionnaires • Random sample of 30 primary schools • Medication use in preceding two weeks • 1534 questionnaires

16. CAM use in the Community Types of CAM

17. CAM use in the Community Reasons for Use

18. CAM use in the Community Source of CAM

19. RCH survey of CAM use • A cross-sectional survey of inpatient and outpatients groups • Questionnaire by face-to-face interview • CAM use in the preceding 12 months • 503 patients surveyed • 101 inpatients and 402 outpatients (general paediatric, gastroenterology, thoracic, diabetes)

20. RCH survey of CAM use CAM Use

21. RCH survey of CAM use Types of Medicinal CAM Other Herbal Vitamin C

22. RCH survey of CAM use Reasons for CAM Use

23. RCH survey of CAM use

24. RCH survey of CAM use • Inpatient group: • 22% had used medicinal CAM in last month • 2 patients (9%) documented • partial documentation only

25. CAM Adverse Events • Surveillance Study via Australian Paediatric Surveillance Unit (APSU) • 29 reports over 20 months(January 2001 to September 2002) • Severity : mild to severe 2 fatality

26. CAM Adverse Events Report Types: A. Adverse events associated with the use of medicinal CAM B. Adverse events associated with failure to use conventional therapy

27. CAM Adverse Events

28. RCH CAM Research • Common in the community • Very common in patients attending RCH½ in last 12 months, ¼ in last month • Evidence of potential adverse effects or interactions. • Families often don’t “tell”

29. RCH CAM GroupDUC Subcommittee • Policy • Guidelines • Resource documents • Drug Information Resources

30. Issues • Acknowledge CAM is used for children and get it “out in the open” • Safety • Parental choice • Legal • Ethical • Documentation • Practical issues • Ward safety

31. RCH CAM Policy

32. RCH CAM Guidelines

33. ? Child at risk

35. Working with families around CAM • Whatever your views on CAM - it cannot be ignored, and it will not go away. • If the parents of children you care for don’t tell about CAM use - there is the potential for an adverse outcome. • Presenting an antagonistic attitude is unlikely to be helpful. • Presenting an open-minded, non-judgmental attitude is likely to improve trust and understanding.

36. Resources www.rch.org.au/genmed/camguidelines.htm The Drug Information Service – ext 5208.