Management of Natural Health Products in Pediatrics
Management of Natural Health Products in Pediatrics
Patient use of NHPs is common, although HCPs frequently do not attempt to manage or discuss them with their patients because of their limited knowledge and lack of confidence (Gilmour, Harrison, Asadi, Cohen, & Vohra, 2011; Kemper, Vohra, & Walls, 2008). Data from the National Health And Nutrition Examination Survey (2007–2010) revealed that 85% of children who use NHPs do so without guidance from their HCP (Bailey et al., 2013). Even though HCPs may not have initiated NHP therapy, they are still expected to provide patients/families with guidance (Gilmour, Harrison, Asadi, et al., 2011). For example, if a parent is giving a toddler elderberry for treatment of influenza, the parent should be advised that studies do not support its use for children younger than 18 years, and preparations containing glycoside sambunigrin can be potentially toxic and lead to cyanide and lead poisoning (Natural Standard, 2014).
HCPs infrequently ask about the use of NHPs as a part of their patient assessments, even though the literature frequently laments this omission (Robinson and McGrail, 2004, Sawni and Thomas, 2007). The National Institutes of Health (NIH) has launched initiatives with their "Time to Talk" campaign for better communication between HCPs and caregivers/patients (National Center for Complementary and Alternative Medicine [NCCAM], 2014). Communication is essential to identify which products are being taken, why, and to prevent potential drug-herb interactions. Depending on its pharmacodynamic interaction, an NHP can alter the function of CYP450 liver enzymes, rendering a prescription drug more toxic or ineffective (Goldman, Rogovik, Lai, & Vohra, 2008). For example, the use of 5-hydroxytryptophan (commonly found in St Johns wort) with concurrent use of antidepressants is contradicted because of the increased risk for serotonin syndrome (Natural Standard, 2013).
Clinical Problem
Patient use of NHPs is common, although HCPs frequently do not attempt to manage or discuss them with their patients because of their limited knowledge and lack of confidence (Gilmour, Harrison, Asadi, Cohen, & Vohra, 2011; Kemper, Vohra, & Walls, 2008). Data from the National Health And Nutrition Examination Survey (2007–2010) revealed that 85% of children who use NHPs do so without guidance from their HCP (Bailey et al., 2013). Even though HCPs may not have initiated NHP therapy, they are still expected to provide patients/families with guidance (Gilmour, Harrison, Asadi, et al., 2011). For example, if a parent is giving a toddler elderberry for treatment of influenza, the parent should be advised that studies do not support its use for children younger than 18 years, and preparations containing glycoside sambunigrin can be potentially toxic and lead to cyanide and lead poisoning (Natural Standard, 2014).
HCPs infrequently ask about the use of NHPs as a part of their patient assessments, even though the literature frequently laments this omission (Robinson and McGrail, 2004, Sawni and Thomas, 2007). The National Institutes of Health (NIH) has launched initiatives with their "Time to Talk" campaign for better communication between HCPs and caregivers/patients (National Center for Complementary and Alternative Medicine [NCCAM], 2014). Communication is essential to identify which products are being taken, why, and to prevent potential drug-herb interactions. Depending on its pharmacodynamic interaction, an NHP can alter the function of CYP450 liver enzymes, rendering a prescription drug more toxic or ineffective (Goldman, Rogovik, Lai, & Vohra, 2008). For example, the use of 5-hydroxytryptophan (commonly found in St Johns wort) with concurrent use of antidepressants is contradicted because of the increased risk for serotonin syndrome (Natural Standard, 2013).
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