(BQ) Part 1 book “Integrative pediatrics - Art, science, and clinical application” hass contents: Introduction to pediatric integrative medicine, physical activity, environmental health, mind–body therapies, botanicals and dietary supplements, manual medicine,… and other contents.
Integrative Pediatrics Integrative Pediatrics Art, Science, and Clinical Application Hilary McClafferty, MD, FAAP Associate Professor, Department of Medicine Director, Pediatric Integrative Medicine in Residency Co-Director, Fellowship in Integrative Medicine University of Arizona Center for Integrative Medicine University of Arizona College of Medicine Tucson, Arizona First published 2017 by Routledge Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 711 Third Avenue, New York, NY 10017 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2017 Hilary McClafferty The right of Hilary McClafferty to be identified as author of this work has been asserted by him/her in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988 All rights reserved No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library ISBN: 978-1-4987-1671-0 (Hardback) ISBN: 978-1-138-19607-0 (Paperback) ISBN: 978-1-4987-1672-7 (Ebook) To Kylie and Liam Contents Foreword by Andrew Weil Foreword by James E Dalen About the Author Acknowledgments ix xi xii xiii PART Integrative Medicine: A New Frontier in Pediatrics 1 Introduction to Pediatric Integrative Medicine Self-Care: Cultivating Healthy Resilience 16 PART Foundations of Health 29 Nutrition 31 Key Dietary Supplements: Omega-3 Fatty Acids, Vitamin D, and Probiotics 50 Physical Activity 63 Mind–Body Therapies 76 Sleep 104 Environmental Health 122 PART Complementary Approaches Botanicals and Dietary Supplements 151 153 10 Manual Medicine 172 11 Aromatherapy 185 viii Contents 12 Whole Medical Systems 192 13 Bioenergetic Therapies 207 PART Clinical Application 215 14 An Integrative Approach to Preventive Health 217 15 Allergy and Asthma 242 16 Dermatology 263 17 Gastroenterology 283 18 Infectious Disease: Upper Respiratory Infections and Otitis Media 318 19 Mental Health: Toxic Stress, Peer Victimization (Bullying), Anxiety, Depression 326 20 Neurodevelopmental Disorders: ADHD and Autism 359 21 Obesity and Metabolic Disease 377 22 Integrative Intake 413 23 Conclusion 421 Index 423 Foreword by Andrew Weil With its focus on preventive health, engagement of the individual’s innate healing capacity, and goals of minimizing invasive procedures and use of prescription medications, integrative medicine is a natural fit for pediatrics Coming from the world of pediatric emergency medicine, Hilary McClafferty would seem an unlikely champion for the field, but, in fact, she has been a most effective one I first met Hilary when she was a Fellow in the University of Arizona Center for Integrative Medicine, Class of 2005 She raised her hand during one of my lectures to ask about the use of integrative medicine in children I replied, “Pediatric integrative medicine is the way of the future,” knowing very well that at the time the field was in its infancy and needed the efforts of committed pediatrician advocates to advance it She took this encouragement to heart and since completing the Fellowship has become involved in local, national, and international initiatives to introduce research and clinical and educational programs on integrative pediatrics into mainstream medicine One of the most innovative she leads is the Pediatric Integrative Medicine in Residency (PIMR) program at the University of Arizona Center for Integrative Medicine, which has just completed a three-year pilot run involving more than 500 pediatric residents at leading academic institutions These residents received foundational training in integrative pediatrics embedded in their conventional medical training The first initiative of its kind in pediatrics, PIMR has grown to include other first-rate pediatric residencies around the country and was recently launched at three children’s hospitals in Germany Hilary has also been a highly effective leader within the American Academy of Pediatrics, where she is immediate past chair of the Section on Integrative Medicine, a group with the ambitious mission of raising awareness about the field throughout the 66,000-member Academy In this role, she also created an integrative medicine model for physician self-care and wellbeing and led development of the first policy statement on physician wellness for the Academy She expects this work to catalyze an array of educational initiatives that will continue to grow in scale and impact Hilary is currently leading the update of the Academy’s Clinical Report on Pediatric Integrative Medicine, an in-depth review of the literature in the field that serves as a guidepost for the Academy and its diverse membership As a leader of the Fellowship in Integrative Medicine at the University of Arizona and as a founding member of the American Board of Integrative Medicine, Hilary is known and admired for her creativity and collaborative spirit and her commitment to mentoring upcoming faculty and students What most people may not know about her is that her passion for integrative pediatrics stems in part from deeply personal experiences in the healthcare system, where as a mother who is also a physician she has lived firsthand 202 Integrative Pediatrics: Art, Science, and Clinical Application conclusive recommendations impossible Challenges in TCM research mirror obstacles faced in other whole medical systems, including the difficulty of studying complex whole person approaches to treatment, lack of full scientific understanding of treatments, uneven quality of studies, and lack of standardization of