“Ask the Question”

Hilary MacGregor’s April 3rd piece in the L.A. Times, On the alternative shelf, addresses many concerns about the increasing use of natural health products (NHP’s) in children.

Drs. Paula Gardiner, Kathi Kemper and Sunita Vohra, fellow members of the American Academy of Pediatrics provisional section on complementary, holistic and integrative medicine (whew, what a name), all weigh in regarding parents and pediatricians coming to terms with wider access and desire for botanical remedies for common children’s health issues. All are terrific leaders in the field, tirelessly campaigning for more pediatric research to demonstrate safety and efficacy of NHP’s specifically in this population. What resonates most with me is Dr. Vohra’s plea to today’s pediatricians: “What we are saying is, ‘Ask the question…Talk openly. Be nonjudgmental and supportive [of parents]. Then, as the evidence accumulates, providers will be more comfortable making actual recommendations.”

This is one of the main recurring themes to date in research on NHP use in children. We NEED to ask the questions – the “don’t ask, don’t tell” mentality doesn’t work well. While more families are use NHP’s, very few disclose use to their children’s doctors. Most studies reveal a disclosure rate of well below 50%, in some cases, hovering around 10-15%. We know there can be complications of herbal use, including contamination with metals and interaction with prescription meds. Most importantly, though, we need to engage our families, not shut them down or ignore their concerns and interests; we must engender trust and work together to develop two-way communication and respect. This is something I try to teach students and residents in every lecture, seminar and encounter. It is the right way, the “good pediatrics” Dr. Kemper has spoken of, and it is needed now more than ever.