Non-Evidence Based Treatments in Pediatrics

Choose pediatric treatments that have been proven to work

Pediatricians sometimes fall into the same treatment traps as everyone else when it comes to non-evidence based treatments. Because they sometimes want to "do something" or they might feel that parents want them to do something, they will sometimes recommend popular treatments that haven't been proven to work.

Unfortunately, these non-evidence based treatments don't work (at best) and sometimes do have the potential to harm the children they are trying to help.

Although this quote is really talking about "alternative or complementary or integrative or holistic medicine," Dr. Paul Offit, in his book "Do You Believe in Magic?," offers some great advice when he states that:

There's only medicine that works and medicine that doesn't. And the best way to sort it out is by carefully evaluating scientific studies - not by visiting Internet chat rooms, reading magazine articles, or talking to friends.

Remember that once treatments are proven to work, they become part of the standard of care by pediatricians, and may even be published in a policy statement from the American Academy of Pediatrics. Unproven or non-evidence based treatments shouldn't be tried on your kids just to see if they might work.

Many pediatric conditions, including uncomplicated ear infections, viruses that cause diarrhea, colic, and teething, etc., typically get better on their own over time without treatment. It is often this "tincture of time" that gets your child better when you use these non-evidence based treatments.

When necessary, choose treatments and remedies that have been proven to work when your kids are sick.  

Sunlight for Jaundice

A phototherapy biliblanket to treat jaundice.
A BiliBlanket is a fiberoptic pad that can deliver phototherapy to babies with jaundice. Photo by Getty Images.

Jaundice is common in newborn babies. Fortunately, as long as it is closely watched and quickly treated with phototherapy if the jaundice levels get too high, there is little reason to be concerned if your baby is jaundiced.

What about sunlight exposure? Is a little sun-bathing a good treatment for jaundice?

The American Academy of Pediatrics in the policy statement "Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation," states that sunlight exposure "is not recommended."

That doesn't seem to keep some pediatricians from recommending it though. In an article for Parenting on "Home treatment for newborns with jaundice or icterus," Dr. William Sears mentions that you can "put your skin-exposed baby next to a closed window and let the rays of sunlight shine on him for around fifteen minutes, four times a day."

Sunlight exposure does make some physiological sense, after all, the spectrum of light (blue light) used in phototherapy (430- to 490-nm band) is included among the wavelengths of visible sunlight (380- to 780-nm).

Using sunlight for jaundice just doesn't make any practical sense though.

According to the AAP, "the practical difficulties involved in safely exposing a naked newborn to the sun either inside or outside (and avoiding sunburn) preclude the use of sunlight as a reliable therapeutic tool."

The problem with sunlight therapy for jaundice, is that in addition to visible sunlight, you are also exposing your baby to ultraviolet light (100- to 400-nm) and infrared light (700- to 1-mm). Even a closed window likely isn't going to block all UV rays that could damage your baby's skin.

To avoid safety concerns, you would be doing it for so short a time, there is hardly any way it could be effective. When filtered sunlight therapy for jaundice was tested (they used special window-tinting film that filters out UV light and infrared light to transmit the blue light used for phototherapy), jaundiced babies were treated for up to five to six hours each day.

Why not try it? If it really has no chance of working and has a potential to harm your baby, the real question should be "why try it?"

In addition to sunlight exposure, because high levels of jaundice can be life-threatening, it is not recommended that parents try other alternative treatments for jaundice either.

Colic Remedies

Would you take your baby to a chiropractor?
Chiropractic has not been proven to help babies with colic. Photo by Getty Images

It is well known that babies can get colic. And while distressing for parents (the idea of a inconsolably crying baby is distressing to most people), fortunately, almost all babies outgrow colic by the time they are three to four months old.

Despite the fact that there are no proven treatments for colic, that doesn't keep many parents from trying one or another colic remedies, some of which might even have been recommended by their pediatrician.

Parents magazine even published a list of "groundbreaking" new colic remedies (they weren't), which all ended with an explanation of 'why it may (not) work for you.'

