Special Issue "Implementing Pediatric Integrative Medicine in Practice"

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Integrative Pediatrics".

Deadline for manuscript submissions: closed (31 August 2018)

Special Issue Editor

Guest Editor
Dr. Hilary McClafferty

Director Pediatric Integrative Medicine Residency Program Center for Integrative Medicine, University of Arizona, Tucson, AZ, USA
Website | E-Mail
Interests: pediatric integrative medicine; mind-body medicine; physician health and wellness; medical education; environmental health; and implementation of integrative medicine in the clinical setting

Special Issue Information

Dear Colleagues,

Pediatric integrative medicine is a growing specialty with great potential to improve children’s health. The field combines conventional and evidence-based complementary therapies, is focused on preventive health, and is used by an estimated 12% of children in the US, with higher use seen internationally. As the field has grown, the need for sustainable clinical models has become increasingly important. The goal of this Special Issue is to explore successful models of pediatric integrative medicine in practice in both private and academic settings. Articles on program development, clinical outcome studies, identified challenges and problems solved, billing and coding solutions, policy gaps, and advocacy initiatives are encouraged.

Dr. Hilary McClafferty
Guest Editor

Manuscript Submission Information

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. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short 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 thoroughly refereed through a single-blind 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 monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 550 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pediatric integrative medicine
  • program development
  • clinical outcome studies
  • billing and coding for integrative medicine
  • pediatric preventive health

Published Papers (11 papers)

