Special Issue "Pediatric Integrative Medicine: An Emerging Field of Pediatrics"

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A special issue of Children (ISSN 2227-9067).

Deadline for manuscript submissions: closed (31 May 2014)

Special Issue Editor

Guest Editor
Dr. Hilary McClafferty (Website1, Website2)

Interim Fellowship Director, University of Arizona Center for Integrative Medicine, Address: 3055 N. Campbell Ave. Suite 113, Tucson, AZ 85719 USA. Director Pediatric Integrative Medicine in Residency program. Associate Professor, Department of Medicine, University of Arizona, Tucson, USA
Interests: pediatric integrative medicine; mind-body medicine; medical acupuncture; education in integrative medicine; physician health and wellness; environmental health; children’s health

Special Issue Information

Dear Colleagues,

Pediatric integrative medicine is a specialty that blends conventional medicine with evidence-based complementary therapies. Research shows that use of integrative medicine is common in children, especially in those living with chronic illness.  Knowledge in several important areas of pediatric integrative medicine has expanded exponentially over the last decade. Despite this progress, many pediatricians and practitioners who work with children remain unaware of developments in this field.

The goal of this special issue is to: define pediatric integrative medicine in its modern context, provide a history of the field’s evolution, highlight areas where research for its use in children is most robust at this time, and identify areas where research is lacking or evolving. Models of the use of integrative medicine in clinical pediatrics will be examined. Bioethics, informed consent, and provider credentialing will be discussed.

Some of the most exciting clinical applications of integrative medicine in pediatrics include the use of mind-body medicine therapies such as guided imagery, hypnosis, and biofeedback for the treatment of pain. Mitigation of toxic stress and its health manifestations in children are another area of great potential application of the mind-body therapies. Other areas include integrative approaches to chronic illness, such as cancer, asthma, arthritis, bowel disease, and other chronic conditions where conventional therapies are necessary, yet leave treatment gaps that can be filled with evidence-based integrative therapies targeting lifestyle elements such as nutrition, sleep, physical activity, and social support that are often overlooked in this patient population. Integrative approaches have great potential in preventative heath. Conditions such as obesity and the metabolic syndrome affect a sobering number of children across all age ranges. Few successful treatment models exist for this patient population. Healthy lifestyle measures learned early in life can be a critical factor in providing a foundation for lifelong health for the child and family. Successful models for the use of integrative medicine in these patient populations are needed and will be explored.

While some progress in these areas has been made, there is substantial room for further debate and investigation. This special issue in Children will act as a forum to discuss and share knowledge about incompletely understood or controversial areas in the field of pediatric integrative medicine. Both reviews and original research contributions will be considered for publication.

I look forward to receiving your contributions!

Dr. Hilary McClafferty
Guest Editor

Submission

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. Papers will be published continuously (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are refereed through a peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed Open Access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. For the first couple of issues the Article Processing Charge (APC) will be waived for well-prepared manuscripts. English correction and/or formatting fees of 250 CHF (Swiss Francs) will be charged in certain cases for those articles accepted for publication that require extensive additional formatting and/or English corrections.

Print Edition available!
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Published Papers (10 papers)

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Editorial

Jump to: Research, Review

Open AccessEditorial Integrative Pediatrics: Looking Forward
Children 2015, 2(1), 63-65; doi:10.3390/children2010063
Received: 7 January 2015 / Revised: 7 January 2015 / Accepted: 20 January 2015 / Published: 28 January 2015
Cited by 1 | PDF Full-text (105 KB) | HTML Full-text | XML Full-text
Abstract
Increase in the prevalence of disease and illness has dramatically altered the landscape of pediatrics. As a result, there is a demand for pediatricians with new skills and a sharper focus on preventative health. Patient demand and shifting pediatric illness patterns have [...] Read more.
Increase in the prevalence of disease and illness has dramatically altered the landscape of pediatrics. As a result, there is a demand for pediatricians with new skills and a sharper focus on preventative health. Patient demand and shifting pediatric illness patterns have accelerated research in the field of pediatric integrative medicine. This emerging field can be defined as healing-oriented medicine that considers the whole child, including all elements of lifestyle and family health. It is informed by evidence and carefully weighs all appropriate treatment options. This Special Issue of Children, containing a collection of articles written by expert clinicians, represents an important educational contribution to the field. The goal of the edition is to raise awareness about integrative topics with robust supporting evidence, and to identify areas where more research is needed. Full article