herbs, and lack of adequate controls Despite recognized challenges, use of TCM is widely prevalent in pediatrics; for example, a survey study of 97,401 Taiwanese school children with allergic rhinitis showed that 63.11% had used TCM for symptom treatment, which is fully reimbursed by National Health Insurance in Taiwan (Yen et al 2015) A second large population-based survey of TCM use in 45,833 Taiwanese children newly diagnosed with asthma showed that 58% had used TCM The most common therapy used was an herbal remedy known as Ding-chuan-tang (Huang et al 2013) Some recent studies in children show promise For example, a 12-week randomized trial of the Chinese herbal formula Pei Tu Qing Xin Tang (PTQXT) given orally for 12 weeks in the treatment group of 275 patients aged 5–25 years with moderate to severe atopic dermatitis was associated with significant improvement in standardized disease severity score and in quality of life at 36 months (p < 0.001) (Liu et al 2015) Research is active in the use of acupuncture in pediatrics as evidenced by a systematic review by Yang et al of 142 randomized controlled trials involving 12,787 children Encouraging findings were seen in treatment of nocturnal enuresis, pain, tic disorders, and cerebral palsy, although authors note that larger high-quality studies are needed before definitive recommendations can be given Adverse events were rare and nonserious in sessions with trained practitioners (Yang et al 2015) A 2011 Cochrane Database Systematic Review of 10 randomized and non-randomized controlled trials involving 390 children with autism did not support the use of acupuncture for treatment of autism spectrum disorder (Cheuk, Wong, and Chen 2011) Cautions and Possible Side Effects Most TCM medicines are sold in the form of dietary supplements distributed worldwide These are considered dietary supplements in the U.S., and subsequently subject to less stringent regulations than over-the-counter medications Reports of contamination with heavy metals and other toxins or drugs have caused significant concerns For example, in 2004 the FDA banned sales of ephedra (ma haung) due to reports of serious cardiovascular and neurological complications (Haller and Benowitz 2000; Bent et al 2003) Chinese herbs may also react with other allopathic medications In experienced hands acupuncture is considered low risk if the needles used are sterile Qi gong and tai chi are considered practical and safe techniques with few associated side effects Reports of allergies, infections, burns, and other more serious outcomes such as pneumothorax exist, but are rare (National Center for Complementary and Integrative Health [b]) Training and Licensing in U.S and Internationally In many states individuals who not have an MD or DO degree must be certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) in order to practice acupuncture This requires a minimum of years of full-time education before eligibility for national certification State-to-state variations Whole Medical Systems 203 exist regarding scope of practice for physicians incorporating acupuncture in their medical practice The American Academy of Medical Acupuncture (AAMA) was founded in 1987 and is a professional society for physicians (MD and DO) in North America who integrate acupuncture into their medical practices (American Academy of Medical Acupuncture) Requirements for other healthcare professionals vary widely and may include as few as 100 hours of acupuncture training A clearinghouse for by-state laws on the requirements can be found at acupuncture.com, although individuals should check for updates (Acupuncture.Com) References Acupuncture.Com “State Laws.” American Academy of Medical Acupuncture http://www.medicalacupuncture.orgAm Association of Accredited Naturopathic Medical Colleges https://aanmc.org/ Barnes, P M., B Bloom, and R L Nahin 2008 “Complementary and alternative medicine use among adults and children: United States, 2007.” Natl Health Stat Report 12: 1–23 Bell, I R., and N N Boyer 2013 “Homeopathic medications as clinical alternatives for symptomatic care of acute otitis media and upper respiratory infections in children.” Glob Adv Health Med 2(1): 32–43 doi: 10.7453/gahmj.2013.2.1.007 Bell, I R., G E Schwartz, N N Boyer, M Koithan, and A J Brooks 2013 “Advances in integrative nanomedicine for improving infectious disease treatment in public health.” Eur J Integr Med 5(2): 126–40 doi: 10.1016/j.eujim.2012.11.002 Bellavite, P., M Marzotto, D Olioso, E Moratti, and A Conforti 2014 “High-dilution effects revisited Physicochemical aspects.” Homeopathy 103(1): 4–21 doi: 10.1016/j homp.2013.08.003 Bent, S., T N Tiedt, M C Odden, and M G Shlipak 2003 “The relative safety of ephedra compared with other herbal products.” Ann Intern Med 138(6): 468–71 Black, L I., T C Clarke, P M Barnes, B J Stussman, and R L Nahin 2015 “Use of complementary health approaches among children aged 4–17 years in the United States: National Health Interview Survey, 2007–2012.” Natl Health Stat Report 78: 1–19 Braun, L A., O Spitzer, E Tiralongo, J M Wilkinson, M Bailey, S G Poole, and M Dooley 2013 “Naturopaths and Western herbalists’ attitudes to evidence, regulation, information sources and knowledge about popular complementary medicines.” Complement Ther Med 21(1): 58–64 doi: 10.1016/j.ctim.2012.11.008 Bukutu, C., J Deol, and S Vohra 2008 “Complementary, holistic, and integrative medicine: therapies for acute otitis media.” Pediatr Rev 29(6): 193–9 doi: 10.1542/pir.29-6-193 Catala-Lopez, F., B Hutton, A Nunez-Beltran, A D Mayhew, M J Page, M Ridao, A Tobias, M A Catala, R Tabares-Seisdedos, and D Moher 2015 “The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: