Table.

Articles on the 5 Most Studied Pediatric Specialty Populations

CitationStudy PopulationType of StudyMain ResultsMost Popular InterventionsDiscussed CAM Use With PhysicianAdverse Events
Laengler A, Spix C, Seifert G, et al. Complementary and alternative treatment methods in children with cancer: a population-based retrospective survey on the prevalence of use in Germany. Eur J Cancer. 2008;44(15):2233–2240.
  • Sample Size: 1063

  • Sample population: children registered by German Childhood Cancer Registry in 2001

  • Location: Germany; German hospitals that treat pediatric cancer

Survey37% of CAM users had family members who previously used CAM; 35% of participants used CAM, patients used between 1 and 15 types of CAM; 69% of treatments were whole medical systems and 53% were biologically based practices; most used CAM for more than 1 yearHomeopathy (37%), dietary supplements (21%), anthroposophic medicine (including mistletoe therapy, 22%)71% discussed with GP, pediatrician, and/or pediatric oncologist4% reported AEs
Clerici CA, Veneroni L, Giacon B, Mariani L, Fossati-Bellani F. Complementary and alternative medical therapies used by children with cancer treated at an Italian pediatric oncology unit. Pediatr Blood Cancer. 2009;53(4):599–604.
  • Sample size: 97

  • Sample population: Children who were hospitalized, attending the outpatient clinics and either receiving treatment or being followed up by the pediatric oncology unit

  • Location: Italy, Hospital

Self-administered survey12.4% used at least one type of CAMHomeopathy, plant therapyNot reportedAsked but none reported any AE
Genc RE, Senol S, Turgay AS, Kantar M. Complementary and alternative medicine used by pediatric patients with cancer in Western Turkey. Onc Nurs Forum. 2009;36(3):e159–e164.
  • Sample size:112;

  • Sample population: pediatric cancer patients;

  • Location: Turkey, University Oncology Hospital

Self-administered questionnaire77% used one or more types of CAMNettle, 63%; prayer, 55%; salvia officinalis, 29%; vitamins or supplements, 28%26% discussed with oncologistNot reported
Hamidah A, Rustam ZA, Tamil AM, et al. Prevalence and parental perceptions of complementary and alternative medicine use by children with cancer in a multi-ethnic southeast Asian population. Pediatr Blood Cancer. 2009;52(1):70–74.
  • Sample size: 97

  • Sample population: Children with cancer diagnosed between 1995 and 2006

  • Location: Malaysia, pediatric oncology center at University Hospital in Kuala Lumpur

Questionnaire84.5% use at least one form of CAM; 62% used more than one typeWater therapy, 78% (drinking spring water from the well of ZAM ZAM in Mecca and Diamond Spring Water; Spirulina, 33%; vitamin C, 27%; multivitamins, 23%; traditional healers, 22%; sea cucumber, 15%; TCM, 15%15% of users sought advice from medical practitioners on CAM useNot reported
Lengler A, Spix C, Edelhuser F, et al. Anthroposophic medicine in paediatric oncology in Germany: results of a population-based retrospective parental survey. Pediatr Blood Cancer. 2010;55(6):1111–1117.
  • Sample size: 1063

  • Sample population: children younger than 15 years diagnosed as having cancer in 2001

  • Location: Germany

Questionnaire35% had used anthroposophic medicine18% used anthroposophic - homeopathic medication; 16% received mistletoe therapy89.8% of anthroposophic medicine users had spoken with a physician about the use of CAMMost parents did not answer this question
Tomlinson D, Hesser T, Ethier MC, Sung L. Complementary and alternative medicine use in pediatric cancer reported during palliative phase of disease. Support Care Cancer. 2011;19(11):1857–1863.
  • Sample size: 77

  • Sample population: children with cancer in palliative care

  • Location: Canada, Hospital for Sick Children, Toronto

Questionnaire55% had considered using CAM, 29% had actually used it22.1% considered, 7.8% received Whole Medical Systems (including homeopathy, naturopathy, and TCM); 19.5% considered, 5.2% received) biologically based therapiesNot reportedNot reported
Al-Qudimat MR, Rozmus CL, Farhan N. Family strategies for managing childhood cancer: using complementary and alternative medicine in Jordan. J Adv Nurs. 2011;67(3):591–597.
  • Sample size: 69

  • Sample population: children with cancer under treatment and follow-up in a pediatric oncology department

  • Location: Jordan

Interview, questionnaire65.2% had used at least one type of CAM during treatment of their children; however, 40% stopped using CAM for multiple reasons70.5% used biological and nutritional CAM (herbs/vitamins/diet); 22.2% used body and soul CAM strategies (music/imagery/acupuncture)22.2% discussed the CAM strategies with their attending health care professionalsNot reported
Naja F, Alameddine M, Abboud M, Bustami D, Al Halaby R. Complementary and alternative medicine use among pediatric patients with leukemia: the case of Lebanon. Integr Cancer Ther. 2011;10(1):38–46.
  • Sample size: 125

