Christie learned about aromatherapy, biofeedback and acupressure. She also received training in guided imagery, a relaxation technique in which patients lie in bed with their eyes closed and imagine they are visiting a “happy place” of their choosing. “You use your five senses,” explains Christie. “First you have to imagine yourself getting there. Some people go in a car, or like a cloud or something. And then when you get there you look at the place and take in everything, and you hear what kind of sounds you’d hear, and what you’d touch and taste and smell.” During her second round of chemo, Christie took regular mental journeys to her own happy place–the Pike Place Market in Seattle, a city where her family once lived. She strolled around, smelled the flowers, tasted the fruit and ice cream and even went to watch the fishmongers toss around the day’s catch. Best of all, she didn’t throw up, not even once. “When you see how sick she was,” says Christie’s mother, “and then see how much it helped, you do tend to think ‘OK, there’s really something to this’.”
Complementary and alternative therapies are playing a bigger role than ever in pediatric medicine as increasing numbers of parents and doctors look for new ways to treat old problems, from the routine drips of preschool colds to the intractable complications of cerebral palsy. Herbs, acupuncture, yoga, massage, hypnosis, chiropractic adjustment, homeopathy, osteopathic manipulation–you name it, someone somewhere is trying it on kids. “People use what’s available,” says Dr. Kathi Kemper, author of “The Holistic Pediatrician.” “And there’s a lot more things available.”
No one knows for sure how many kids receive CAM therapy in the United States; the handful ofstudies that have been done so far offer a range of estimates. One study pegs overall use of CAM among kids 5 and under at 12 percent. Another survey found that 21 percent of parents reported treating their child with alternative therapies. Still another found that 73 percent of children with cancer used some type of complementary or alternative medicine. What is clear to those in the field is that the numbers–whatever they may be–are growing. “In primary-care pediatrics, CAM is on the tip of everybody’s tongue every day,” says Dr. Timothy Culbert, medical director of the integrative-care program at Children’s in Minneapolis. “We’re going to see more of it, and it behooves us to understand a lot more about it.”
That’s exactly what Burris Duncan is trying to do at the University of Arizona’s Steele Memorial Children’s Research Center. Duncan, who completed his residency in 1965, is a seasoned clinician who has spent decades caring for children with cerebral palsy. Like his patients and their families, he has been frustrated at times by the lack of progress in treating the condition, with its maddening constellation associated problems. “I’ve followed some of these kids for 20 years or so,” he says, “and I don’t see them getting much better.” Always on the lookout for promising new treatments, Duncan went to China –several years ago and met with doctors there who use acupuncture and other therapies to treat cerebral palsy. Impressed by what he saw, he returned to the United States and secured a grant from the National Institutes of Health to study acupuncture as a treatment for the condition.
The three-year study Duncan conducted, with the help of a trained acupuncturist, ended this past summer. He is in the process of analyzing the data, but reports from the parents of his patients are encouraging, he says. Of the 19 patients who received acupuncture, 12 reported improved gait or improved use of their hands; 10 showed improved sleep; 6 improved mood; 6 improved speech. The vocabulary of one 6-year-old increased from one word to 17 words. A 5-year-old girl was able to run for the first time in her life. But some patients did not show any change. And the variety of improvements actually complicates matters. “They all changed in different ways,” Duncan says, “so it’s very difficult to know what to make of this.” Determined not to raise false hopes, Duncan says the only thing he knows for certain is that more research is needed, and he plans to continue his work.
Duncan is a member of a small but growing cadre of researchers who are subjecting pediatric CAM therapies to the rigors of traditional, randomized, controlled clinical trials. Other studies underway around the country are looking at the effectiveness of the herb echinacea and osteopathic manipulation in preventing ear infections; the use of guided imagery and camomile tea to treat children with recurrent abdominal pain, and the use of massage therapy to reduce stress in children being treated for cancer.
Such serious science is crucial to the growth of integrative medicine, but the driving force in the pediatric CAM revolution is still parents like Sheldon and Tosha Janz, who simply want what they think is best for their children. When their pediatrician told the Janzes that he wanted to put their 2-year-old son Grant on steroids to treat his asthma, they went to another doctor, who told them the exact same thing. They didn’t like the idea of starting Grant on such long-term drug treatment at such a young age, however, and eventually they met with Dr. Russell Greenfield, director of Carolinas Integrative Health in Charlotte, N.C. “It was definitely not a culture that we were involved in,” Sheldon Janz says of integrative medicine. Greenfield, coauthor with Stuart Ditchek of “Healthy Child, Whole Child,” recommended a simple change in diet for Grant–no dairy products–along with regular doses of a probiotic (so-called friendly bacterium). Greenfield considers dairy products “pro-inflammatory,” and stopping dairy is usually one of the first things he tries with his asthma patients. At the same time, he does not forego conventional asthma therapies like steroids; he uses them readily when warranted. While some research suggests an association between dairy and wheezing in children, more studies are needed. But the regimen worked for Grant Janz, who has now gone more than two months without wheezing.
While the Janzes worked hand in hand with a pediatrician, many parents explore the world of CAM on their own. That’s not necessarily a problem with aromatherapy, massage therapy and other such treatments that might or might not help a child, but are basically harmless. But when it comes to the use of herbs and dietary supplements, parents should definitely keep their pediatrician in the loop. “As a parent,” asks Greenfield, “would you rather be getting your information for your beloved child from the 17-year-old health-food-store clerk or from a physician who has training?” The lack of regulation of herbs and supplements by the Food and Drug Administration is a special concern to doctors. “I think there’s evidence that echinacea is probably good in the early stages of a cold,” says Dr. Laurence Sugarman, a general and behavioral pediatrician in Rochester, N.Y. But when people ask him if they should go down to their local drugstore to get some, Sugarman warns them that, unlike prescription drugs, when it comes to herbs, there’s no guarantee that you are getting what you pay for. “There’s no evidence that that isn’t cat poop in there,” he says. Nor is it safe to assume that the herbs Mom and Dad use without complication are OK for Junior, too. “Kids are not just tiny adults,” says Kemper. “A lot of the cold medicines that work for adults don’t work for kids, so there’s good reason to think that a lot of the herbs and vitamins that work for adults might not work for kids.” And then there’s the Internet, where charlatans are rife and slick-looking Web sites lure parents with false promises and bogus claims. “You’ve got to use your common sense,” Kemper says. “Anything that sounds too good to be true probably is. Anything that says it is 100 percent safe and effective has got to be lying.”
Ultimately, the most important ingredient in integrative pediatric medicine is the kids themselves. They are the ones who bring together the conventional and the unconventional to create something new. Like Christie Blackwood, calm and cheerful in the face of cancer, combining the power of chemotherapy and the power of her imagination as she wages the fight of her life.