protocol for a systematic review and network meta-analysis of randomized controlled trials.” Syst Rev 4: 19 doi: 10.1186/s13643-015-0005-7 Cheuk, D K., V Wong, and W X Chen 2011 “Acupuncture for autism spectrum disorders (ASD).” Cochrane Database Syst Rev 9: CD007849 doi: 10.1002/14651858.CD007849 pub2 Colas, A., K Danno, C Tabar, J Ehreth, and G Duru 2015 “Economic impact of homeopathic practice in general medicine in France.” Health Econ Rev 5(1): 55 doi: 10.1186/ s13561-015-0055-5 Cottingham, P., J Adams, R Vempati, J Dunn, and D Sibbritt 2015 “The characteristics, experiences and perceptions of naturopathic and herbal medicine practitioners: results from 204 Integrative Pediatrics: Art, Science, and Clinical Application a national survey in New Zealand.” BMC Complement Altern Med 15: 114 doi: 10.1186/ s12906-015-0616-5 Coulter, M K., and M E Dean 2007 “Homeopathy for attention deficit/hyperactivity disorder or hyperkinetic disorder.” Cochrane Database Syst Rev 4: CD005648 doi: 10.1002/14651858 CD005648.pub2 Danno, K., A Colas, J L Masson, and M F Bordet 2013 “Homeopathic treatment of migraine in children: results of a prospective, multicenter, observational study.” J Altern Complement Med 19(2): 119–23 doi: 10.1089/acm.2011.0821 Dave, U P., S R Dingankar, V S Saxena, J A Joseph, B Bethapudi, A Agarwal, and V Kudiganti 2014 “An open-label study to elucidate the effects of standardized Bacopa monnieri extract in the management of symptoms of attention-deficit hyperactivity disorder in children.” Adv Mind Body Med 28(2): 10–15 Downey, L., P T Tyree, C E Huebner, and W E Lafferty 2010 “Pediatric vaccination and vaccine-preventable disease acquisition: associations with care by complementary and alternative medicine providers.” Matern Child Health J 14(6): 922–30 doi: 10.1007/ s10995-009-0519-5 Edwards, E., D Mischoulon, M Rapaport, B Stussman, and W Weber 2013 “Building an evidence base in complementary and integrative healthcare for child and adolescent psychiatry.” Child Adolesc Psychiatr Clin N Am 22(3): 509–29, vii doi: 10.1016/j.chc.2013.03.007 Frei, H., R Everts, K von Ammon, F Kaufmann, D Walther, S F Schmitz, M Collenberg, M Steinlin, C Lim, and A Thurneysen 2007 “Randomised controlled trials of homeopathy in hyperactive children: treatment procedure leads to an unconventional study design Experience with open-label homeopathic treatment preceding the Swiss ADHD placebo controlled, randomised, double-blind, cross-over trial.” Homeopathy 96(1): 35–41 doi: 10.1016/j homp.2006.11.004 Frei, H., and A Thurneysen 2001 “Homeopathy in acute otitis media in children: treatment effect or spontaneous resolution?” Br Homeopath J 90(4): 180–2 Gadgil, V D 2010 “Understanding ayurveda.” J Ayurveda Integr Med 1(1): 77–80 doi: 10.4103/0975-9476.59836 Haidvogl, M., D S Riley, M Heger, S Brien, M Jong, M Fischer, G T Lewith, G Jansen, and A E Thurneysen 2007 “Homeopathic and conventional treatment for acute respiratory and ear complaints: a comparative study on outcome in the primary care setting.” BMC Complement Altern Med 7: doi: 10.1186/1472-6882-7-7 Haller, C A., and N L Benowitz 2000 “Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids.” N Engl J Med 343(25): 1833–8 doi: 10.1056/NEJM200012213432502 Huang, T P., P H Liu, A S Lien, S L Yang, H H Chang, and H R Yen 2013 “Characteristics of traditional Chinese medicine use in children with asthma: a nationwide population-based study.” Allergy 68(12): 1610–13 doi: 10.1111/all.12273 Jacobs, J., D A Springer, and D Crothers 2001 “Homeopathic treatment of acute otitis media in children: a preliminary randomized placebo-controlled trial.” Pediatr Infect Dis J 20(2): 177–83 Kassab, S., M Cummings, S Berkovitz, R van Haselen, and P Fisher 2009 “Homeopathic medicines for adverse effects of cancer treatments.” Cochrane Database Syst Rev 2: CD004845 doi: 10.1002/14651858.CD004845.pub2 Kean, J D., J Kaufman, J Lomas, A Goh, D White, D Simpson, A Scholey, H Singh, J Sarris, A Zangara, and C Stough 2015 “A randomized controlled trial investigating the effects of a special extract of Bacopa monnieri (CDRI 08) on hyperactivity and inattention in male children and adolescents: BACHI Study Protocol (ANZCTRN12612000827831).” Nutrients 7(12): 9931–45 doi: 10.3390/nu7125507 Klein, S D., L Torchetti, M Frei-Erb, and U Wolf 2015 “Usage of complementary medicine Whole Medical Systems 205 in Switzerland: results of the Swiss Health Survey 2012 and development since 2007.” PLoS One 10(10): e0141985 doi: 10.1371/journal.pone.0141985 Kuehn, B M 2009 “Despite health claims by manufacturers, little oversight for homeopathic products.” JAMA 302(15): 1631–2, 1634 doi: 10.1001/jama.2009.1476 Lee, A C., and K J Kemper 2000 “Homeopathy and naturopathy: practice characteristics and pediatric care.” Arch Pediatr Adolesc Med 154(1): 75–80 Liu, J., X Mo, D Wu, A Ou, S Xue, C Liu, H Li, Z Wen, and D Chen 2015 “Efficacy of a Chinese herbal medicine for the treatment of atopic dermatitis: a randomised controlled study.” Complement Ther Med 23(5): 644–51 doi: 10.1016/j.ctim.2015.07.006 Merrell, W C., and E Shalts 2002 “Homeopathy.” Med Clin North Am 86(1): 47–62 Mukherjee, P K., N K Nema, P Venkatesh, and P K Debnath 2012 “Changing scenario for promotion and development of Ayurveda—way forward.” J Ethnopharmacol 143(2): 424–34 doi: 10.1016/j.jep.2012.07.036 National Ayurvedic Medical Association http://www.ayurvedanama.org/ National Center for Complementary and Integrative Health [a] “Naturopathy.” https://nccih nih.gov/health/naturopathy National Center for Complementary and Integrative Health [b] “Traditional Chinese Medicine.” https://nccih.nih.gov/health/whatiscam/chinesemed.htm Nestler, G 2002 “Traditional