Abstract
Pediatric use of complementary and alternative medicine (CAM) in the Netherlands is highly prevalent. The risks of pediatric CAM use are, however, largely unknown. Therefore, a 3-year survey was carried out at the Dutch Pediatric Surveillance Unit. Pediatricians were asked to register cases of adverse events associated with pediatric CAM usage. In 3 years, 32 unique adverse events were registered. Twenty-two of these adverse events were indirect and not related to the specific CAM therapy but due to delaying, changing, or stopping of regular treatment, a deficient or very restrictive diet or an incorrect diagnosis by a CAM therapist. These events were associated with many different CAM therapies. Nine events were deemed direct adverse events like bodily harm or toxicity and one-third of them occurred in infants. Only supplements, manual therapies, and (Chinese) herbs were involved in these nine events. In one case, there was a risk of a serious adverse event but harm had not yet occurred.
Conclusion: Relatively few cases of adverse events associated with pediatric CAM usage were found, mostly due to delaying or stopping conventional treatment. Nevertheless, parents, pediatricians and CAM providers should be vigilant for both direct and indirect adverse events in children using CAM, especially in infants.
What’s Known: • The use of complementary and alternative medicine (CAM) in children is common. • Previous surveillance studies in other countries showed severe adverse events may occur after pediatric CAM usage. | |
What is New: • In the Netherlands CAM-related adverse events are rare but can occur, with variable etiology and severity (from mild to potentially life-threatening) • Most CAM-related adverse events are not directly the result of CAM toxicities but rather are associated with withdrawal from appropriate therapies or with providers unable to recognize health-relevant states and delaying important diagnoses. |
Similar content being viewed by others
Data Availability
The collected data can be made available in Dutch and after removal of personal information in the submitted cases.
Abbreviations
- CAM:
-
Complementary and alternative medicine
- DPSS:
-
Dutch Pediatric Surveillance System
References
World Health Organization WHO | Traditional Medicine: Definitions. http://www.who.int/medicines/areas/traditional/definitions/en/. Accessed 11 Jan 2020
Centraal Bureau voor de Statistiek (2017) Gezondheid en zorggebruik. In: Statline. https://opendata.cbs.nl/statline/#/CBS/nl/dataset/83005ned/table?fromstatweb. Accessed 11 Jan 2020
Vlieger AM, van de Putte EM, Hoeksma H (2006) The use of complementary and alternative medicine in children at a general paediatric clinic and parental reasons for use. Ned Tijdschr Geneeskd 150:625–630
Vlieger AM, Blink M, Tromp E, Benninga MA (2008) Use of complementary and alternative medicine by pediatric patients with functional and organic gastrointestinal diseases: results from a multicenter survey. Pediatrics 122:e446–e451. https://doi.org/10.1542/peds.2008-0266
Singendonk M, Kaspers G-J, Naafs-Wilstra M, Meeteren ASV, Loeffen J, Vlieger A (2013) High prevalence of complementary and alternative medicine use in the Dutch pediatric oncology population: a multicenter survey. Eur J Pediatr 172:31–37. https://doi.org/10.1007/s00431-012-1821-6
Franik S, Huidekoper HH, Visser G, de Vries M, de Boer L, Hermans-Peters M, Rodenburg R, Verhaak C, Vlieger AM, Smeitink JAM, Janssen MCH, Wortmann SB (2015) High prevalence of complementary and alternative medicine use in patients with genetically proven mitochondrial disorders. J Inherit Metab Dis 38:477–482. https://doi.org/10.1007/s10545-014-9773-9
Ding J-L, Taylor DM, Lee M et al (2017) Observational study of alternative therapies among paediatric emergency department patients. Emerg Med Australas 29:136–142. https://doi.org/10.1111/1742-6723.12744