Research

Jump to: Editorial, Review

Open AccessArticle Pediatric Integrative Medicine in Residency (PIMR): Description of a New Online Educational Curriculum
Children 2015, 2(1), 98-107; doi:10.3390/children2010098
Received: 6 February 2015 / Revised: 3 March 2015 / Accepted: 9 March 2015 / Published: 17 March 2015
Cited by 2 | PDF Full-text (246 KB) | HTML Full-text | XML Full-text
Abstract
Use of integrative medicine (IM) is prevalent in children, yet availability of training opportunities is limited. The Pediatric Integrative Medicine in Residency (PIMR) program was designed to address this training gap. The PIMR program is a 100-hour online educational curriculum, modeled on [...] Read more.
Use of integrative medicine (IM) is prevalent in children, yet availability of training opportunities is limited. The Pediatric Integrative Medicine in Residency (PIMR) program was designed to address this training gap. The PIMR program is a 100-hour online educational curriculum, modeled on the successful Integrative Medicine in Residency program in family medicine. Preliminary data on site characteristics, resident experience with and interest in IM, and residents’ self-assessments of perceived knowledge and skills in IM are presented. The embedded multimodal evaluation is described. Less than one-third of residents had IM coursework in medical school or personal experience with IM. Yet most (66%) were interested in learning IM, and 71% were interested in applying IM after graduation. Less than half of the residents endorsed pre-existing IM knowledge/skills. Average score on IM medical knowledge exam was 51%. Sites endorsed 1–8 of 11 site characteristics, with most (80%) indicating they had an IM practitioner onsite and IM trained faculty. Preliminary results indicate that the PIMR online curriculum targets identified knowledge gaps. Residents had minimal prior IM exposure, yet expressed strong interest in IM education. PIMR training site surveys identified both strengths and areas needing further development to support successful PIMR program implementation. Full article