Chinese medicine.” Med Clin North Am 86(1): 63–73 Oberbaum, M., I Yaniv, Y Ben-Gal, J Stein, N Ben-Zvi, L S Freedman, and D Branski 2001 “A randomized, controlled clinical trial of the homeopathic medication TRAUMEEL S in the treatment of chemotherapy-induced stomatitis in children undergoing stem cell transplantation.” Cancer 92(3): 684–90 Patwardhan, B., D Warude, P Pushpangadan, and N Bhatt 2005 “Ayurveda and traditional Chinese medicine: a comparative overview.” Evid Based Complement Alternat Med 2(4): 465–73 doi: 10.1093/ecam/neh140 Ramchandani, N M 2010 “Homoeopathic treatment of upper respiratory tract infections in children: evaluation of thirty case series.” Complement Ther Clin Pract 16(2): 101–8 doi: 10.1016/j.ctcp.2009.09.008 Romeyke, T., and H Stummer 2015 “Evidence-based complementary and alternative medicine in inpatient care: take a look at Europe.” J Evid Based Complementary Altern Med 20(2): 87–93 doi: 10.1177/2156587214555714 Rossi, E., P Bartoli, A Bianchi, and M Da Fre 2012 “Homeopathy in paediatric atopic diseases: long-term results in children with atopic dermatitis.” Homeopathy 101(1): 13–20 doi: 10.1016/j.homp.2011.09.003 Saper, R B., R S Phillips, A Sehgal, N Khouri, R B Davis, J Paquin, V Thuppil, and S N Kales 2008 “Lead, mercury, and arsenic in US- and Indian-manufactured Ayurvedic medicines sold via the Internet.” JAMA 300(8): 915–23 doi: 10.1001/jama.300.8.915 Sarrell, E M., H A Cohen, and E Kahan 2003 “Naturopathic treatment for ear pain in children.” Pediatrics 111(5 Pt 1): e574–9 Schmidt, J M 2010 “200 years Organon of Medicine: a comparative review of its six editions (1810–1842).” Homeopathy 99(4): 271–7 doi: 10.1016/j.homp.2010.08.004 Sencer, S F., T Zhou, L S Freedman, J A Ives, Z Chen, D Wall, M L Nieder, S A Grupp, L C Yu, I Sahdev, W B Jonas, J D Wallace, and M Oberbaum 2012 “Traumeel S in preventing and treating mucositis in young patients undergoing SCT: a report of the Children’s Oncology Group.” Bone Marrow Transplant 47(11): 1409–14 doi: 10.1038/bmt.2012.30 Shafei, H F., S M AbdelDayem, and N H Mohamed 2012 “Individualized homeopathy in a group of Egyptian asthmatic children.” Homeopathy 101(4): 224–30 doi: 10.1016/j homp.2012.08.006 Sinha, M N., V A Siddiqui, C Nayak, V Singh, R Dixit, D Dewan, and A Mishra 2012 “Randomized controlled pilot study to compare homeopathy and conventional therapy in acute otitis media.” Homeopathy 101(1): 5–12 doi: 10.1016/j.homp.2011.08.003 206 Integrative Pediatrics: Art, Science, and Clinical Application Spigelblatt, L 2005 “Homeopathy in the paediatric population.” Paediatr Child Health 10(3): 173–7 Tang, J L., B Y Liu, and K W Ma 2008 “Traditional Chinese medicine.” Lancet 372(9654): 1938–40 doi: 10.1016/S0140-6736(08)61354-9 Taylor, J A., and J Jacobs 2011 “Homeopathic ear drops as an adjunct to standard therapy in children with acute otitis media.” Homeopathy 100(3): 109–15 doi: 10.1016/j homp.2011.03.002 Trichard, M., G Chaufferin, and N Nicoloyannis 2005 “Pharmacoeconomic comparison between homeopathic and antibiotic treatment strategies in recurrent acute rhinopharyngitis in children.” Homeopathy 94(1): 3–9 Waisse, S 2012 “The science of high dilutions in historical context.” Homeopathy 101(2): 129–37 doi: 10.1016/j.homp.2012.01.001 Witt, C M., R Ludtke, and S N Willich 2010 “Homeopathic treatment of patients with migraine: a prospective observational study with a 2- year follow-up period.” J Altern Complement Med 16(4): 347–55 doi: 10.1089/acm.2009.0376 Yang, C., Z Hao, L L Zhang, and Q Guo 2015 “Efficacy and safety of acupuncture in children: an overview of systematic reviews.” Pediatr Res 78(2): 112–19 doi: 10.1038/pr.2015.91 Yen, H R., K L Liang, T P Huang, J Y Fan, T T Chang, and M F Sun 2015 “Characteristics of traditional Chinese medicine use for children with allergic rhinitis: a nationwide populationbased study.” Int J Pediatr Otorhinolaryngol 79(4): 591–7 doi: 10.1016/j.ijporl.2015.02.002 13 Bioenergetic Therapies Bioenergetic therapies have come to attention in modern medicine as non-invasive therapies that are low cost, technology free, and useful in offering comfort and reducing pain and anxiety in patients with a wide variety of conditions Some of the oldest types of bioenergetic therapies are shamanism and spiritual healing, which reach dimensions far beyond the boundaries of the typical biopsychosocial healthcare model, causing many to view them with skepticism The underlying premise in the bioenergetic therapies is that a healthy individual is considered to have an energy field that supports balanced and unobstructed flow, whereas a patient with an imbalanced or obstructed energy field may present with physical or emotional symptoms The common goal of the bioenergetic therapies is opening of the mind, body, and spirit to encourage the potential for deep healing to occur (Engebretson and Wardell 2012) Newer iterations of the bioenergetic therapies include reiki, which originated in Japan, and therapeutic touch and healing touch, both originating from the nursing domain Other bioenergetic therapies include acupuncture, qi gong, tai chi, and homeopathy, all thought to work by harnessing the energetic power of the body The mechanisms of actions of the bioenergetic therapies as a group have not been fully elucidated, which has naturally slowed their acceptance into mainstream medicine The bioenergetic therapies may be unfamiliar to some practitioners but are frequently used by patients An estimated 23,300 adults reported use of some type of bioenergetic therapy in the 2007 NHIS survey (Barnes, Bloom, and Nahin 2008) More recently, therapeutic touch and healing touch have been growing in popularity with hospital programs