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Adverse events associated with pediatric complementary and alternative medicine in the Netherlands: a national
Björn Vos1, Jan Peter Rake2,3,4, Arine Vlieger5
1Martini Hospital, Groningen, Netherlands. vos@mzh.nl.
Insights
Adverse events from pediatric complementary and alternative medicine (CAM) are rare in the Netherlands. Most risks stem from delaying conventional treatment rather than direct CAM toxicity, especially in infants.
Area of Science:
- Pediatric Medicine
- Complementary and Alternative Medicine (CAM)
- Public Health Surveillance
Background:
- Pediatric use of complementary and alternative medicine (CAM) is prevalent in the Netherlands.
- The potential risks associated with pediatric CAM use remain largely uncharacterized.
- Previous international studies indicated that severe adverse events can occur with pediatric CAM usage.
Purpose of the Study:
- To investigate the prevalence and nature of adverse events linked to pediatric CAM usage in the Netherlands.
- To identify the direct and indirect risks associated with CAM therapies in children.
- To inform parents, pediatricians, and CAM providers about potential pediatric CAM-related adverse events.
Main Methods:
- A 3-year survey conducted by the Dutch Pediatric Surveillance Unit.
- Pediatricians were tasked with registering adverse events associated with pediatric CAM usage.
- Analysis of registered cases to categorize event types and associated therapies.
Main Results:
- A total of 32 unique adverse events were registered over 3 years.
- Twenty-two events were indirect, resulting from treatment delays, dietary issues, or misdiagnoses by CAM providers.
- Nine direct adverse events (bodily harm, toxicity) were reported, with one-third affecting infants; supplements, manual therapies, and herbs were implicated.
Conclusions:
- Adverse events associated with pediatric CAM use in the Netherlands are relatively infrequent.
- The majority of adverse events are indirect, primarily due to the interruption or delay of conventional medical treatment.
- Vigilance for both direct and indirect adverse events is crucial for all stakeholders, particularly for infants using CAM.
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.
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