In the past decade the use of complementary and alternative medicine (CAM) has dramatically increased in adult, adolescent, and pediatric populations in the United States, Canada, and Western Europe. There are multiple reasons for this, including the search for natural therapies, curative and ameliorative therapies for chronic illnesses that are unresponsive to conventional therapy, attraction to therapists or alternative modalities suggested by friends, and the autonomy of obtaining unregulated products and services. This review will address recent studies concerning adolescent use of specific CAM therapies for asthma, urinary tract infections, headaches, dietary supplements in athletes, and mental health conditions. Health care providers need to be aware of the CAM therapies their patients are using, the potential side effects, and the possibilities for including effective complementary therapies into the conventional care they provide.
Abbreviations:CAM complementary and alternative medicine, UTI urinary tract infections
The following is a review of the most current research on complementary and alternative medicine (CAM) used by adolescents. Currently, there is very little data on the use and efficacy of CAM in teenagers. This paper will review the surveys on CAM use in adolescents and will look at promising areas of research.
Alternative medicine refers to therapies that are not generally taught in American medical schools or provided in hospitals, that lack evidence of effectiveness, and that are not reimbursed by third party payers [1]. The definition of CAM is ever changing; modalities such as stress reduction and acupuncture, once considered alternative, are now becoming mainstream. The Cochrane collaboration [2] defines CAM as 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 systems of a particular society or culture in a given historical period.
A recent survey [3] reported that American adults using CAM increased from 34% in 1990 to 42% in 1997, and out-of-pocket expenditures increased 45% during this same period. Adults studied in the survey used herbal medicine, massage, megavitamins, self-help groups, folk remedies, energy healing, and homeopathy. The survey also found that alternative therapies were used most frequently for chronic conditions, including back problems, anxiety, depression, and headaches.
In 1994, the percentage of general pediatric patients using CAM was approximately 11%. In the presidential plenary session of the Pediatric Academic Society Meeting in 1999, Ottolini noted an increase to 20% in 1997 (Otolini et al., paper presented at the presidential plenary session of the Pediatric Academic Society Meeting, 1999) [4]. The percentage is substantially higher for children and families faced with chronic, recurrent, or fatal conditions such as cancer, asthma, cystic fibrosis, and juvenile rheumatoid arthritis [5,6]. In children and adolescents afflicted with these conditions, rates of CAM use range from 30% to more than 70%, depending on age, background, and access to services [7].
What about CAM use in generally healthy adolescents? In a 1998 British survey [8] looking at CAM use in a general pediatric outpatient setting, researchers received 521 completed parent questionnaires. More than 20% of children studied had previously used one or more forms of CAM, usually for respiratory, ear, nose, and throat, dermatological, and neurological conditions. In another 1998 survey [7], researchers looked at 163 homeless adolescents who were receiving health care at a youth clinic in Seattle. A total of 70% of the participants reported using CAM, and more than 70% of those used herbs and vitamins. Other forms of CAM used included massage, special exercise, acupuncture, meditation, aromatherapy, homeopathy, and chiropractic. Although the most common reason for using a CAM was because it was a natural medicine (43%), other reasons noted were low cost, perceived efficacy, negative experience with physicians, and friend's use and recommendation of CAM. More than 87% of the youth reported that CAM helped them either some or a lot. The youth visited the clinic for acute medical problems such as upper respiratory infections, vaginal and penile discharge, diarrhea, and musculoskeletal injury, and for chronic conditions such as asthma, stomach pain, and headaches.
There are many reasons why adolescents choose CAM or why parents choose CAM for their adolescents. First, they are attracted to a therapist or modality that has been personally recommended by a family member, health care professional, or peer. They may be looking for a natural solution and are concerned about possible side effects of conventional therapies. They may be looking for a solution to a chronic health problem that cannot be improved with traditional treatment, or they are dissatisfied with conventional care [4]. Finally, some adolescents who want to actively participate in their health care choose CAM because it gives them a sense of autonomy.
The evidence of efficacy of CAM therapies varies by the specific condition and specific type of therapy. This review will focus on asthma, urinary tract infections (UTIs), headaches, the use of performance enhancing supplements, and other conditions commonly seen in adolescents.