in the U.S in both acute and non-acute settings as a non-pharmaceutical approach to complement conventional care, thereby serving as an important conduit for introduction to a broader medical audience (Rindfleisch 2010; Dufresne et al 2015) One of the main cautions noted by the National Center for Complementary and Integrative Health Care is that bioenergetic therapies are not recommended as a substitute for conventional care, and individuals should not postpone seeing a healthcare provider about a health condition, especially one that is chronic or severe Background It is widely recognized that the body has sophisticated electrical pathways, commonly measured by electrocardiogram, electroencephalogram, and electromyography, but discussion of bioenergetic therapies pushes into territory where identification of subtle energies that may surround and move through the body have not been definitely 208 Integrative Pediatrics: Art, Science, and Clinical Application measured or recorded Theories based in quantum physics and wave theory exist, although to date no consensus has been reached and measurement tools for the bioenergetics therapies remain areas of active study Despite these challenges, some positive clinical results have been reported One example shows measurable effects of non-local healing energy In an experiment by Achterberg et al., 22 recipients placed in fMRI scanners distant from experienced energy healers showed measurable changes in brain activity when the healers sent non-local energy healing Correlation of brain changes with a randomized “on-off” sequence by the healers was found to be highly significant (p < 0.000127) (Achterberg et al 2005) Acupuncture point stimulation has also been associated with measurable change in brain function based on fMRI imaging (Chae et al 2013) Some large reviews of healing therapies have shown modest positive effects in adults; for example, a 2008 Cochrane review of touch therapies for pain included 24 studies involving 1153 adult patients who experienced therapeutic touch, healing touch, or reiki and concluded that touch therapies “may have a modest effect on pain relief.” No significant placebo effect was seen in this systematic review (So, Jiang, and Qin 2008) A second large review of 66 studies on biofield therapies including therapeutic touch, healing touch, or reiki in adults found supporting evidence for the reduction of pain in certain patient populations, reduction of anxiety in hospitalized patients, and reduction of agitated behavior in dementia patients in the study population (Jain and Mills 2010) Studies on the use of biofield therapies in children remain sparse, although interest and demand for them have been shown to increase in families where children have a new cancer diagnosis (McLean and Kemper 2006) Research on these therapies remains active and guidelines have been established for ongoing research (Jonas and Chez 2004; Feinstein and Eden 2008) Therapeutic Touch Summary and Overview Therapeutic touch is a technique that has become more widely recognized in the last 25 years It has been used to promote physical healing, management of pain, and for reduction of anxiety, depression, and other stressors By definition therapeutic touch involves the assimilation of energies, which are transferred by means of the healer’s hands, purportedly establishing a kind of association between the healer and patient (Mulloney and Wells-Federman 1996) Brief History Therapeutic touch (often abbreviated as TT) in its current form originated in the 1970s from a collaboration between Dr Dolores Krieger, Ph.D., R.N., Professor Emeritus at New York University, and associate Dora Kunz, an intuitive healer who together established a healing procedure directed towards those with difficult to treat medical problems The technique is based on the theory that humans are comprised of complex and multidimensional energy systems that are in constant flux with others and their surroundings This complex interactivity creates potential for one to modulate the energy field of another as seen in the study of the universal life force found in many Eastern cultures and religions (Mulloney and Wells-Federman 1996) Bioenergetic Therapies 209 Types of Assessments Offered Therapeutic touch helps the individual to attain a sense of natural healing and calmness The basic approach includes the therapist centering their awareness while generating a compassionate intention to promote the patient’s innate potential for self-healing Physical contact is not required The therapist is trained to perceive the human energy field by sense of touch, and uses hands approximately 2–6 inches above the body to modulate the flow of energy around the patient There are five phases of therapeutic touch, taught as: centering, assessment, clearing or unruffling, treatment, and evaluation One of the goals of the procedure is to facilitate the relaxation response in the patient, which in turn facilitates the healing response Therapists may perceive sensations such as warmth, coolness, static, and tingling (Mulloney and Wells-Federman 1996) Therapeutic touch has been evaluated in adults for a variety of conditions including: pain, wound healing, disability associated with arthritis, tension headache, burn-related pain and anxiety, and post-operative pain, although studies have been hampered by variable quality of design and small sample size (Fazzino et al 2010) Evidence in Pediatrics Pediatric studies are relatively sparse An early randomized pilot study in 20 HIVpositive children aged 6–12 years demonstrated the effectiveness of therapeutic touch in reduction of anxiety as compared to controls (Ireland 1998) A review by