  • Sample population: all pediatric oncology patients from 2005 to 2009 in 2 oncology facilities

  • Location: Lebanon

Telephone surveyOverall, 15.2% of respondents reported using one or more CAM therapies for their childDietary supplements (most popular was “black seed”), prayer/spiritual healing, and unconventional cultural practices (ingesting bone ashes)Of CAM users. 6 discussed use, 13 did notNo CAM AEs reported
Paisley MA, Kang TI, Insogna IG, Rheingold SR. Complementary and alternative therapy use in pediatric oncology patients with failure of frontline chemotherapy. Pediatr Blood Cancer. 2011;56(7):1088–1091.
  • Sample Size: 44

  • Sample population: patients 0-25 years of age with a diagnosis of cancerbeing treated in the Division of Oncology at The Children’sHospital of Philadelphia with failure of frontline therapy within last 60 days

  • Location: United States, Children's Hospital Philadelphia

QuestionnaireWhen frontline therapy failed, 52% increased their use of CAM, 35% did not change their use of CAM, and 13% decreased their use of CAMPrayer/spiritual healing (83%) and oral/dietary supplements (31%)56% of respondents said their oncologist was aware of all use, 39% said their oncologist was aware of none or only some of their CAM useNot reported
Singendonk M, Kaspers GJ, Naafs-Wilstra M, et al. High prevalence of complementary and alternative medicine use in the Dutch pediatric oncology population: a multicenter survey. Eur J Pediatr. 2013;172(1):31–37.
  • Sample size: 288

  • Sample population: children attending pediatric outpatient clinics in academic hospitals

  • Location: Netherlands

Prospective multicenter study42.4% reported CAM use; more than 80% of the respondents identified a need for information about CAM from their pediatrician and 85.7% were positive toward research on CAM; half of the parents were interested in participating in future CAM trialsHomeopathy (18.8%) and dietary supplements (11.5%)Only one-third of the parents had discussed CAM use with their pediatric oncologistNot reported
Asthma
Babayigit A, Olmez D, Karaman O, Uzuner N. Complementary and alternative medicine use in Turkish children with bronchial asthma. J Altern Complement Med. 2008;14(7):797–799.
  • Sample size: 250

  • Sample population: children with asthma

  • Location: Turkey

Questionnaire46.4% had used CAM in the past; 23.6% used it in the last 6 months, and 39.6% of them used CAM in the last 12 monthsHerbal medicine, 29.7%; quail eggs, 16.1%; Turkish honey, 14.4%; 11% used vitamins and minerals; 35.6% used multiple CAM therapiesNot reportedNot reported
Torres-Llenza V, Bhogal S, Davis M, Ducharme F. Use of complementary and alternative medicine in children with asthma. Can Respir J. 2010;17(4):183–187.
  • Sample size: 2027

  • Sample population: physician-diagnosed asthma

  • Location: Canada, Asthma Center, Montreal Children's Hospital

Questionnaire13% used CAM; used morein patients who were of preschool age, of Asianethnicity, or who had episodic asthma or poor asthma controlVitamins (24%), homeopathy (18%), acupuncture (11%)Not reportedNot reported
Cotton S, Luberto CM, Yi MS, Tsevat J. Complementary and alternative medicine behaviors and beliefs in urban adolescents with asthma. J Asthma. 2011;48(5):531–538.
  • Sample size: 151

  • Sample population: adolescents with asthma from the Teen Health Center;

  • Location: United States, Cincinnati Children’s Hospital Medical Center (CCHMC)

Questionnaire71% used CAM in the past month; 30% used prayer specifically for asthma symptom management64% used relaxation, 61% prayer, 33% meditation, 31% guided imagery59% disclosed their use of yoga; 57% reported dietary changesNot reported
Luberto CM, Yi MS, Tsevat J, Leonard AC, Cotton S. Complementary and alternative medicine use and psychosocial outcomes among urban adolescents with asthma. J Asthma. 2012;49(4):409–415.
  • Sample size:129

  • Sample population: urban adolescents with asthma

  • Location: United States, Ohio

Self-report measuresHigh and low CAM users differed significantly in terms of several psychosocial health outcomes, both cross-sectionally and longitudinally; in cross-sectional multivariable analyses, greater frequency of praying was associated with better psychosocial HRQoLNot reportedNot reportedNot reported
Philp JC, Maselli J, Pachter LM, Cabana MD. Complementary and alternative medicine use and adherence with pediatric asthma treatment. Pediatrics. 2012;129(5):e1148–1154.
  • Sample size: 187