Of them all, giving your baby a probiotic is perhaps the one treatment that just might help, although a very recent double-blind, placebo controlled randomised trial in Australia concluded that "L reuteri DSM 17938 did not benefit a community sample of breastfed infants and formula fed infants with colic."

Among the alternative treatments for colic include:

  • gripe water
  • chiropractic
  • infant massage
  • changing formulas (formula intolerance isn't colic)
  • restricted diets for breastfeeding mothers (an intolerance to things in a breastfeeding mother's diet isn't colic)
  • "magic" teas made from fennel and cumin seeds

What is the safest and most effective treatment for colic?

According to many pediatricians and summarized best by Scott Gavura, a pharmacist in Canada, "the best, most effective intervention for colic remains the passage of time. Colic will pass. Reassurance is probably the best advice of all."

It is important to remember that although often blamed on digestive problems or formula allergies, colic is likely a normal developmental stage that some babies go through. Many experts describe it as a baby's way of blowing off steam.

Also keep in mind that a 2011 study published in Pediatrics, "Nutritional Supplements and Other Complementary Medicines for Infantile Colic: A Systematic Review," concluded that "the notion that any form of complementary and alternative medicine is effective for infantile colic currently is not supported from the evidence from the included randomized clinical trials."

Alternating Tylenol and Motrin

A sick child with a fever recovering in bed.
Don't panic when your kids have a fever. You could do more harm than good. Photo by Getty Images

Tylenol (acetaminophen) and Motrin or Advil (ibuprofen) are commonly used fever reducers in kids. Although parents sometimes have preferences about which to use, both types of over-the-counter medicines usually work well to bring down or control a child's high temperature.

What happens when they don't though?

Is your child fairly comfortable? Does he appear sick? If not, then you can simply wait until he is due for his next dose of whichever fever reducer you prefer. It is important to remember that according to the American Academy of Pediatrics, "A primary goal of treating the febrile child should be to improve the child's overall comfort."

So you don't have to get your child back to a normal temperature when treating your child's fever.

The AAP does not recommend alternating fever reducers.  In their report on "Fever and Antipyretic Use in Children," the AAP states that "combination therapy with acetaminophen and ibuprofen may place infants and children at increased risk because of dosing errors and adverse outcomes."

Other things to remember when your child has a fever include that you should:

  • not give him a cold bath (give a lukewarm sponge bath instead if you really have to)
  • never rub him down with alcohol
  • not give both acetaminophen and ibuprofen at the same time
  • not give extra doses of either acetaminophen or ibuprofen (it won't make them work better and you can easily and quickly overdose your child)
  • not give either acetaminophen or ibuprofen (or any other medication) when you aren't sure of the correct dose
  • not combine different medicines that have the same ingredient, for example, some cold medicines include acetaminophen, so you wouldn't want to give them and a dose of regular acetaminophen too.

Throwing Away your Toothbrush after Strep Infections

Kids brushing their teeth.
With proper care, toothbrushes shouldn't have to be replaced every time your kids are sick. Photo by Igor Emmerich/Getty Images

Have you ever been told to throw out your children's toothbrush after they have had strep throat?

The theory behind getting a new toothbrush is that the strep bacteria could contaminate the toothbrush and reinfect your child once they finished their antibiotics. If you have never heard of this, are you going to start throwing away your children's toothbrush when they have strep now, or after a bout with a cold virus or the flu?

While this is not an uncommon practice, there isn't exactly any good research to suggest that any of us do it.

What about if your child keeps getting strep throat over and over again? That is probably when many pediatricians make the recommendation to throw out the old toothbrush. Invariably though, the parents have already tried that, and a contaminated toothbrush isn't the source of the child's new infection.