Ireland and Olson of 14 massage studies and five therapeutic touch studies in a broad range of children showed that both modalities reliably triggered the relaxation response However, the massage studies overall had better quality of design and more consistent positive results Insufficient evidence was found to recommend therapeutic touch without further study in this review No adverse events were reported (Ireland and Olson 2000) A randomized trial of 78 premature infants evaluated weight, length of hospital stay, medical complications, and parental satisfaction with care in infants receiving therapeutic touch Results showed a significant reduction in length of stay and rate of medical complication in the treatment group (Dominguez Rosales et al 2009) Another small study of 40 infants hospitalized in the NICU showed reduction of perceived pain after procedure in infants receiving therapeutic touch as measured by statistically significant reductions in heart rate, respiratory rate, and pain score (Ramada, Almeida Fde, and Cunha 2013) A study of 10 hospitalized premature infants demonstrated that therapeutic touch was effective in reducing neural activation in response to stimulation mimicking a heel stick as measured by non-invasive near-infrared spectroscopy measuring cerebral oxygenation in sleeping infants undergoing a controlled sensory stimulus Therapeutic touch was delivered by a trained nurse holding the baby in both hands from minute before stimulus to 30 seconds after stimulus Although study size was small, these findings add to the growing number of studies searching for non-pharmacologic approaches to pain management in vulnerable infants (Honda et al 2013) Cautions and Possible Side Effects In general, therapeutic touch is considered a safe, gentle treatment No reports exist of 210 Integrative Pediatrics: Art, Science, and Clinical Application serious adverse events in generally healthy individuals Reports of fatigue, lightheadedness, or emotional release during therapy exist Appropriate caution or avoidance should be considered in any patient with psychosis or other serious mental illness, or in those with a history of physical, sexual, or emotional abuse Bioenergetic therapies should not replace conventional workup if diagnosis is uncertain or in cases where acute care is indicated It is generally recommended that children, elderly people, or those in poor health should be treated for a very short span of time Training and Licensing in the U.S and Internationally Credentialing is available through the Therapeutic Touch International Association (http://therapeutic-touch.org) No specific background requirements or licensing exist Training to become a qualified therapeutic touch practitioner typically consists of a minimum of 12 hours of basic training and 14 hours of intermediate training taught by a qualified practitioner A 1-year mentorship is also required which includes documentation of case studies and practice sessions Healing Touch Summary and Overview Healing touch is another bioenergetic therapy that comes out of the nursing domain, with roots in ancient shamanic and aboriginal healing traditions The technique may involve both physical touch and noncontact touch above the body It purportedly initiates a flow of energy, establishing a connection between therapist and patient with the goal of facilitating a sense of peace and healing in the recipient Similar to therapeutic touch, the premise is to restore and balance the energy of the patient’s body and spirit Brief History and Types of Assessments Offered The Healing Touch program was founded by Janet Mentgen, R.N., BSN in 1980, with sponsorship of the American Holistic Nurses Association (AHNA) It is based in part on the work done in therapeutic touch and incorporates ancient healing practices from cultures around the world The practice involves the therapist setting an intention for the highest good of the patient and placement of hands in a certain pattern on or just above the patient’s body The originally developed standardized curriculum is taught through the Healing Touch Program (HTP) (http://www.healingtouchprogram.com) still offered through the Mentgen family Classes progress from beginning to advanced practice The initial step in the process involves the preparation of the healer to summon their own energies to provide assistance in healing The treatment process begins with a scan of the patient’s energy field by placement of the therapist’s hand over the body of the client, concentrating on the affected areas The healer then decides which healing touch techniques should be used It is used in outpatient, inpatient, and office settings and has also been used in the operating suite and for pre- and post-operative care It has been introduced into several academic medical centers in the U.S Healing touch has been evaluated in adults for a variety of conditions including: chronic pain, fibromyalgia, anxiety, post-operative pain, and nausea with mixed positive effects reported Serious adverse events have not been reported (Anderson and Taylor 2011) Bioenergetic Therapies 211 Evidence in Pediatrics A small pilot study by Kemper et al evaluated the use of healing touch in pediatric oncology patients and found a statistically significant reduction in stress and decrease in sympathetic activation as measured by heart rate variability (Kemper et al 2009) Healing touch has also been used successfully in preterm infants in the NICU in reducing perceived pain as measured by heart rate, oxygenation saturation, and observed pain in a retrospective study of 186 hospitalized neonates when used alone or in conjunction with massage (Hathaway et al 2015) Cautions