  • Sample population: caregivers of patients with asthma

  • Location: United States

Cohort studyCAM use is not necessarily “competitive” with conventional asthma therapies; families may incorporate different health belief systems simultaneously in their asthma managementNot reportedNot reportedNot reported
Shen J, Oraka E. Complementary and alternative medicine (CAM) use among children with current asthma. Prev Med. 2012;54(1):27–31.
  • Sample size: 5435

  • Sample population: children with asthma from BRFSS states report

  • Location: United States

Survey26.7% of children with current asthma reported CAM use in the previous 12 monthsBreathing techniques (58.5%); vitamins (27.3%) and herbal products (12.8%)Not reportedNot reported
Autistic Spectrum Disorder
Christon LM, Mackintosh VH, Myers BJ. Use of complementary and alternative medicine (CAM) treatments by parents of children with autism spectrum disorders. Res Autism Spectr Disord. 2010;4(2):249–259.
  • Sample size: 248

  • Sample population: diagnosed as having autism at 21 years or younger recruited through a number of autism centers/organizations (national, state, and county)

  • Location: United States

Online surveyMore than 70% had tried at least one CAM treatment and approximately half were currently using one or more CAMsLifetime use: special diet (29.4%), special vitamins (27.0%), animal therapy (23.8%), auditory; current use: vitamins (19.8%), special diet (14.1%)Not reported2.6% of parents reported CAM made it worse
Article I. Wong VCN. Use of complementary and alternative medicine (CAM) in autism spectrum disorder (ASD): comparison of Chinese and western culture (Part A). J Autism Dev Disord. 2009;39(3):454–463.
  • Sample size: 98

  • Sample population: ASD children

  • Location: China, Hospital assessment center for children with neurodevelopmental disabilities

Interview-administered questionnaire40.8% used CAMAcupuncture, 47.5%; TCM, 30%22.4% informed their physicians92.5% reported no AEs; those AEs reported included: allergy, diarrhea, vomiting, general ill health, worsening of disease symptoms
Frye RE, Sreenivasula S, Adams JB. Traditional and non-traditional treatments for autism spectrum disorder with seizures: an on-line survey. BMC Pediatr. 2011;11:37.
  • Sample size: 1023

  • Sample population: Finnish children with ASD

  • Location: Finland

Online surveyKetogenic diet was perceived to improve both seizures and other clinical factorsKetogenic dietNot reportedRate of AEs was higher with traditional antiepileptic drugs than in nonantiepileptic drugs
Hall SE, Riccio CA. Complementary and alternative treatment use for autism spectrum disorders. Complement Ther Clin Pract. 2012;18(3):159–163.
  • Sample size: 452

  • Sample population: parents/caregivers of children with an ASD

  • Location: Internet, but mostly United States

Web-based surveyFour general factors emerge as influencing the decision-making processes of parents/caregivers from this study: severity, child willingness to engage in the treatment, marital status, and educational levelGluten-free/casein-free diet, probiotics, ω3 fatty acids, and melatoninNot reportedNot reported
Perrin JM, Coury DL, Hyman SL, et al. Complementary and alternative medicine use in a large pediatric autism sample. Pediatrics. 2012;130(suppl.2):S77–S82.
  • Sample size: 3173

  • Sample population: Autism Speaks Autism Treatment Network patient registry

  • Location: Canada and United States

Cross-sectional analysis28% reported CAM use; 17% special diets and 20% other CAM; higher rates of CAM use were associated with GI symptomsSpecial dietsNot reportedNot reported
Gastrointestinal Diseases
Gerasimidis K, McGrogan P, Hassan K, Edwards CA. Dietary modifications, nutritional supplements and alternative medicine in paediatric patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2008;27(2):155-165.
  • Sample size: 86

  • Sample population: pediatric IBD patients who attended follow-up clinical appointments

  • Location: United Kingdom, Yorkhill Royal Hospital of Sick Children, Scotland

Questionnaire61% reported prior CAM use to manage IBD, 37% using at time of recruitment; most had no opinion about CAM safetyDairy-free diet, 28%; gluten-free diet, 15%; aloe, 19%; probiotics, 44%; fish/ω-3 oils, 27%27% discussed with physician1 respondent mentioned AEs and 1 mentioned deterioration of disease condition
Vlieger AM, Blink M, Tromp E, Benninga MA. Use of complementary and alternative medicine by pediatric patients with functional and organic gastrointestinal diseases: results from a multicenter survey. Pediatrics. 2008; 122(2):e446–451.
  • Sample size: 749

  • Sample population: outpatient patients with functional and organic GI disease

  • Location: Netherland, GI outpatient clinics in academic hospitals and teaching hospitals