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Research

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Open AccessArticle Integrative Pediatrics: Successful Implementation of Integrative Medicine in a German Hospital Setting—Concept and Realization
Children 2018, 5(9), 122; https://doi.org/10.3390/children5090122
Received: 26 July 2018 / Revised: 23 August 2018 / Accepted: 28 August 2018 / Published: 4 September 2018
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Abstract
Complementary and Alternative Medicine (CAM) has not been systematically institutionalized in pediatric hospital care in Germany so far. For the responsible implementation and systematic evaluation of CAM in pediatric care, a model project was initialized in three different pediatric hospitals in Germany, one
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Complementary and Alternative Medicine (CAM) has not been systematically institutionalized in pediatric hospital care in Germany so far. For the responsible implementation and systematic evaluation of CAM in pediatric care, a model project was initialized in three different pediatric hospitals in Germany, one of them being the “Kinderkrankenhaus St. Marien” in Landshut, Germany. During this project, a concept of the implementation process was developed based on clinical care, teaching, and scientific evaluation. A project group was formed in St. Marien, which included leaders of the hospital, physicians, nurses, and physiotherapists. Over a period of three years, pediatric treatment modalities of the CAM-spectrum were systematically integrated into routine pediatric care and a new integrative medicine department was established. CAM is now being applied in an inpatient as well as outpatient setting, in addition to conventional medical treatments. The modalities now applied include Traditional Chinese Medicine (TCM), relaxation, hypnosis, reflexology, wraps and poultices, aromatherapy, homeopathy, yoga, and herbal medicine. Studies were initiated in some areas. The process and concept leading up to this successful implementation will be described in this article. We show that with motivated team players and structured proceedings, implementation of integrative medicine in a children’s hospital can be successful. Full article
(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)
Open AccessArticle Can the Mindful Awareness and Resilience Skills for Adolescents (MARS-A) Program Be Provided Online? Voices from the Youth
Children 2018, 5(9), 115; https://doi.org/10.3390/children5090115
Received: 27 July 2018 / Revised: 23 August 2018 / Accepted: 23 August 2018 / Published: 28 August 2018
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Abstract
Mindfulness-based interventions (MBIs) have been shown to improve health and well-being in adolescents with chronic illnesses. Because they are most often delivered in person in a group setting, there are several barriers that limit access to MBIs for youth with limited mobility or
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Mindfulness-based interventions (MBIs) have been shown to improve health and well-being in adolescents with chronic illnesses. Because they are most often delivered in person in a group setting, there are several barriers that limit access to MBIs for youth with limited mobility or who cannot access in-person MBIs in their communities. The objective of this study was to determine if eHealth is a viable platform to increase accessibility to MBIs for teens with chronic illnesses. This study reports the qualitative results of a mixed method randomized trial describing the experience of the Mindful Awareness and Resilience Skills for Adolescents (MARS-A) program, an eight-week MBI, delivered either in person or via eHealth. Participants were adolescents between the ages of 13 and 18 with a chronic illness recruited at a tertiary pediatric hospital in Toronto, Canada. Individual semi-structured post-participation audio-video interviews were conducted by a research assistant. A multiple-pass inductive process was used to review interview transcripts and interpret emergent themes from the participants’ lived experiences. Fifteen participants (8 online and 7 in person) completed post-participation interviews. Four distinct themes emerged from participants in both groups: Creation of a safe space, fostering peer support and connection, integration of mindfulness skills into daily life, and improved well-being through the application of mindfulness. Direct quotations representative of those four themes are reported. Results from this study suggest that eHealth delivery of an adapted MBI for adolescents with chronic illnesses may be an acceptable and feasible mode of delivery for MBIs in this population. EHealth should be considered in future studies of MBIs for adolescents with chronic illnesses as a promising avenue to increase access to MBIs for youth who might not be able to access in-person programs. Full article
(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)
Open AccessArticle Applied Pediatric Integrative Medicine: What We Can Learn from the Ancient Teachings of Sebastian Kneipp in a Kindergarten Setting
Children 2018, 5(8), 102; https://doi.org/10.3390/children5080102
Received: 13 June 2018 / Revised: 13 July 2018 / Accepted: 24 July 2018 / Published: 26 July 2018
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Abstract
Pediatric integrative medicine focuses on the whole child and the environment in which the child grows up during the treatment of a child’s illness. Nowadays, many different treatment modalities are applied even in children, and doctors need to know about them and, ideally,
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Pediatric integrative medicine focuses on the whole child and the environment in which the child grows up during the treatment of a child’s illness. Nowadays, many different treatment modalities are applied even in children, and doctors need to know about them and, ideally, be able to apply different approaches in the process of treating a child themselves. The program Pediatric Integrative Medicine in Residency (PIMR) already provides residents with several tools to provide this kind of service for the child. In our PIMR pilot program in Germany, we chose to diversify our knowledge about treatment and prevention options by visiting a Kneipp-certified kindergarten in Germany. The philosophy of Sebastian Kneipp focuses on five pillars of health, which incorporate aspects of prevention, self-awareness, self-responsibility, and consciousness of health by means of hydrotherapy, herbal medicine, exercise, nutrition, and lifestyle-medicine. These are being taught to the children during the early years they spend in kindergarten, and represent integral parts of integrative medicine. Integration of Kneipp-based health programs within a kindergarten setting can work well and provides an effective means of early prevention education in childhood. Full article
(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)
Open AccessArticle Family-Based Mindful Eating Intervention in Adolescents with Obesity: A Pilot Randomized Clinical Trial
Received: 23 May 2018 / Revised: 24 June 2018 / Accepted: 3 July 2018 / Published: 6 July 2018
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Abstract
Mindfulness has gained attention in the treatment of obesity. However, there is a paucity of data on family-based training in mindful eating in children. The objective of this pilot randomized clinical trial was to evaluate the feasibility and acceptability of a family-based mindful
[...] Read more.
Mindfulness has gained attention in the treatment of obesity. However, there is a paucity of data on family-based training in mindful eating in children. The objective of this pilot randomized clinical trial was to evaluate the feasibility and acceptability of a family-based mindful eating intervention (MEI) in adolescents with obesity, and to compare the efficacy of the MEI versus standard dietary counseling (SDC) for decreasing weight and improving cardiometabolic risk markers. Twenty-two adolescents (age 14.5–17.9 years) and parent pairs were randomized to the MEI or SDC. The MEI was administered in four 90-min sessions over 10 weeks and SDC was provided at baseline, 12 weeks, and 24 weeks. Despite the requirement of more frequent visits with the MEI, adolescents and parents attended 100% of the sessions and there were no dropouts in that group. High density lipoprotein (HDL) cholesterol increased in the SDC group, but not in the MEI group. Adolescents receiving the MEI demonstrated an increase in awareness at 24 weeks (p = 0.01) and a decrease in distraction during eating at 12 weeks (p = 0.04), when compared with the SDC group. The family-based MEI showed feasibility and acceptability in adolescents with obesity. Future studies with more intense therapy and larger sample sizes are warranted to examine the role of mindful eating in treating pediatric obesity. Full article
(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)
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Open AccessArticle Pediatric Integrative Medicine in Residency Program: Relationship between Lifestyle Behaviors and Burnout and Wellbeing Measures in First-Year Residents
Received: 9 February 2018 / Revised: 12 April 2018 / Accepted: 17 April 2018 / Published: 23 April 2018
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Abstract
It is widely recognized that burnout is prevalent in medical culture and begins early in training. Studies show pediatricians and pediatric trainees experience burnout rates comparable to other specialties. Newly developed Accreditation Council for Graduate Medical Education (ACGME) core competencies in professionalism and
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It is widely recognized that burnout is prevalent in medical culture and begins early in training. Studies show pediatricians and pediatric trainees experience burnout rates comparable to other specialties. Newly developed Accreditation Council for Graduate Medical Education (ACGME) core competencies in professionalism and personal development recognize the unacceptably high resident burnout rates and present an important opportunity for programs to improve residents experience throughout training. These competencies encourage healthy lifestyle practices and cultivation of self-awareness, self-regulation, empathy, mindfulness, and compassion—a paradigm shift from traditional medical training underpinned by a culture of unrealistic endurance and self-sacrifice. To date, few successful and sustainable programs in resident burnout prevention and wellness promotion have been described. The University of Arizona Center for Integrative Medicine Pediatric Integrative Medicine in Residency (PIMR) curriculum, developed in 2011, was designed in part to help pediatric programs meet new resident wellbeing requirements. The purpose of this paper is to detail levels of lifestyle behaviors, burnout, and wellbeing for the PIMR program’s first-year residents (N = 203), and to examine the impact of lifestyle behaviors on burnout and wellbeing. The potential of the PIMR to provide interventions addressing gaps in lifestyle behaviors with recognized association to burnout is discussed. Full article
(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)
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Review