and Possible Side Effects Healing touch is generally considered a gentle and safe therapy No serious adverse events have been reported Like the other bioenergetics therapies, it does not replace conventional care, and people suffering from an ongoing disease should consult with their doctors before treatment The standard cautions regarding treatment of those with any prior history of trauma (physical, sexual, emotional) or mental illness apply Training and Licensing in the U.S and Internationally A standardized curriculum covering five levels is available through the Healing Touch Program (http://www.healingtouchprogram.com) Levels 1, 2, and consist of a minimum of 16 hours of course work Levels and require 30 hours per level Students who complete each level become eligible for certification A 1-year mentorship is an integral part of the program There are no restrictions as to who may take the training The Healing Touch certification program is currently offered in over 30 countries Reiki Summary and Overview Reiki is a Japanese term equated with universal life energy, “rei” (universal energy), and “ki” (life energy of all living creatures), introduced as a healing therapy by Dr Mikao Usui in Japan in the 1840s It is used to purportedly channel the universal life force to the recipient with the intent for strength, balance, and physical and mental healing Technically, reiki can be performed with or without direct touch similar to therapeutic and healing touch therapies Reiki has been studied in adults in a variety of conditions including: musculoskeletal pain, wound healing, stress, post-operative pain, and anxiety Results are mixed and again limited by study design and small sample sizes as those in the other bioenergetic therapies (Hammerschlag, Marx, and Aickin 2014) One randomized controlled study done in 49 hospitalized cardiac patients at YaleNew Haven Hospital showed that those receiving reiki treatment by trained nurses had a more beneficial effect on heart rate variability and emotional state than those experiencing music therapy or quiet resting as a control (Friedman et al 2010) Reiki is also being explored as a therapy with potential to benefit caregivers (Kundu et al 2013), and as a supportive therapy for healthcare professionals (Tarantino et al 2013; Rosada et al 2015) 212 Integrative Pediatrics: Art, Science, and Clinical Application Brief History and Assessments The practitioner begins the treatment with either a hands-on or hands-off technique and sessions vary in length Training can be undertaken by anyone, and no prior training is required Reiki training consists of two levels and is received in sessions called attunements provided by a reiki master Training is variable and there is no national certifying body Additional training is needed to progress to the level of reiki master Evidence in Pediatrics Evidence to support the efficacy of reiki in pediatrics remains sparse In one study, an in-hospital reiki training program offered to 18 families of children admitted to either medical or oncology services was found by 65% of families to enhance relaxation and improve comfort in their hospitalized child Pain relief was experienced by 41% of participating children Additional benefits were the family’s sense of active participation in the child’s care (Kundu et al 2013) Cautions and Possible Side Effects Due caution is indicated with any patient with history of mental illness, or history of physical, sexual, or emotional abuse Vulnerable patients such as those undergoing treatment for cancer or other serious illness or the very young or old are recommended to receive short treatments in proportion to their tolerance Training and Licensing in the U.S and Internationally Courses of different varieties are offered around the world to obtain professional qualifications and training to become a reiki practitioner No national or international standardized certification process exists (Cohen 2004) When discussing bioenergetic therapies with a patient it is important to keep an open mind so as to invite a full discussion of all therapies in use Familiarity with the basic bioenergetic therapies can help the practitioner be ready to address questions or provide resources to patients and families It is important to fully understand the background and training of any complementary practitioner and their experience treating children of various ages This holds especially true with the bioenergetic therapies where training is less standardized and no licensing or minimum standards for education exist Rindfleisch, MD, MPhil provides an excellent overview of an expanded range of bioenergetic therapies applied in primary care in a 2010 article in the journal Primary Care (Rindfleisch 2010) In general, the bioenergetic therapies can be viewed as gentle, non-invasive therapies that can offer comfort to patients and their caregivers with a wide range of medical issues They should be provided by a trained individual and are not intended to take the place of conventional care as needed Family members have also been taught how to administer these therapies to their own children to good effect, which has resulted in a feeling of greater connection and involvement in the child’s treatment Bioenergetic Therapies 213 References Achterberg, J., K Cooke, T Richards, L J Standish, L Kozak, and J Lake 2005 “Evidence for correlations between distant intentionality and brain function in recipients: a functional magnetic resonance imaging analysis.” J Altern Complement Med 11(6): 965–71 doi: 10.1089/ acm.2005.11.965 Anderson, J G., and A G Taylor 2011 “Effects of healing touch in clinical practice: a systematic review of randomized clinical