The preliminary results of a small study that was recently presented at the Pediatric Academic Societies (PAS) annual meeting in Washington, DC., "Group A Streptococcus on Toothbrushes," concludes that their data do not support the practice of throwing out toothbrushes from group A Streptococcus infected children. None of the toothbrushes they tested of children with strep throat actually grew the strep bacteria, which is good news for parents who are tired of buying new toothbrushes before they typically would - every 3 to 4 months or when the bristles appear worn.

"This study supports that it is probably unnecessary to throw away your toothbrush after a diagnosis of strep throat," said co-author Judith L. Rowen, MD, associate professor of pediatrics in the Department of Pediatrics at UTMB.

Instead, you can likely just teach your kids to clean their toothbrush after they use it, following the advice of the CDC - "After brushing, rinse your toothbrush thoroughly with tap water to ensure the removal of toothpaste and debris, allow it to air-dry, and store it in an upright position."

It is important to remember that strep throat is a common childhood infection. Many kids get strep throat at least two or three times a year, and most experts don't consider taking out a child's tonsils until they get strep throat at least seven times in a single year (if they would do it at all).

Other myths about strep throat include that:

  • strep carriers are contagious, which sometimes leads to repeat treating of the child, testing of the whole family, and even the family dog, searching for a carrier when someone in the family gets strep a lot. While kids who get strep very frequently may very well be strep carriers, according to the latest guidelines of the Infectious Disease Society of America, "GAS carriers do not ordinarily justify efforts to identify them nor do they generally require antimicrobial therapy because GAS carriers are unlikely to spread GAS pharyngitis to their close contacts and are at little or no risk for developing suppurative or nonsuppurative complications."
  • you can tell that someone has strep by looking at their throat - of course, you can not tell without the results of a rapid antigen detection strep test or a throat culture.
  • you can use natural remedies to treat strep. Since kids with strep throat will eventually get better on their own without antibiotics, it is not surprising that whatever natural remedy you choose will eventually work. The very real problem is that without proper treatment with antibiotics, children with strep throat are at risk for developing acute rheumatic fever or other complications, including a peritonsillar abscess, mastoiditis, and other invasive infections.

Amber Teething Necklaces

Infant alternative therapy fad necklaces can be choking hazards.
An infant wearing a rose quartz nacklace and an amber teething necklace. Photo by Daniel MacDonald / Getty Images

Most pediatricians have likely seen infants come into the office wearing amber teething necklaces. And while they might not have recommended getting one, your pediatrician just as likely didn't recommend that you take it off either.

Like teething tablets, amber necklaces are the latest fad treatment for teething. And unfortunately, like homeopathic teething tablets, amber necklaces don't really help relieve any symptoms of teething. Sure, some people swear by them, but that isn't evidence that they work.

How are amber necklaces supposed to work? Is the Baltic amber charged with healing energy? Does the amber release succinic acid, which your baby can absorb through her skin? Is succinic acid an analgesic?

However they are supposed to work, there have been no studies to prove that they work or even that they could possibly work - not for relieving teething symptoms and certainly not for any of the other conditions amber necklaces claim to treat, such as depression, arthritis, or infections, etc.

Amber necklaces also have some very real hazards - strangulation and choking. So while they might "make a treasured keepsake, and look beautiful on your little one," they are certainly not without some risk.

One popular site that sells amber teething necklaces, including necklaces made from "the most exclusive Natural Baltic Amber" boasts that they will "will help boost your child’s immune system, reduce inflammation and accelerate healing as teething progresses." They also warn that their amber teething necklaces:

  • are not for children under 36 months old
  • should be removed when child is sleeping or unattended!
  • should be kept out of reach and sight of children when they are not being worn

If worn safely and properly then, that kind of limits when you can use your exclusive Natural Baltic Amber necklace to help your child's teething pain.

BRAT Diet for Diarrhea

This is an oldie, but a goodie.

The BRAT diet - Bananas, Rice, Applesauce, and Toast.

This combo of bland foods is sometimes still recommended for children who have diarrhea or as they are recovering from an illness with diarrhea and vomiting. In fact, the American Academy of Family Physicians still advises that "after you have diarrhea or vomiting, follow the BRAT diet to help your body ease back into normal eating."