Questionnaire37.6% had used CAM in past 12 months; 63.7% of them had visited a CAM provider; the other 36.3% used OTC remedies or received treatment from parents; 93% of parents consider it important for pediatricians to initiate researchHerbal remedies, 46%; food supplements, 36%; manual therapies, 23.7%; homeopathy, 21.9%; energy medicine, 17.3%; TCM. 10.8%51% discussed CAM use with their pediatrician or pediatric gastroenterologistNot reported
Wong AP, Clark AL, Garnett EA, et al. Use of complementary medicine in pediatric patients with inflammatory bowel disease: results from a multicenter survey. J Pediatr Gastroenterol Nutr. 2008;48(1):55–60.
  • Sample size: 362

  • Sample population: children with IBD or chronic constipation

  • Location: United States, pediatric IBD centers in San Francisco, Houston, Atlanta

Survey49.6% use CAM in IBD group; 23% in chronic constipationIBD: spiritual intervention, nutritional supplements, herbal remediesConstipation: herbal remedies, alternative practices, nutritional supplementsNot reportedSome patients reported that some therapies worsened their condition
Cotton S, Humenay Roberts Y, et al. Mind-body complementary alternative medicine use and quality of life in adolescents with inflammatory bowel disease. Inflamm Bowel Dis. 2010;16(3):501–506.
  • Sample size: 67

  • Sample population: 12- to 19-year old patients with IBD (including Crohn disease)

  • Location: United States, Cincinnati Children's Hospital Medical Center and University Hospital, Cincinnati

QuestionnaireNo correlation with quality of life and CAM use, except lower HRQoL scores with those that practice yoga; females, those with severe symptoms, younger adolescents, and those with worse HRQoL more likely to try CAM62% used prayer, 40% relaxation, 21% imagery used in last monthNot reportedNot reported
Wadhera V, Lemberg DA, Leach ST, Day AS. Complementary and alternative medicine in children attending gastroenterology clinics: usage patterns and reasons for use. J Paediatr Child Health. 2011;47(12):904–910.
  • Sample size: 98

  • Sample population: children attending gastroenterology clinics

  • Location: Sydney, Australia

Cross-sectional study79% were using or had used CAM; 75.4% expressed that they would use CAM again; 80% believed that physicians should support the use of CAMNutritional supplements (n= 37, 56% of CAM users) and probiotics (n= 33, 50%)More than two-thirds discussed CAM use (47 of 62 families)Not reported
Pediatric Emergency Care
Zuzak TJ, Zuzak-Siergast I, Simoes-Wust AP, Rist K, Staubli G. Use of complementary and alternative medicine by patients presenting to a paediatric emergency department. Eur J Pediatr. 2009;168:431–37.
  • Sample size: 1143

  • Sample population: Children attending ED;

  • Location: Switzerland, University Children's Hospital, Zurich

Onsite self-complete questionnaire58% reported patient had used some form of CAM; 25% at present illness, 49% for former illnessNot reported50% did not discuss CAM useNot reported
Goldman RD, Vohra S, Rogovik AL Vitamin use among children attending a Canadian pediatric emergency department. Fundam Clin Pharmacol. 2011;25(1):131–137.
  • Sample size: 1804

  • Sample population: every third pediatric family in the ED from 12 pm to 12 am, March to November 2004

  • Location: Canada

Questionnaire32.3% of families used vitamins in preceding 3 months; of these children, 61% used them daily, 23% weekly, 9.3% once a month, and 7.2% in last 3 monthsMultivitamins38% did not discuss CAM useNot reported
Zuzak TJ, Zuzak-Siegrist I, Rist L, Staubli G, Simo AP. Medicinal systems of complementary and alternative medicine: a cross-sectional survey at a pediatric emergency department. J Altern Complement Med. 2010;16(4):473–479.
  • Sample size: 1143

  • Sample population: Children attending ED

  • Location: Switzerland, University Children's Hospital, Zurich

QuestionnaireRespondents perceived the effectiveness of CAM therapies in general to be inferior to that of CM, although 49% of all respondents stated that CAM therapies were more effective than CM in certain cases/against certain diseases and 13% that CAM therapies were as effective as CMHomeopathy (77%), herbal medicine (64%), anthroposophic medicine (24%), TCM (13%)Not reported93% of the respondents indicated no AEs
  • AE=adverse effect; ASD=autism spectrum disorder; BRFSS=Behavior Risk Factor Surveillance System; CAM=complementary and alternative medicine; CM=complementary medicine; ED=emergency department; GI=gastrointestinal; GP=general practitioner; HRQoL=health-related quality of life; IBD=irritable bowel disease; TCM=traditional Chinese medicine.