Children Can Benefit From Complementary Therapies Like Yoga and Acupuncture, Doctors Say

If your child is sick, making them feel better is your top priority. But sometimes, that’s easier said than done. A growing number of families are adding complementary medical therapies to traditional techniques to achieve better outcomes for their children—particularly for issues such as chronic pain, mental health, anxiety and sleep problems.

Such therapies, which can include acupuncture, meditation, yoga and supplements, have been growing in popularity. According to the most recent “Children and the Use of Complementary Health Approaches” report from the National Center for Complementary and Integrative Health, 11.6 percent of children ages 4-17 questioned in its 2012 National Health Interview Survey had participated in or used a complementary health product or practice in the past year. In a limited 2017 follow-up, the NCCIH (part of the National Institutes of Health) noted the number of kids participating in yoga rose from 3.1 percent to 8.4 percent in five years, and those using meditation rose from 0.6 percent to 5.4 percent.

While the terms alternative, complementary and integrative medicine are often used interchangeably, the NIH does draw distinctions, stating that if a “nonmainstream approach” is used together with conventional medicine, it’s complementary. Used in place of conventional medicine, it’s alternative. Integrative health, meanwhile, brings conventional and complementary techniques together.

What’s driving the interest? “It’s multifactorial,” says Dr. Chris Peltier, president of the Ohio Chapter of the American Academy of Pediatrics. “We are seeing more and more chronic illnesses, both physical and mental health, in kids.”

Peltier, who practices at Pediatric Associates of Mount Carmel Inc. in Cincinnati, is also director of the community section of the Division of General and Community Pediatrics at Cincinnati Children’s Hospital Medical Center. He’s seeing more patients with mental health and anxiety issues who suffer from headaches and chronic abdominal pain, as well as those with chronic pain disorders, including a “large cadre” of females with fibromyalgia. “It’s hard for these kids to get relief,” he says.

Parents want their children to feel better, Peltier says, so they are seeking out any approach that could help. But he also believes the pandemic played a role in how some view allopathic, or conventional, medicine. “Clearly the pandemic has really shifted the way that many people view science and physicians,” he says. “There is some distrust in the medical community.” That has driven some families toward alternative treatment options or providers.

Dr. Nicole Van Steyn, a pediatrician with Step By Step Pediatrics (part of Central Ohio Primary Care), agrees. “As we kind of as a culture start to get more exposed to things, social media can bring things to the forefront,” she says. “There’s just a little bit more questioning and a move towards doing holistic health and gathering from different modalities in medicine, and not necessarily just allopathic medicine but osteopathic medicine, relaxation, massage therapy, that sort of thing. I’ve seen more patients in the last couple of years here for sure doing or trying to implement those things.”

Physicians say regardless of the treatment option under consideration, it’s important to look at all factors. “There are risks and benefits to everything we do in medicine, whether it’s prescribing amoxicillin for an ear infection or talking about CBD oil or having a chiropractor do manipulations on an infant,” Peltier says. “It always comes down to, ‘First, do no harm,’ and always looking at the risk-benefit ratio.”

Van Steyn agrees. Her practice has had families who took infants with torticollis, a shortening of the neck muscle, to a chiropractor for stretching and osteopathic manipulation, “which are very low risk for parents to do,” she says. Also low risk, she says, are modalities for relaxation. “We have a lot of kids who have anxiety disorders at this point who are having difficulty sleeping, relaxing, focusing, and utilizing complementary modalities like deep breathing, meditation, guided relaxation [can help],” Van Steyn says.

Doctors have encountered more pediatric patients with anxiety in recent years. “Pandemic, social media, [it’s] a combination of a lot of things. We’re still sort of, you know, dealing with the fallout of the pandemic and trying to teach kids good coping skills for when they are having anxiety,” Van Steyn says.

Managing Pediatric Pain

Dr. Linda Chun, who works in the Comprehensive Pain Management Clinic at Nationwide Children’s Hospital, sees patients with a variety of ailments, including stress, insomnia, sleep problems, musculoskeletal pain and chronic and acute anxiety. Complementary therapies can be most helpful for chronic conditions, Chun says. “That’s where conventional medicine has limitations a lot of times,” she says.

Chun says mental health disorders or impaired or inadequate coping strategies and sleep problems commonly contribute to chronic pain, which can bring referrals to the clinic. “I like to talk about nutrition and diet with our patients a lot. In the integrative world, there’s a huge focus on food and nutrition, which I think is generally lacking in conventional medicine,” says Chun, also an Ohio State University College of Medicine clinical assistant professor who sees patients at OSU Integrative Health. “Something we like to talk about is nutrition and dietary habits and then ways perhaps changes can be made to help pain and energy.”

Other useful techniques are more psychological. “At the top of the list would be mind-body therapies or pain psychology,” Chun says. Those include relaxation and pain management strategies and skills, such as biofeedback, guided imagery, muscle relaxation and breathing techniques. The clinic also uses acupuncture with aromatherapy, massage therapy, physical therapy, medications, and supplements such as omega-3 fatty acids, magnesium and vitamin D, Chun says.

Help for Sleep Issues

Chun says uncontrolled pain can cause or contribute to sleep problems. “We talk about sleep hygiene—you know, the behaviors surrounding bedtime,” she says. “There’s a lot of education about the importance of restorative sleep.”