Recommending a BRAT diet is in sharp contrast to the recommendations of the American Academy of Pediatrics though, who have long stated that "children who have diarrhea and are not dehydrated should continue to be fed age-appropriate diets."

Unrestricted diets, including full-strength milk or other age-appropriate lactose-containing feedings (breastmilk or formula), should be given to your child, in addition to a glucose containing electrolyte solution, like Pedialyte.

What's the problem with the BRAT diet?

These limited foods may be well-tolerated by your child when she is sick, but unfortunately, they don't include enough calories, protein, or fat. You are much better off sticking to your child's regular diet, even if it isn't all well absorbed, or at least add many more foods to the classic BRAT diet, including:

  • more complex carbohydrates (wheat, potatoes, bread, cereals, etc.)
  • lean meats
  • yogurt
  • fruits
  • vegetables
  • milk

You should avoid fatty foods and foods that are high in sugar or caffeine, especially fruit juice, soda, and tea. That's a good recommendation all of the time though - not just when your kids have diarrhea.

Vitamins and Supplements

Eating oranges is a great way to get vitamin C.
Your kids can get plenty of vitamins and minerals from the foods they eat. Photo by Laurence Mouton/Getty Images

Many parents seem worried about how well their kids eat.

Are they too picky?

Do they eat enough fruits and vegetables?

Would a little extra vitamin C help keep them from getting that cold that is going around at school?

How about some extra zinc or echinacea to help boost your child's immune system?

Although some people recommend these types of vitamins and supplements as ways to avoid infections, it is important to keep in mind that there is no evidence that most of them work. Dr. William Sears, instead of offering evidence, simply recommends that you give "as many of these supplements as you feel is appropriate every day."

But will supplements hurt?

Studies are actually showing that they might.

In addition to the fact that you might not actually know what's in your supplement, recent studies have shown that:

  • too much omega-3 fatty acids are associated with an increased risk of developing prostate cancer
  • children taking echinacea were more likely to develop rashes and no less likely to develop colds than those taking a placebo
  • chamomile products can trigger life-threatening allergic reactions in susceptible people
  • taking zinc has been linked to copper deficiency
  • intranasal zinc products can cause a possibly permanent loss of the sense of smell

While vitamin deficiencies are certainly associated with significant risks, except for isolated iron deficiency or vitamin D deficiency, the micronutrient mineral and vitamin deficiencies that would lead to an impaired immune system are typically associated with many other symptoms and signs. For example, children with zinc deficiency also have decreased growth, rashes (acrodermatitis enteropathica), and poor wound healing, etc., in addition to an impaired immune system.

Fortunately, zinc deficiency is very rare in developed countries, even among picky eaters. 

Parents considering vitamins and supplements for their kids should remember that the National Center for Complementary and Alternative Medicine has found that "there is no conclusive evidence that any complementary health approach is useful for the flu." They also found that "echinacea has not been proven to prevent colds or relieve their symptoms," and that vitamin C doesn't reduce the number of colds that kids catch.

Even the AAP states that "healthy children receiving a normal, well-balanced diet do not need vitamin supplementation."

Caffeine for ADHD

Would you give your child coffee or a can of soda if you thought he had ADHD?

Do you think that some caffeine might be safer or better than a prescription ADHD medication?

If so, keep in mind that the American Academy of Pediatrics actually advises that caffeine has no place in a child's or teen's diet. So whether or not your child has ADHD, you should likely be avoiding drinks with caffeine.

It is important to realize that caffeine is a drug. It is well known to be addictive and to cause withdrawal symptoms in many people. It is even prescribed for premature babies who have apnea and bradycardia. A drug related to caffeine, theophylline, was until recently commonly used to treat asthma.

Interestingly, theophylline and caffeine are both members of the methylxanthine class of drugs.

Giving children with ADHD caffeine isn't even a new idea.