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Open AccessReview A Review of Non-Pharmacological Treatments for Pain Management in Newborn Infants
Children 2018, 5(10), 130; https://doi.org/10.3390/children5100130
Received: 2 August 2018 / Revised: 5 September 2018 / Accepted: 17 September 2018 / Published: 20 September 2018
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Abstract
Pain is a major problem in sick newborn infants, especially for those needing intensive care. Pharmacological pain relief is the most commonly used, but might be ineffective and has side effects, including long-term neurodevelopmental sequelae. The effectiveness and safety of alternative analgesic methods
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Pain is a major problem in sick newborn infants, especially for those needing intensive care. Pharmacological pain relief is the most commonly used, but might be ineffective and has side effects, including long-term neurodevelopmental sequelae. The effectiveness and safety of alternative analgesic methods are ambiguous. The objective was to review the effectiveness and safety of non-pharmacological methods of pain relief in newborn infants and to identify those that are the most effective. PubMed and Google Scholar were searched using the terms: “infant”, “premature”, “pain”, “acupuncture”, “skin-to-skin contact”, “sucrose”, “massage”, “musical therapy” and ‘breastfeeding’. We included 24 studies assessing different methods of non-pharmacological analgesic techniques. Most resulted in some degree of analgesia but many were ineffective and some were even detrimental. Sucrose, for example, was often ineffective but was more effective than music therapy, massage, breast milk (for extremely premature infants) or non-invasive electrical stimulation acupuncture. There were also conflicting results for acupuncture, skin-to-skin care and musical therapy. Most non-pharmacological methods of analgesia provide a modicum of relief for preterm infants, but none are completely effective and there is no clearly superior method. Study is also required to assess potential long-term consequences of any of these methods. Full article
(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)
Open AccessReview Integrating Pediatric Hypnosis with Complementary Modalities: Clinical Perspectives on Personalized Treatment
Children 2018, 5(8), 108; https://doi.org/10.3390/children5080108
Received: 15 June 2018 / Revised: 30 July 2018 / Accepted: 31 July 2018 / Published: 7 August 2018
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Abstract
While pediatric integrative medicine (PIM) emphasizes an “evidence-based practice using multiple therapeutic modalities”; paradoxically, literature reviews examining the prevalence and/or efficacy of such mind–body approaches often address PIM modalities separately. Such contributions are relevant, yet documentation of how to deliver combined complementary approaches
[...] Read more.
While pediatric integrative medicine (PIM) emphasizes an “evidence-based practice using multiple therapeutic modalities”; paradoxically, literature reviews examining the prevalence and/or efficacy of such mind–body approaches often address PIM modalities separately. Such contributions are relevant, yet documentation of how to deliver combined complementary approaches in children and youth are scarce. Nevertheless, integrative practitioners in clinical practice routinely mix approaches to meet the individual needs of each patient. Best practices are flexible, and include blending and augmenting services within the same session, and/or connecting modalities sequentially for an incremental effect, and/or referring to outside resources for additional interventions. Resonating with integrative medicine’s definition, this article’s goal is to demonstrate paradigms that “bring together complementary approaches in a coordinated way within clinical practice” by linking clinical hypnosis, the trail-blazer modality in PIM’s history, with mindfulness, biofeedback, acupuncture, and yoga. Following the consideration of the overlap of guided imagery with hypnosis and an abridged literature report, this clinical perspective considers the selection of modalities within a collaborative relationship with the child/teen and parents, emphasizing goodness-of-fit with patients’ contexts, e.g., symptoms, resources, interests, goals, and developmental stage. Case vignettes illustrate practical strategies for mixing approaches. Full article
(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)
Open AccessReview Pediatric Headache Clinic Model: Implementation of Integrative Therapies in Practice
Received: 22 May 2018 / Revised: 5 June 2018 / Accepted: 8 June 2018 / Published: 12 June 2018
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Abstract
The demand for integrative medicine has risen in recent years as research has demonstrated the efficacy of such treatments. The public has also become more conscientious of the potential limitations of conventional treatment alone. Because primary headache syndromes are often the culmination of
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The demand for integrative medicine has risen in recent years as research has demonstrated the efficacy of such treatments. The public has also become more conscientious of the potential limitations of conventional treatment alone. Because primary headache syndromes are often the culmination of genetics, lifestyle, stress, trauma, and environmental factors, they are best treated with therapies that are equally multifaceted. The Children’s Mercy Hospital, Kansas City, Missouri Headache Clinic has successfully incorporated integrative therapies including nutraceuticals, acupuncture, aromatherapy, biofeedback, relaxation training, hypnosis, psychology services, and lifestyle recommendations for headache management. This paper provides a detailed review of the implementation of integrative therapies for headache treatment and discusses examples through case studies. It can serve as a model for other specialty settings intending to incorporate all evidenced-based practices, whether complementary or conventional. Full article
(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)

