What’s the Bottom Line?

How much do we know about complementary health approaches for children?

We know a lot about the usage rates of complementary health approaches for children but little about their effects and safety. In the past, children were often excluded from research studies due to special protections, and findings from studies of adults were applied to children. Today, the National Institutes of Health requires that children be included in all studies, unless there are scientific and ethical reasons not to.

What do we know about the effectiveness of complementary health approaches for children?

Studies have looked at many complementary health approaches for children with different conditions, but the evidence generally isn’t strong enough to show what works and what doesn’t.

What do we know about the safety of complementary health approaches for children?

Many complementary approaches haven’t been tested for safety in children.

Patterns in the Use of Complementary Health Approaches for Children

The 2012 National Health Interview Survey (NHIS) included a comprehensive survey on the use of complementary health approaches by almost 45,000 Americans, including more than 10,000 children aged 4 to 17. The survey found that 11.6 percent of the children had used or been given some form of complementary health product or practice, such as yoga or dietary supplements, during the past year. Data from the 2017 NHIS found that from 2012 to 2017 the use of yoga and meditation in the past 12 months significantly increased among U.S. children (aged 4 to 17 years). The percentage of children using yoga more than doubled and the percentage of children meditating showed an almost tenfold increase.

The most frequently used approaches for children were natural products (fish oil, melatonin, and probiotics), and chiropractic or osteopathic manipulation. This does not include vitamins and minerals.

For children, complementary health approaches were most often used for back or neck pain, other musculoskeletal conditions, head or chest colds, anxiety or stress, attention-deficit hyperactivity disorder (ADHD) or attention-deficit disorder (ADD), and insomnia or trouble sleeping.

For more information from the NHIS study on children’s use of complementary health approaches, visit the National Center for Complementary and Integrative Health’s (NCCIH) NHIS Statistics pages at nccih.nih.gov/research/statistics/NHIS/2012.

Other studies show that children in the United States who use or are given complementary health approaches vary in age and health status. For example:

• About 10 percent of infants are given teas or botanical supplements, usually for fussiness or stomach problems.
• About 40 percent of children aged 2 to 8 are given dietary supplements containing vitamins or minerals. However, that age group generally eats a nutritionally adequate diet.
• Teens are particularly likely to use products that claim to improve sports performance, increase energy levels, or promote weight loss.
• Children with chronic medical conditions, including anxiety, musculoskeletal conditions, and recurrent headaches, are more likely than other children to use complementary health approaches, usually along with conventional care.

What the Science Says About the Safety and Side Effects of Complementary Health Approaches for Children

• Dietary supplements result in about 23,000 emergency room visits every year. Many of the patients are young adults who come to the emergency room with heart problems from taking weight-loss or energy products. One-fifth of the visits are children; most of whom took a vitamin or mineral when unsupervised. (Child-resistant packaging isn’t required for dietary supplements.)
• Some dietary supplements contain contaminants, including drugs, chemicals, or metals.
• Children’s small size, developing organs, and immature immune system make them more vulnerable than adults to having allergic or other adverse reactions to dietary supplements.
• Some products may worsen conditions. For example, echinacea is a type of ragweed so people sensitive to ragweed may also react to echinacea.
• Do not rely on asthma products sold over-the-counter and labeled as homeopathic, the U.S. Food and Drug Administration (FDA) warns. Homeopathic remedies and dietary supplements are not evaluated by the FDA for safety or effectiveness.
• Biofeedback, guided imagery, hypnosis, mindfulness, and yoga are some of the complementary health approaches that have the best evidence of being effective for children for various symptoms (such as anxiety and stress) and are low-risk. However, spinal manipulation, a common complementary approach, is associated with rare but serious complications.

More to Consider

• Make sure that your child has received an accurate diagnosis from a licensed health care provider.
• Educate yourself about the potential risks and benefits of complementary health approaches.
  • Ask your child’s health care provider about the effectiveness and possible risks of approaches you’re considering or already using for your child.
• Remind your teenagers to talk to their health care providers about any complementary approaches they may use.
• Do not replace or delay conventional care or prescribed medications with any health product or practice that hasn’t been proven safe and effective.
• If a health care provider suggests a complementary approach, do not increase the dose or duration of the treatment beyond what is recommended (more isn’t necessarily better).
• If you have any concerns about the effects of a complementary approach, contact your child’s health care provider.
• As with all medications and other potentially harmful products, store dietary supplements out of the sight and reach of children.
• Tell all your child’s health care providers about any complementary or integrative health approaches your child uses. Give them a full picture of what you do to manage your child’s health. This will help ensure coordinated and safe care.

Selecting a Complementary Health Practitioner

If you’re looking for a complementary health practitioner for your child, be as careful and thorough in your search as you are when looking for conventional care. Be sure to ask about the practitioner’s:

• Experience in coordinating care with conventional health care providers.
• Experience in delivering care to children.
• Education, training, and license.

In general, the research on the efficacy of fish oil supplementation for any condition in children consists of some systematic reviews, several observational studies and a few small, randomized controlled trials. Overall, large, high-quality studies on natural products for children is lacking.

What Does the Research Show?

