Collaborative treatment: whole child, whole family health-creation and prevention
(Mentioned in this brief: Cleveland Clinic; Pediatric Integrative Medicine Residency (U of Arizona); Lawrence Rosen (Oradell Pediatrics); American Academy of Pediatrics; NCCIH (NCCAM).)
Parents have been interested in and made substantial use of alternative medical treatments for their children for many years.
As elsewhere in US healthcare, this experience and its sustained positive outcomes are bringing integrative and complementary medicine deeper into conventional pediatric medicine. It is not difficult to see why this is so:
“The statistics are staggering: the rates of autism, ADHD, asthma, food allergies, obesity and diabetes continue to rise at an unprecedented pace. The conventional solution to date has been a “disease treatment system” that incentivizes more care at higher cost. Our kids are sicker than ever before, despite throwing tons of money – and quick-fix prescriptions – at the problem. Our one ill-one pill solution is expensive, ineffective and increasingly unsafe. Health care transformation is no longer a luxury wish-list item; it has become an absolute imperative.”
The Whole Child Center, Oradell NJ
This imperative is encouraging doctors to expand their views of treatment, of healing and of health. Graciela Wilcox MD, a faculty advisor for the new Pediatrics Integrative Medicine Residency program at the University of Arizona (see below), speaks for many conventionally trained MDs:
“We as pediatricians need to become more familiar with integrative medicine so we can better counsel our families, many of whom already are using complementary and alternative remedies.”
While medical doctors (MDs) and doctors of osteopathy (DOs) have been extending their education into integrative medicine in recent years it is important to keep in mind that the foundations for this education stem from the health care provided over the last 30 years by highly trained health professionals in discrete professions or whole systems –- naturopathic physicians, chiropractors, massage therapists; and in Traditional Chinese Medicine (TCM) and Ayurveda. These are the CAM/integrative professions for which Section 2706 of the Affordable Care Act was written: to end insurer discrimination faced by their practitioners.
Children and Complementary and Integrative Medicine
The National Institutes of Health with the National Health Interview Survey (NHIS) have been tracking this use of CAM options – now better known as integrative health – since 2002. Its surveys of 2007 and most recently of 2012 include these data points about the use complementary therapies for children. Among the main points of the 2012 survey:
- 11.6% of U.S. children age 4 to 17 used complementary health approaches in 2012.
- Among those about 1.6% (927,000) participated in meditation.
- Yoga has become as popular among children as it has among adults: 3.1% of U.S. children practiced yoga in 2012, up from 2.3% in 2007.
- 3.3% used chiropractic or osteopathic services
For more on this survey data, released in early 2015, see the reports from the National Center for Complementary and Integrative Health, NCCIH (formerly NCCAM).
Complementary and Alternative Foundations
In its strategic plan of 2011, NCCIH (then NCCAM) made a point of acknowledging the role and authority of the highly trained and experienced professionals in the complementary and alternative disciplines and how their work has led to our understanding of the value, outcomes and potential for these healthcare approaches. The report noted:
“CAM practitioners are the key holders of knowledge related to the potential applications of CAM interventions and disciplines.”
This role has also applied in pediatrics. Naturopathic doctors (NDs) and chiropractic doctors (DCs) have been providing primary and pediatric care for many years independently of, but also complementary with, conventional pediatric physicians. Now, as care for personal lifestyles finds its way into healthcare, the longstanding positive outcomes of CAM approaches for children has become an important part of pediatric integrative medicine.
Integrative Medicine for Pediatric Docs
The process of integrating what was then CAM into conventional pediatrics began in the 1990’s when Boston Children’s Hospital established a Center for Pediatric Integrative Medicine. In 2005, the American Academy of Pediatrics reflected the growing belief of MDs like Dr. Wilcox and established a formal Section on Complementary and Integrative Medicine (SOCIM) as resource for pediatricians everywhere. SOCIM coordinates research and disseminates information on integrative therapies for many conditions, including eating disorders, chronic disease, and infant brain development. (For a thorough introduction to and background on SOCIM view this PDF article by one of its founders Lawrence Rosen, MD)
The 1990’s was also the period when integrative medicine began to find places within conventional medicine settings, such as medical schools. The Consortium of Academic Health Centers for Integrative Members (CAHCIM) now numbers more than 50 member US medical schools that operate centers of integrative medicine. Several are also bringing integrative medicine to pediatrics: the University of Miami, the Osher Center at the University of California at San Francisco, New Hampshire’s Hospital for Children and Boston Children’s Hospital.