In addition to modifying behaviors—including through guided meditation—Chun uses melatonin in her clinic. Peltier says the supplement also is useful for treating patients with ADHD. “I see a lot of kids with ADHD that struggle with sleep,” he says, “and I use a lot of melatonin in my practice.”

As a first step, Peltier recommends investigating a child’s sleep routine, including use of caffeine and screens before bed. “Melatonin helps regulate your sleep-wake cycle,” he says. “Melatonin works to help you fall asleep. It is not going to keep you asleep through the night. So a child that wakes up several times throughout the night, melatonin is not going to fix that.”

Van Steyn says the supplement can be very beneficial for the right type of patient. “It’s actually pretty helpful with that onset insomnia that children with ADHD or autism have,” Van Steyn says. “I don’t recommend it in just your normal teenager who’s having a hard time falling asleep because they’re not tired until 11 o’clock at night.”

Van Steyn and Peltier advise parents to pay careful attention to what they’re buying because there is no consistency among manufacturers. “The problem with melatonin is that it is sold as a supplement, which means there really is no FDA regulation, and there are lots of different preparations of melatonin, and there is no standardization,” Peltier says.

Dearth of Research on Effectiveness in Children

Practitioners acknowledge complementary therapies lack research proving their effectiveness for children. The physicians interviewed for this story all point to a lack of financial incentives as a key reason for this issue.

“There needs to be more research in this area looking at different therapies,” Chun says. “I think the pediatric population just tends to be studied less than in the adult world.” Plus, there’s a perception that complementary techniques won’t bring in much revenue, unlike pharmaceuticals. “It is a challenge. … We just hope with time more studies will come out,” Chun says. 

Before trying any new therapy or product, physicians urge parents to check with their child’s doctor. “I want parents to start the conversations with their doctors about what they want. They should push their docs to help them find new ways to help their kids be healthier in the world of nutrition, supplements, mind-body therapy,” Chun says. “Parents may hesitate to ask, or they feel like they may be judged, so then the conversations don’t happen.”

Other Complementary Treatment Options for Children

Acupuncture

In addition to providing relief from chronic pain, acupuncture also can help with chemotherapy-related nausea, sleep troubles and anxiety, says Dr. Linda Chun, who works in the Comprehensive Pain Management Clinic at Nationwide Children’s Hospital. Dr. Chris Peltier, president of the Ohio Chapter of the American Academy of Pediatrics, says the practice is similar to dry needling, which physical therapists use to relax muscles, and is low risk with the right practitioner. “Seek out a practitioner who’s had appropriate training and who’s used to working with kids,” Chun advises.

Aromatherapy

Essential oils are regarded by some as a natural approach to soothe various conditions, but pediatricians say they must be used with caution. Dr. Nicole Van Steyn, a pediatrician with Step By Step Pediatrics, says some of her parents use a humidifier with added eucalyptus or peppermint oil if their child has a cold, but other uses may not be advisable. “There’s companies where they recommend ingesting oil, which we never recommend, so I would just kind of warn parents that that’s not something that should ever be attempted in a child,” she says. “Even applying it topically, it needs to be diluted in another medium because it can be very caustic to the skin. Even if it’s an essential oil, it doesn’t mean it can be applied directly to the skin.”

Chiropractic

Advice on chiropractic manipulation varies from doctor to doctor.

Peltier urges caution when dealing with young children whose spine and vertebrae are not fully developed and recommends physical therapy first, including for torticollis. “Chiropractors get very little pediatric training,” he says. For older teens, who have a sports injury or have been in an accident, the story may be different. “I don’t know if there’s going to be benefit, but it’s probably low risk.

“I do not recommend that young children see a chiropractor for either musculoskeletal things or especially for nonmusculoskeletal things,” Peltier says, citing chiropractors who erroneously claim they can treat ear infections, colic and gastrointestinal reflux.

Van Steyn says she has parents who have wanted to add chiropractic onto their child’s conventional treatment plan, and if it seems to work and is not doing harm, she generally will work with them. “It depends on what the chiropractor is going to do. If it’s an athlete who’s 16 and is having a little bit of low back pain and they’re just going to have some stretching, of course that’s low risk. But I don’t recommend it because the evidence for what we typically treat is just not there for chiropractic medicine, so we are obviously practicing evidence-based medicine.”

Meditation and Yoga

Yoga and meditation can be useful for teens and children with anxiety and sometimes even ADHD. “I think we all should meditate,” Peltier says, citing the value of just having some quiet time to spend with oneself.

Van Steyn says her practice routinely recommends such techniques for patients struggling with anxiety “just as a way to balance and find some peace and calm and regulate their nervous system. It’s very, very successful to do that.”

Yoga also can be helpful for fibromyalgia and musculoskeletal pain, Chun says.

CBD

The physicians interviewed for this story say they’ve received few inquiries about the use of CBD in teens and children, and there have been no significant studies about safety or effectiveness. Peltier says he has seen more patients with mental health issues asking about THC and medical marijuana to cope with anxiety.

This story is from the Columbus Parent section in the September 2023 issue of Columbus Monthly.