A 1975 study in the American Journal of Psychiatry looked at caffeine, methlyphenidate (Ritalin), and d-amphetamine (Dexderine), and found that while caffeine was not better than placebo in treating children with ADHD, both prescription drugs did provide significant improvement over both placebo and caffeine.

All together, it looks six controlled studies were done on the effects of caffeine in children with ADHD in the 1970s, and they did not show convincing evidence of benefit.

An article in Experimental & Clinical Psychopharmacology even suggested that "Caffeine appears to slightly improve vigilance performance and decrease reaction time in healthy children who habitually consume caffeine but does not consistently improve performance in children with attention deficit-hyperactivity disorder."

Should you try the caffeine for ADHD treatment for your child's ADHD? Besides the fact that studies have shown it isn't effective, the whole idea of addiction to coffee and caffeine should make you think twice.

Antibiotics for Bronchitis

Cover your Cough to prevent germs from spreading.
You can always cure your child's cough, but you can teach them to cover their cough so that they don't spread their germs to others. Photo by Mario Tama/Getty Images

It is well known that antibiotics are overused for colds and other viral infections.

What about kids with bronchitis?

They often have a lingering cough that can last for weeks and weeks, but many don't last that long without getting an antibiotic prescription. That is despite the fact that the AAP, in their clinical report on the "Principles of Judicious Antibiotic Prescribing for Upper Respiratory Tract Infections in Pediatrics" states that "antibiotics should not be prescribed for" acute bronchitis or acute cough illnesses.

The CDC also states that "antibiotics will rarely be needed since acute bronchitis and bronchiolitis are almost always caused by a virus and chronic bronchitis requires other therapies."

Following standard antibiotic prescribing guidelines can also help you avoid unnecessary antibiotic prescriptions for colds, the flu, and viral sore throats, etc.

Essential Oils

Essential Oils for sale at a market.
Essential Oils are certainly not essential for your child's health. Photo by Kylie McLaughlin/Getty Images

Essential oils seem like the latest fad for "treating" everything and can supposedly ease achy joints, elevate your mood, increase your energy, support your immune system, and even help those who have trouble paying attention and sustaining focus.

One company, Young Living, recently received a warning from the FDA because their paid consultants were promoting "Young Living Essential Oil Products for conditions such as, but not limited to, viral infections (including ebola), Parkinson’s disease, autism, diabetes, hypertension, cancer, insomnia, heart disease, post-traumatic stress disorder (PTSD), dementia, and multiple sclerosis," even though "there are no FDA-approved applications for these products."

So what makes them essential? Unlike essential fatty acids (EFAs), which your body can't make by itself and must get from food or vitamins in order to stay healthy, there is nothing really "essential" about essential oils.

Essential oils are certainly not essential for your child's health.

Used in aromatherapy, massage oils, and applied to the skin, they have perhaps become popular because they are even sold by some parents as a part of Multilevel Marketing companies. In fact, that person telling you how great essential oils are might very well be an Independent Product Consultant who is trying to sell you some of their products. Even if they don't convince you to buy or try essential oils, they might recruit you to sell them too (so they can get a cut of your sales).

But why not try them? They sure do smell nice, don't they?

In addition to the fact that they have been proven to not work, using essential oils can be harmful. Some can have hormone-like effects when applied to the skin and others can cause skin irritation.

And according to the National Cancer Institute, "a study of inhaled bergamot in children and adolescents receiving stem cell transplants reported an increase in anxiety and nausea and no effect on pain."

As with most of the these other alternative treatments, the real question should be "why try them?"

Why Recommend Non-Evidence Based Treatments?

Why do some pediatricians recommend non-evidence based treatments?

Like parents who seek these types of treatments out on their own, these pediatricians are likely just wanting to "do something" that might help.

Unfortunately, these types of treatments don't usually help or only help by way of a placebo effect and they can have side effects. Stick with treatments that have been proven to work. You might start with putting your baby in the sun when he is a little jaundiced, but what's next, skipping vaccines and putting breast milk in his eye when he has pink eye?

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