Review

Jump to: Editorial, Research

Open AccessReview Toxic Stress: Effects, Prevention and Treatment
Children 2014, 1(3), 390-402; doi:10.3390/children1030390
Received: 3 June 2014 / Revised: 28 September 2014 / Accepted: 9 October 2014 / Published: 3 November 2014
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Abstract
Children who experience early life toxic stress are at risk of long-term adverse health effects that may not manifest until adulthood. This article briefly summarizes the findings in recent studies on toxic stress and childhood adversity following the publication of the American [...] Read more.
Children who experience early life toxic stress are at risk of long-term adverse health effects that may not manifest until adulthood. This article briefly summarizes the findings in recent studies on toxic stress and childhood adversity following the publication of the American Academy of Pediatrics (AAP) Policy Report on the effects of toxic stress. A review of toxic stress and its effects is described, including factors of vulnerability, resilience, and the relaxation response. An integrative approach to the prevention and treatment of toxic stress necessitates individual, community and national focus. Full article
Open AccessReview Iron, Magnesium, Vitamin D, and Zinc Deficiencies in Children Presenting with Symptoms of Attention-Deficit/Hyperactivity Disorder
Children 2014, 1(3), 261-279; doi:10.3390/children1030261
Received: 31 May 2014 / Revised: 12 August 2014 / Accepted: 21 August 2014 / Published: 29 September 2014
Cited by 1 | PDF Full-text (256 KB) | HTML Full-text | XML Full-text
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder increasing in prevalence. Although there is limited evidence to support treating ADHD with mineral/vitamin supplements, research does exist showing that patients with ADHD may have reduced levels of vitamin D, zinc, ferritin, and magnesium. These [...] Read more.
Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder increasing in prevalence. Although there is limited evidence to support treating ADHD with mineral/vitamin supplements, research does exist showing that patients with ADHD may have reduced levels of vitamin D, zinc, ferritin, and magnesium. These nutrients have important roles in neurologic function, including involvement in neurotransmitter synthesis. The aim of this paper is to discuss the role of each of these nutrients in the brain, the possible altered levels of these nutrients in patients with ADHD, possible reasons for a differential level in children with ADHD, and safety and effect of supplementation. With this knowledge, clinicians may choose in certain patients at high risk of deficiency, to screen for possible deficiencies of magnesium, vitamin D, zinc, and iron by checking RBC-magnesium, 25-OH vitamin D, serum/plasma zinc, and ferritin. Although children with ADHD may be more likely to have lower levels of vitamin D, zinc, magnesium, and iron, it cannot be stated that these lower levels caused ADHD. However, supplementing areas of deficiency may be a safe and justified intervention. Full article
Open AccessReview Vitamin D in Children’s Health
Children 2014, 1(2), 208-226; doi:10.3390/children1020208
Received: 28 May 2014 / Revised: 14 August 2014 / Accepted: 22 August 2014 / Published: 12 September 2014
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Abstract
Knowledge of vitamin D in the health of children has grown greatly over the years, extending past the importance for calcium homeostasis and bone growth. There is growing recognition of the role vitamin D plays in health impacting the innate immune system [...] Read more.
Knowledge of vitamin D in the health of children has grown greatly over the years, extending past the importance for calcium homeostasis and bone growth. There is growing recognition of the role vitamin D plays in health impacting the innate immune system to prevent infections and the adaptive immune system to modulate autoimmunity. Other studies are starting to reveal the neurohormonal effects of vitamin D on brain development and behavior, with a link to mental health disorders. Many of these effects start well before the birth of the child, so it is important that each pregnant woman be assessed for vitamin D deficiency and supplemented for the best possible health outcome of the child. It is recommended that targeting a 25(OH)D level of 40–70 ng/mL for each individual would provide optimal health benefits and reduce health care costs. Current recommended doses of vitamin D supplementation fall short of what is needed to obtain ideal serum levels. A vitamin D supplementation program to prevent disease, much like the current vaccination program, could potentially have a dramatic impact on overall health worldwide. Full article
Open AccessReview Pediatric Integrative Medicine Approaches to Attention Deficit Hyperactivity Disorder (ADHD)
Children 2014, 1(2), 186-207; doi:10.3390/children1020186
Received: 30 May 2014 / Revised: 22 July 2014 / Accepted: 15 August 2014 / Published: 27 August 2014
PDF Full-text (240 KB) | HTML Full-text | XML Full-text
Abstract
Attention deficit hyperactivity disorder (ADHD) is the most common neuropsychiatric disorder in children and is increasing in prevalence. There has also been a related increase in prescribing stimulant medication despite some controversy whether ADHD medication makes a lasting difference in school performance [...] Read more.
Attention deficit hyperactivity disorder (ADHD) is the most common neuropsychiatric disorder in children and is increasing in prevalence. There has also been a related increase in prescribing stimulant medication despite some controversy whether ADHD medication makes a lasting difference in school performance or achievement. Families who are apprehensive about side effects and with concerns for efficacy of medication pursue integrative medicine as an alternative or adjunct to pharmacologic and cognitive behavioral treatment approaches. Integrative medicine incorporates evidence-based medicine, both conventional and complementary and alternative therapies, to deliver personalized care to the patient, emphasizing diet, nutrients, gut health, and environmental influences as a means to decrease symptoms associated with chronic disorders. Pediatric integrative medicine practitioners are increasing in number throughout the United States because of improvement in patient health outcomes. However, limited funding and poor research design interfere with generalizable treatment approaches utilizing integrative medicine. The use of research designs originally intended for drugs and procedures are not suitable for many integrative medicine approaches. This article serves to highlight integrative medicine approaches in use today for children with ADHD, including dietary therapies, nutritional supplements, environmental hygiene, and neurofeedback. Full article