• ADHD: A 2012 Cochrane systematic review of 13 trials involving 1,011 children and adolescents with attention-deficit hyperactivity disorder (ADHD) concluded that overall, there is little evidence that polyunsaturated fatty acids (PUFA) supplementation provides any benefit for the symptoms of ADHD in children and adolescents. The majority of data showed no benefit of PUFA supplementation; however, there were some limited data that did show an improvement when omega-3 and omega-6 supplementations were combined.
• Asthma: Studies assessing the effects of omega-3 fatty acids on asthma have had conflicting results. In one small, randomized controlled trial of 29 children with asthma, those who took fish oil supplements rich in eicosapentaenoic (EPA) and docosahexaenoic (DHA) for 10 months reduced their symptoms compared to children who took placebo. However, most studies have shown no effect.
• Autism Spectrum Disorders: A 2011 Cochrane systematic review of two small, randomized controlled trials with a total of 37 children evaluated omega-3 fatty acids for autism spectrum disorders (ASD) and found insufficient evidence that omega-3 fatty acids supplementation is effective for improving core and associated symptoms of ASD.
• Elevated Triglycerides: A small 2014 study of 25 children aged 10 to 19 years with elevated triglyceride levels found that high-dose omega-3 fatty acid supplements were well tolerated, but produced no significantly different effects on triglyceride levels compared to placebo.
• Insulin Resistance: A 2013 study of 201 obese, insulin-resistant children and adolescents assessed the effect of Metformin or omega-3 polyunsaturated fatty acids on insulin resistance, lipid profile, and body mass index (BMI) and found that omega-3 polyunsaturated fatty acids significantly decreased the concentrations of glucose and insulin. The effects of Metformin on insulin levels were negligible. Omega-3s significantly improved triglyceride levels as well as BMI.

Safety

• Although fish oil/omega-3 fatty acid supplements appear to be well tolerated in adults, the long-term safety profile of these supplements in children has not been well studied. An Australian study in 616 infants who received supplements of tuna fish oil or a Sunola oil (a low in omega-3 fatty acids control), from 6 months of age to 5 years did not report any adverse effects.

The research on efficacy of melatonin supplementation for managing sleep disorders in children consists of only a few small controlled trials in primarily children with disabilities.

What Does the Research Show?

• A 2016 randomized controlled trial of 48 children and adolescents aged 1 to 18 years with sleep disturbance and physician-diagnosed atopic dermatitis involving at least 5 percent of the total body surface area found that after melatonin treatment, the participants saw improvements in their atopic dermatitis compared to placebo, and the sleep onset-latency was shortened by 21.4 minutes compared to placebo.
• A 2011 review of herbal medicines, including melatonin, in the pediatric population concluded that although some studies of melatonin have noted benefit, particularly for a reduction in sleep onset, research has been limited by small sample sizes, differing doses, and varying methodology.
• A 2012 study in Europe of 146 children ages 3 years to 15 years 8 months with a range of neurological and developmental disorders had similar results—a modest increase (22.4 minutes) in total sleep time as well as a reduction in sleep onset.
• A 2014 review on the effect of melatonin supplementation for sleep disorders in children with autism spectrum disorders (ASD) found that melatonin may be beneficial in children with ASD who have problems with sleep latency or sleep maintenance.

Safety

• Melatonin appears to be safe for adults when used short-term, but there is a lack of research on its long-term safety in children.

Although only a few randomized controlled trials on meditation and mindfulness techniques have been conducted in children, findings from these studies suggest some benefits for anxiety, depressive, and other negative affect, behavioral and emotional symptoms, and somatic functioning.

What Does the Research Show?

• A 2016 review concluded that mindfulness reduces psychological symptoms, such as anxiety, and improves emotion regulation; improves attention and ability to focus; and reduces maladaptive coping and rumination. However, there remains a need for rigorous scientific evaluation of mindfulness interventions for children and youth.
• A 2014 review found that meditative and movement techniques have been shown to produce benefits for anxiety, depressive, and other negative affect, behavioral and emotional symptoms, and somatic functioning. The review concluded that some clinicians may consider meditation and mindfulness techniques for limited clinical use as adjunctive therapies in selected cases. Nevertheless, clinicians need to be mindful that risks and potential contraindications are not yet well defined, and are advised to consider consents for these interventions.

Safety

• Meditation is generally considered safe for most people, and no significant adverse effects have been identified.

The evidence base on the efficacy of yoga and other movement therapies in children for any condition consists of a limited number of studies, many with small sample sizes and high risk of bias.

What Does the Research Show?

• A 2015 systematic review of 16 studies (including 6 randomized controlled trials, 2 nonrandomized preintervention-postintervention control-group designs, 7 uncontrolled preintervention-postintervention studies, and 1 case study) for yoga interventions addressing anxiety among children and adolescents concluded that nearly all studies included in the review indicated reduced anxiety following a yoga intervention. However, the reviewers noted that because of the wide variety of study populations, limitations in some study designs, and variable outcome measures, further research is needed to enhance the ability to generalize and apply yoga to reduce anxiety.
• A 2008 systematic review found some physiological benefits of yoga for children that may provide benefits through the rehabilitation process, but many of the studies included in the review were of poor quality and small sample size.
• A 2010 randomized controlled trial examined the effects of yoga on eating disorders in 50 girls and 4 boys aged 11 to 21 compared to standard care. Participants in the yoga group saw improvements in their eating disorder upon examination and had significantly reduced food preoccupation immediately after yoga sessions.

Safety

• Yoga is generally low-impact and safe for healthy people when practiced appropriately under the guidance of a well-trained instructor.
• Overall, those who practice yoga have a low rate of side effects, and the risk of serious injury from yoga is quite low.