Complementary Health Approaches
in Developmental and Behavioral
Pediatrics
Complementary and alternative medicine has been defined 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 and as practices “not presently considered an integral part of conventional medicine.”
The term complementary medicine has been used to describe nonstandard approaches
that are used with conventional medicine, and the term alternative medicine has been used to
refer to therapies that are a replacement for mainstream medical practices.
Complementary health approaches (CHA) has been divided into 2 main domains: natural
products and mind-body practices. Natural products include botanical agents, vitamins,
minerals, and special diets, whereas mind-body practices include such approaches as massage therapy,
yoga, chiropractic, and acupuncture. Use of CHA is as high as 12% in general pediatric population
especially among chronically ill children.
How to Evaluate Therapies
Questions in 3 main domains:
1. Questions related to the underlying theoretical basis for the therapy.
2. Questions related to the scientific evaluation of the therapy.
3. Questions related to the promotion and marketing of the therapy.
Summary Recommendations for the Use of Selected Complementary and
Alternative Therapies in Developmental-Behavioral Disorders Based on
Available Evidence
3 categories:
1. Not recommended: insufficient or absent empiric support (or strong evidence of
inefficacy), low plausibility-
• Homeopathy
• Chiropractic
• Auditory integration therapy
• Vestibular stimulation
• Vision therapy, visual perceptual training
• Reflexology
• Craniosacral therapy
• Patterning, Doman-Delacato method
• Acupuncture
• Therapeutic touch
• Magnet therapy
• Reiki, Qi gong
• Hypnosis
• Pharmacological doses of vitamins (except in known metabolic disorders)
• Herbal remedies
• Chelation therapy
• Secretin in ASD
• Hyperbaric oxygen
• Antifungal agents
• Antiviral agents
• Antioxidants
• Immunoglobulins
• Stem cell therapy
• Gluten-free, casein-free diet in ASD
2. More research needed: limited empiric support, limited plausibility .
• Biofeedback, EEG/EMG biofeedback
• Meditation, relaxation techniques
• Music therapy
• Massage
• Sensory integration therapy
• Omega-3 fatty acids
• Oxytocin
• Transcranial magnetic stimulation
3. Adequate empiric evidence to support current use - e.g Melatonin use for prolonged sleep
latency.
Counseling Families of Children With
Developmental-Behavioral Disorders About CHAs
It has been suggested that parents increase their knowledge about nonstandard practices, be
able to critically analyze the merits of specific therapies, identify potential safety risks, provide families
with information about all therapeutic options, and emphasize the importance of investigating
nonstandard practices using rigorous scientific methodology.
Caregiver of children with developmental- behavioral disorders may be considerably influenced by
factors other than what the scientific community considers acceptable evidence regarding their
decisions about which treatments to pursue for their children. One potential explanation is that when
anxiety is high as a consequence of having a child with a condition that has unclear etiology and
uncertain outcome, a caregiver may have a greater likelihood of adopting a belief that might be viewed
as unscientific. Such beliefs can be powerfully reinforced by the social milieu (eg, support groups or
social media) in which parents may find themselves immersed.
Role of primary pediatric health care professional: Primary pediatric health care
professionals need to use several different approaches when discussing CHAs with families.
1. Families should be strongly advised to avoid those therapies that are clearly risky and have insufficient
evidence of efficacy (for example, chelation therapy in ASD).
2. Therapies for which there is adequate evidence of safety and efficacy in children with developmental-
behavioral disorders should be recommended.
3. Primary pediatric health care professionals should not be afraid to use reasoned arguments to
dissuade families from pursuing inappropriate therapies .
Ethical consideration:
Principles that need to be considered within an ethical framework include beneficence, nonmaleficence,
autonomy, justice, and truth- fulness. In the case of the use of CHAs in children, these principles may
come into direct conflict with one another, and clinicians must give careful attention to each.
A primary pediatric health care professional has the responsibility to administer therapies
that are beneficial to the patient and society. The importance of basing treatment decisions on the best
available evidence is paramount.
Pediatric health care professionals need to continue to carefully balance the principles of beneficence,
non- maleficence, and autonomy in deciding whether it is justifiable to recommend (or tacitly support) a
treatment that is ineffective, lacks a sufficient evidence base, or is based on an implausible, underlying
theoretical framework.
Conclusion : Truly family-centered care should include efforts to teach families of children
with developmental-behavioral disorders to evaluate therapeutic claims critically and to clearly
understand the potential hazards (physical, emotional, and financial) that can accompany the use of
unproved therapies.