Open AccessReview Integrative Therapies and Pediatric Inflammatory Bowel Disease: The Current Evidence
Children 2014, 1(2), 149-165; doi:10.3390/children1020149
Received: 4 June 2014 / Revised: 5 August 2014 / Accepted: 11 August 2014 / Published: 25 August 2014
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Abstract
Inflammatory bowel disease (IBD) primarily describes two distinct chronic conditions with unknown etiology, ulcerative colitis (UC) and Crohn’s disease (CD). UC is limited to the colon, while CD may involve any portion of the gastrointestinal tract from mouth to anus. These diseases [...] Read more.
Inflammatory bowel disease (IBD) primarily describes two distinct chronic conditions with unknown etiology, ulcerative colitis (UC) and Crohn’s disease (CD). UC is limited to the colon, while CD may involve any portion of the gastrointestinal tract from mouth to anus. These diseases exhibit a pattern of relapse and remission, and the disease processes are often painful and debilitating. Due to the chronic nature of IBD and the negative side effects of many of the conventional therapies, many patients and their families turn to complementary and alternative medicine (CAM) for symptom relief. This article focuses on the current available evidence behind CAM/integrative therapies for IBD. Full article
Open AccessReview Acupuncture for Pediatric Pain
Children 2014, 1(2), 134-148; doi:10.3390/children1020134
Received: 7 June 2014 / Revised: 14 July 2014 / Accepted: 7 August 2014 / Published: 21 August 2014
Cited by 2 | PDF Full-text (189 KB) | HTML Full-text | XML Full-text
Abstract
Chronic pain is a growing problem in children, with prevalence as high as 30.8%. Acupuncture has been found to be useful in many chronic pain conditions, and may be of clinical value in a multidisciplinary treatment program. The basic principles of acupuncture [...] Read more.
Chronic pain is a growing problem in children, with prevalence as high as 30.8%. Acupuncture has been found to be useful in many chronic pain conditions, and may be of clinical value in a multidisciplinary treatment program. The basic principles of acupuncture are reviewed, as well as studies exploring basic mechanisms of acupuncture and clinical efficacy. Conditions commonly treated in the pediatric pain clinic, including headache, abdominal pain, fibromyalgia, juvenile arthritis, complex regional pain syndrome, cancer pain, as well as perioperative pain studies are reviewed and discussed. Areas in need of further research are identified, and procedural aspects of acupuncture practice and safety studies are reviewed. Acupuncture can be an effective adjuvant in the care of pediatric patients with painful conditions, both in a chronic and an acute setting. Further studies, including randomized controlled trials, as well as trials of comparative effectiveness are needed. Full article
Open AccessReview Integrative Treatment of Reflux and Functional Dyspepsia in Children
Children 2014, 1(2), 119-133; doi:10.3390/children1020119
Received: 6 June 2014 / Revised: 24 July 2014 / Accepted: 29 July 2014 / Published: 18 August 2014
Cited by 1 | PDF Full-text (236 KB) | HTML Full-text | XML Full-text
Abstract
Gastroesophageal reflux disease (GERD) and functional dyspepsia (FD) are common problems in the pediatric population, with up to 7% of school-age children and up to 8% of adolescents suffering from epigastric pain, heartburn, and regurgitation. Reflux is defined as the passage of [...] Read more.
Gastroesophageal reflux disease (GERD) and functional dyspepsia (FD) are common problems in the pediatric population, with up to 7% of school-age children and up to 8% of adolescents suffering from epigastric pain, heartburn, and regurgitation. Reflux is defined as the passage of stomach contents into the esophagus, while GERD refers to reflux symptoms that are associated with symptoms or complications—such as pain, asthma, aspiration pneumonia, or chronic cough. FD, as defined by the Rome III classification, is a persistent upper abdominal pain or discomfort, not related to bowel movements, and without any organic cause, that is present for at least two months prior to diagnosis. Endoscopic examination is typically negative in FD, whereas patients with GERD may have evidence of esophagitis or gastritis either grossly or microscopically. Up to 70% of children with dyspepsia exhibit delayed gastric emptying. Treatment of GERD and FD requires an integrative approach that may include pharmacologic therapy, treating concurrent constipation, botanicals, mind body techniques, improving sleep hygiene, increasing physical activity, and traditional Chinese medicine and acupuncture. Full article
Open AccessReview Clinical Hypnosis with Children and Adolescents—What? Why? How?: Origins, Applications, and Efficacy
Children 2014, 1(2), 74-98; doi:10.3390/children1020074
Received: 27 May 2014 / Revised: 13 July 2014 / Accepted: 21 July 2014 / Published: 12 August 2014
Cited by 1 | PDF Full-text (529 KB) | HTML Full-text | XML Full-text
Abstract
This review article addresses the process, intention, and therapeutic value of clinical hypnosis with children and adolescents. A brief historical perspective is followed by a digest of the published laboratory and clinical research that has accelerated substantially over the past two decades. [...] Read more.
This review article addresses the process, intention, and therapeutic value of clinical hypnosis with children and adolescents. A brief historical perspective is followed by a digest of the published laboratory and clinical research that has accelerated substantially over the past two decades. This review lends appropriate credence to the benefits and integration to clinical practice of this powerful tool for teaching young people self-regulation skills. The breadth of application is described, and several clinical vignettes are provided as examples of what is possible. In addition to the provision of the most relevant citations in the pediatric, psychological, and neuroscience literature, this synopsis concludes with information regarding availability of skill development training in pediatric clinical hypnosis. Full article

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