Other

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Open AccessCorrection Correction: Esparham, A., et al., Pediatric Integrative Medicine: Vision for the Future. Children, 2018, 5, 111
Children 2018, 5(9), 123; https://doi.org/10.3390/children5090123
Received: 29 August 2018 / Accepted: 30 August 2018 / Published: 5 September 2018
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Abstract
The authors wish to make the following corrections to their paper [...] Full article
(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)
Open AccessBrief Report Pediatric Integrative Medicine: Vision for the Future
Children 2018, 5(8), 111; https://doi.org/10.3390/children5080111
Received: 26 July 2018 / Revised: 16 August 2018 / Accepted: 16 August 2018 / Published: 20 August 2018
Cited by 1 | PDF Full-text (1620 KB) | HTML Full-text | XML Full-text | Correction
Abstract
Pediatric integrative medicine (PIM) is of significant interest to patients, with 12% of the general pediatric population and up to 80% of children with chronic conditions using PIM approaches. The field of PIM has evolved over the past 25 years, approaching child health
[...] Read more.
Pediatric integrative medicine (PIM) is of significant interest to patients, with 12% of the general pediatric population and up to 80% of children with chronic conditions using PIM approaches. The field of PIM has evolved over the past 25 years, approaching child health with a number of guiding principles: preventive, context-centered, relationship-based, personalized, participatory, and ecologically sustainable. This manuscript reviews important time points for the field of PIM and reports on a series of meetings of PIM leaders, aimed at assessing the state of the field and planning for its future. Efforts in the first decade of the 2000s led to increased visibility in academic and professional pediatric organizations and through international listservs, designed to link those interested in and practicing PIM, all of which continue to flourish. The PIM leadership summits in recent years resulted in specific goals to advance PIM further in the following key areas: research, clinical practice, professional education, patient and family education, and advocacy and partnerships. Additionally, goals were developed for greater expansion of PIM professional education, broader support for pediatric PIM research, and an expanded role for PIM approaches in the provision of pediatric care. Full article
(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)
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Open AccessBrief Report Implementing Integrative Nursing in a Pediatric Setting
Children 2018, 5(8), 103; https://doi.org/10.3390/children5080103
Received: 29 June 2018 / Revised: 18 July 2018 / Accepted: 20 July 2018 / Published: 31 July 2018
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Abstract
Pediatric blood and marrow transplantation (BMT) is one of the most challenging allopathic treatments a patient and family can be faced with. A large Midwest academic health center, and leader in pediatric BMT, made the decision in 2013 to incorporate integrative nursing as
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Pediatric blood and marrow transplantation (BMT) is one of the most challenging allopathic treatments a patient and family can be faced with. A large Midwest academic health center, and leader in pediatric BMT, made the decision in 2013 to incorporate integrative nursing as the care delivery model. Nurses trained in advanced nursing practice and specialized in integrative health and healing performed a deep-dive needs assessment, national benchmarking, a comprehensive review of the literature, and ultimately designed a comprehensive integrative program for pediatric patients and their families undergoing BMT. Four years after implementation, this paper discusses lessons learned, strengths, challenges and next phases of the program, including a research agenda. The authors conclude that it is feasible, acceptable and sustainable to implement a nurse-led integrative program within an academic health center-based pediatric BMT program. Full article
(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)
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