In 2014, the University of Arizona Center for Integrative Medicine (AzCIM) further embedded integrative medicine into pediatric training when it launched the first national Pediatric Integrative Medicine (PIM) residency online curriculum. Some 350 pediatric residents and faculty participate from Stanford University, University of Chicago, University of Kansas, Eastern Virginia Medical School Children’s Hospital of the King’s Daughters, as well as at the University of Arizona College of Medicine.
From med schools to hospitals and clinics
As in the medical schools, Arizona’s PIM curriculum borrows directly from the best-known complementary therapies delivered by practitioners from the CAM disciplines: nutrition, mind-body medicine, integrative approaches to mental health, sleep, whole medical systems such as Traditional Chinese Medicine (TCM) and naturopathy, physical activity, behavior and lifestyle change, environmental medicine and a full course on physician health and wellness.
(The education and credentialing completed by the professionals in the integrative disciplines themselves is shown in our section “The Professions.”)
The application of these disciplines is also evident at major healthcare provider organizations like the Cleveland Clinic, which is investing heavily in lifestyle and functional medicine programs that are based on the precepts of integrative medicine. This includes its Children’s Hospital and its Center for Pediatric Integrative Medicine, where you will find a familiar sampling of therapies:
Acupuncture, Acupressure, Laser Acupuncture
Integrated Dry Needling
Frequency Specific Micro-current Therapy
Therapeutic Touch (Infants)
The Center’s web site explains: “Integrative medicine may help to reduce the severity or frequency of disease episodes, decrease stress related to chronic disease, and (enable patients to) enjoy a better quality of life.” It goes on to highlight an important distinction in what are being recognized as the mutually reinforcing outcomes that are driving the adoption of integrative options across US health care:
“While conventional medicine can help diminish the consequences of unhealthy lifestyles, integrative medicine can reverse those consequences, prevent illness and reduce symptoms.”
The benefits provided by these approaches have long been familiar to patients of integrative disciplines and their providers.
Enhanced immune function; fewer infections
Lowered blood pressure, cholesterol and glucose levels
Improved bowel function
Less anxiety and depression related to illness
Fewer complications after surgery
Additional treatment of PTSD
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Synchronizing with other health initiatives for kids in local communities
It is worth noting that the growing attention pediatrics is placing on integrative approaches for children is being mirrored in communities across the nation by innovators who are decidedly non-medical but who are working on health-creating initiatives that engage children. Mindfulness practices, environmental education in green schools, school gardens, farm-to-school initiatives, nutrition and exercise programs will resonate with integrative pediatricians who see their role as extending beyond diagnosis and treatment.
In the Pediatric Integrative Clinic
One such practice is the Whole Child Center in Oradell, NJ, established by Lawrence Rosen, MD a pediatrician who has been instrumental in bringing integrative medicine to pediatric care since the 1990s. He was a founder and then Chair of the SOIM Section at the AAP, and he speaks and writes widely. His practice focuses not only on the whole child but the “whole family” and its community.
In the following video interview with CNN, Dr. Rosen explains the integration of natural therapeutics in his pediatric practice as options for parents who often seek alternatives for their children’s ailments. It is a good description of how integrative therapies and natural options fit together in a pediatric practice where prevention and health-creation are primary objectives for the long term.
Ultimately, this growing collaboration between health and healing systems and philosophies — conventional and integrative — may deliver the best near-term improvements for US healthcare, especially if broad implementation of Section 2706 provides greater access to the less intense, less invasive, often less costly group of integrative therapies that are effective and appeal to parents.