trials.” J Holist Nurs 29(3): 221–8 doi: 10.1177/0898010110393353 Barnes, P M., B Bloom, and R L Nahin 2008 “Complementary and alternative medicine use among adults and children: United States, 2007.” Natl Health Stat Report 12: 1–23 Chae, Y., D S Chang, S H Lee, W M Jung, I S Lee, S Jackson, J Kong, H Lee, H J Park, H Lee, and C Wallraven 2013 “Inserting needles into the body: a meta-analysis of brain activity associated with acupuncture needle stimulation.” J Pain 14(3): 215–22 doi: 10.1016/j jpain.2012.11.011 Cohen, M H 2004 “Legal and ethical issues in complementary medicine: a United States perspective.” Med J Aust 181(3): 168–9 Dominguez Rosales, R., M J Albar Marin, B Tena Garcia, M T Ruiz Perez, M J Garzon Real, M A Rosado Poveda, and E Gonzalez Caro 2009 “[Effectiveness of the application of therapeutic touch on weight, complications, and length of hospital stay in preterm newborns attended in a neonatal unit].” Enferm Clin 19(1): 11–5 doi: 10.1016/j.enfcli.2008.07.001 Dufresne, F., B Simmons, P J Vlachostergios, Z Fleischner, R Joudeh, J Blakeway, and K Julliard 2015 “Feasibility of energy medicine in a community teaching hospital: an exploratory case series.” J Altern Complement Med 21(6): 339–49 doi: 10.1089/acm.2014.0157 Engebretson, J., and D W Wardell 2012 “Energy therapies: focus on spirituality.” Explore (NY) 8(6): 353–9 doi: 10.1016/j.explore.2012.08.004 Fazzino, D L., M T Griffin, R S McNulty, and J J Fitzpatrick 2010 “Energy healing and pain: a review of the literature.” Holist Nurs Pract 24(2): 79–88 doi: 10.1097/ HNP.0b013e3181d39718 Feinstein, D., and D Eden 2008 “Six pillars of energy medicine: clinical strengths of a complementary paradigm.” Altern Ther Health Med 14(1): 44–54 Friedman, R S., M M Burg, P Miles, F Lee, and R Lampert 2010 “Effects of reiki on autonomic activity early after acute coronary syndrome.” J Am Coll Cardiol 56(12): 995–6 doi: 10.1016/j.jacc.2010.03.082 Hammerschlag, R., B L Marx, and M Aickin 2014 “Nontouch biofield therapy: a systematic review of human randomized controlled trials reporting use of only nonphysical contact treatment.” J Altern Complement Med 20(12): 881–92 doi: 10.1089/acm.2014.0017 Hathaway, E E., C M Luberto, L H Bogenschutz, S Geiss, R S Wasson, and S Cotton 2015 “Integrative care therapies and physiological and pain-related outcomes in hospitalized infants.” Glob Adv Health Med 4(4): 32–7 doi: 10.7453/gahmj.2015.029 Honda, N., S Ohgi, N Wada, K K Loo, Y Higashimoto, and K Fukuda 2013 “Effect of therapeutic touch on brain activation of preterm infants in response to sensory punctate stimulus: a near-infrared spectroscopy-based study.” Arch Dis Child Fetal Neonatal Ed 98(3): F244–8 doi: 10.1136/archdischild-2011-301469 Ireland, M 1998 “Therapeutic touch with HIV-infected children: a pilot study.” J Assoc Nurses AIDS Care 9(4): 68–77 doi: 10.1016/S1055-3290(98)80046-0 Ireland, M., and M Olson 2000 “Massage therapy and therapeutic touch in children: state of the science.” Altern Ther Health Med 6(5): 54–63 Jain, S., and P J Mills 2010 “Biofield therapies: helpful or full of hype? A best evidence synthesis.” Int J Behav Med 17(1): 1–16 doi: 10.1007/s12529-009-9062-4 Jonas, W B., and R A Chez 2004 “Recommendations regarding definitions and standards in healing research.” J Altern Complement Med 10(1): 171–81 doi: 10.1089/107555304322849101 214 Integrative Pediatrics: Art, Science, and Clinical Application Kemper, K J., N B Fletcher, C A Hamilton, and T W McLean 2009 “Impact of healing touch on pediatric oncology outpatients: pilot study.” J Soc Integr Oncol 7(1): 12–8 Kundu, A., R Dolan-Oves, M A Dimmers, C B Towle, and A Z Doorenbos 2013 “Reiki training for caregivers of hospitalized pediatric patients: a pilot program.” Complement Ther Clin Pract 19(1): 50–4 doi: 10.1016/j.ctcp.2012.08.001 McLean, T W., and K J Kemper 2006 “Complementary and alternative medicine therapies in pediatric oncology patients.” J Soc Integr Oncol 4(1): 40–5 Mulloney, S S., and C Wells-Federman 1996 “Therapeutic touch: a healing modality.” J Cardiovasc Nurs 10(3): 27–49 Ramada, N C., A Almeida Fde, and M L Cunha 2013 “Therapeutic touch: influence on vital signs of newborns.” Einstein (Sao Paulo) 11(4): 421–5 Rindfleisch, J A 2010 “Biofield therapies: energy medicine and primary care.” Prim Care 37(1): 165–79 doi: 10.1016/j.pop.2009.09.012 Rosada, R M., B Rubik, B Mainguy, J Plummer, and L Mehl-Madrona 2015 “Reiki reduces burnout among community mental health clinicians.” J Altern Complement Med 21(8): 489– 95 doi: 10.1089/acm.2014.0403 So, P S., Y Jiang, and Y Qin 2008 “Touch therapies for pain relief in adults.” Cochrane Database Syst Rev 4: CD006535 doi: 10.1002/14651858.CD006535.pub2 Tarantino, B., M Earley, D Audia, C D’Adamo, and B Berman 2013 “Qualitative and quantitative evaluation of a pilot integrative coping and resiliency program for healthcare professionals.” Explore (NY) 9(1): 44–7 doi: 10.1016/j.explore.2012.10.002 Part Clinical Application ... the British Library ISBN: 97 8 -1 -4 98 7 -1 67 1- 0 (Hardback) ISBN: 97 8 -1 -1 3 8 -1 960 7-0 (Paperback) ISBN: 97 8 -1 -4 98 7 -1 67 2-7 (Ebook) To Kylie and Liam Contents Foreword by Andrew Weil Foreword by James... Botanicals and Dietary Supplements 15 1 15 3 10 Manual Medicine 17 2 11 Aromatherapy 18 5 viii Contents 12 Whole Medical Systems 19 2 13 Bioenergetic Therapies 207 PART Clinical Application 215 14 An Integrative. .. http://iom.nationalacademies.org/Reports/2 012 /Best-Care-atLower-Cost- The- Path- to- Continuously- Learning- Health- Care- in- America.aspx?utm_ source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+IomTopicHealthServices CoverageAndAccess+(IOM+Topic%3A+Health+Services+Coverage +and+ Access)