Published online September 30, 2005
PEDIATRICS Vol. 116 No. 4 October 2005, pp. e568-e575 (doi:10.1542/peds.2005-0496)
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ELECTRONIC ARTICLE

Pediatric Use of Complementary Therapies: Ethical and Policy Choices

Michael H. Cohen, JD, MBA*,{ddagger},§, Kathi J. Kemper, MD, MPH||, Laura Stevens, BA, Dean Hashimoto, JD, MD and Joan Gilmour, LLB, JSD#

* Division for Research and Education in Complementary and Integrative Medical Therapies, Harvard Medical School, Boston, Massachusetts
{ddagger} LLB Program, College of the Bahamas, Nassau, Bahamas
§ Institute for Integrative and Energy Medicine, Cambridge, Massachusetts
|| Department of Pediatrics, Brenner Children’s Hospital, Wake Forest University School of Medicine, Winston-Salem, North Carolina
Boston College School of Law, Boston, Massachusetts
# Osgoode Hall Law School, York University, Toronto, Ontario, Canada

Objective. Many pediatricians and parents are beginning to integrate use of complementary and alternative medical (CAM) therapies with conventional care. This article addresses ethical and policy issues involving parental choices of CAM therapies for their children.

Methods. We conducted a literature search to assess existing law involving parental choice of CAM therapies for their children. We also selected a convenience sample of 18 states of varying sizes and geographic locations. In each state, we inquired within the Department of Health and Human Services whether staff were aware of (1) any internal policies concerning these issues or (2) any cases in the previous 5 years in which either (a) the state initiated proceedings against parents for using CAM therapies for their children or (b) the department received telephone calls or other information reporting abuse and neglect in this domain. We asked the American Academy of Pediatrics and the leading CAM professional organizations concerning any relevant, reported cases.

Results. Of the 18 state Departments of Health and Human Services departments surveyed, 6 reported being aware of cases in the previous 5 years. Of 9 reported cases in these 6 states, 3 involved restrictive dietary practices (eg, limiting children variously to a watermelon or raw foods diet), 1 involved dietary supplements, 3 involved children with terminal cancer, and 2 involved religious practices rather than CAM per se. None of the professional organizations surveyed had initiated proceedings or received telephone calls regarding abuse or neglect concerning parental use of CAM therapies.

Conclusions. Pediatric use of CAM therapies raises complex issues. Clinicians, hospitals, state agencies, courts, and professional organizations may benefit from a policy framework to help guide decision making.

Key Words: alternative • complementary • integrative • liability • malpractice • negligence • pediatric

Abbreviations: CAM, complementary and alternative medical • DHHS, Department of Health and Human Services • AAP, American Academy of Pediatrics • USFSMB, US Federation of State Medical Boards • FDA, Food and Drug Administration • AANP, American Association of Naturopathic Physicians

Accepted May 2, 2005.