Taylor DM, Dhir R, Craig SS et al (2015) Complementary and alternative medicine use among paediatric emergency department patients. J Paediatr Child Health 51:895–900. https://doi.org/10.1111/jpc.12898
Zorzela L, Boon H, Mior S, Yager J, Gross A, Vohra S (2014) Serious adverse events associated with pediatric complementary and alternative medicine. Eur J Integr Med 6:467–472. https://doi.org/10.1016/j.eujim.2014.05.001
Lim A, Cranswick N, South M (2011) Adverse events associated with the use of complementary and alternative medicine in children. Arch Dis Child 96:297–300. https://doi.org/10.1136/adc.2010.183152
Centraal Bureau voor de Statistiek (2017) Medisch Specialistische Zorg; DBC’s naar diagnose, zorgkenmerken. In: Statline. https://opendata.cbs.nl/statline/#/CBS/nl/dataset/82471NED/table?ts = 1604569613741. Accessed 1 Nov 2020
Quandt SA, Verhoef MJ, Arcury TA, Lewith GT, Steinsbekk A, Kristoffersen AE, Wahner-Roedler DL, Fønnebø V (2009) Development of an international questionnaire to measure use of complementary and alternative medicine (I-CAM-Q). J Altern Complement Med 15:331–339. https://doi.org/10.1089/acm.2008.0521
Geller AI, Shehab N, Weidle NJ, Lovegrove MC, Wolpert BJ, Timbo BB, Mozersky RP, Budnitz DS (2015) Emergency department visits for adverse events related to dietary supplements. N Engl J Med 373:1531–1540. https://doi.org/10.1056/NEJMsa1504267
Goldman RD, Rogovik AL, Lai D, Vohra S (2008) Potential interactions of drug– natural health products and natural health products—natural health products among children. J Pediatr 152:521–526.e4
Izzo AA, Ernst E (2009) Interactions between herbal medicines and prescribed drugs: an updated systematic review. Drugs 69:1777–1798. https://doi.org/10.2165/11317010-000000000-00000
Teschke R, Wolff A, Frenzel C, Schulze J (2014) Review article: herbal hepatotoxicity - An update on traditional Chinese medicine preparations. Aliment Pharmacol Ther 40:32–50. https://doi.org/10.1111/apt.12798
Zuzak TJ, Rauber-Lüthy C, Simões-Wüst AP (2010) Accidental intakes of remedies from complementary and alternative medicine in children—analysis of data from the Swiss Toxicological Information Centre. Eur J Pediatr 169:681–688. https://doi.org/10.1007/s00431-009-1087-9
Vohra S, Johnston BC, Cramer K, Humphreys K (2007) Adverse events associated with pediatric spinal manipulation: a systematic review. 119:275–283. https://doi.org/10.1542/peds.2006-1392
Holla M, IJland MM, van der Vliet AM(T) et al (2009) Death of an infant following “craniosacral” manipulation of the neck and spine. Ned Tijdschr Geneeskd 153:1–4
Funding
The research was funded by The Netherlands Organization for Health Research and Development (ZonMw) and the research department of the Martini hospital in Groningen.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have indicated they have no potential conflicts of interest to disclose. JPR was and BV is employed at the Martini hospital in Groningen but both did not work for the research department that funded this study.
Ethical approval
This is a surveillance study. The Research Ethics Committee of the St. Antonius Hospital in Nieuwegein, Netherlands has confirmed that no ethical approval is required.
Consent to participate
N/A
Consent for publication
N/A
Code availability
N/A
Authors’ Contributions
BV coordinated the data collection, performed the analysis of the results and wrote the draft and final version of the manuscript. JPR and AV conceptualized and initiated the survey, contributed to the analysis of the results, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Additional information
Communicated by Gregorio Paolo Milani
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Vos, B., Rake, J.P. & Vlieger, A. Adverse events associated with pediatric complementary and alternative medicine in the Netherlands: a national surveillance study. Eur J Pediatr 180, 2165–2171 (2021). https://doi.org/10.1007/s00431-020-03899-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-020-03899-8