Emergency C Vitamin Supplement Articles & Resources

Even if a supplement has proven clinical efficacy and safety, the quality of supplements and lack of standardization are obstacles misidentification; contamination with heavy metals, pesticides, or herbicides; and adulteration with other herbs or pharmaceuticals could cause toxicity in a child, but not in an adult. (8) A recent study (9) of Ayurvedic herbal products found that 20 percent were contaminated with heavy metals (., lead, arsenic, mercury); 50 percent of the contaminated products were marketed for children.

Parents give their children dietary supplements for many reasons (., health maintenance, prevention and treatment of acute and chronic diseases), yet parents do not always report the use of these supplements to their family physicians. Of 142 families surveyed while waiting in an emergency department, 45 percent reported giving their child an herbal product. (10) Only 45 percent of parents who give their children herbal products reported discussing these products with their child's primary health care professional. (10) Parents learn about supplements from family, popular press, television advertisements, health food stores, and the Internet. It is critical for physicians to know what dietary supplements their patients are using and why, and to clearly document the use of these supplements. The following guide-lines8 may be helpful when talking with parents about using dietary supplements:

* Ask all parents which herbal or dietary supplements (., traditional remedies, teas, multivitamins, special foods, over-the-counter products) they are giving their children.

* Encourage parents to seek professional guidance for information on efficacy and safety before using dietary supplements. Dietary supplements may have beneficial effects as well as expected and sometimes unexpected toxicity. Dietary supplements are not regulated as strictly as drugs by the . Food and Drug Administration, so it is truly a case of "buyer beware." Variable and unpredictable concentrations, ingredients, and contaminants are of concern, especially when such products are used in children.

TABLE 1
Evidence-Based Internet Resources for
Herbal and Dietary Supplements

Altmedex
 Subscription service through Micromedex
 .com/products/healthcare
Holistic Kids
 Pediatric integrative medicine education project
 .org
Longwood Herbal Task Force
 Free patient handouts and evidence-based monographs
 on common childhood herbs
 .edu/herbal
MedWatch
 Report adverse events and drug-herb interactions
 .gov/medwatch
 Telephone: 800-FDA-1088 (800-221-1088)
National Institutes of Health Office of Dietary Supplements
 Free patient handouts available
 .
Natural Medicines Comprehensive Database
 Subscription service with evidence-based monographs
 .com
Natural Standard
 Subscription service with evidence-based monographs
 .com/

TABLE 2
Guidelines on CAM and Dietary Supplements

Guideline Web site

Calcium .org/policy/
CAM .org/
Echinacea /
Ephedra .org/
Folic acid .org/policy/
Herbal medicine /
Vitamin D .org/policy/

CAM = complementary and alternative medicine.

REFERENCES

(1.) Muller JL, Clauson KA. Pharmaceutical consideration of common herbal medicine. Am J Managed Care 1997;3:1753-70.

(2.) Kleinman R. Current approaches to standards of care for children: how does the pediatric community currently approach this issue? Nutr Today 2002;37:177-9.

(3.) Wilson K. Herbal medicine use by adolescents in the US: preliminary data and feasibility of online survey methods. In: Abstracts of the Annual Meeting of the Society for Adolescent Medicine. March 2003. J Adolesc Health 2003;32:127.

(4.) Johnston GA, Bilbao RM, Graham-Brown RA. The use of complementary medicine in children with atopic dermatitis in secondary care in Leicester. Br J Dermatol 2003;149:566-71.

(5.) Cala S, Crimson ML, Baumgartner J. A survey of herbal use in children with attention-deficit-hyperactivity disorder or depression. Pharmacotherapy 2003;23:222-30.

(6.) Heuschkel R, Afzal N, Wuerth A, Zurakowski D, Leichtner A, Kemper K, et al. Complementary medicine use in children and young adults with inflammatory bowel disease. Am J Gastroenterol 2002;97:382-8.

(7.) Kemper K, Wornham WL. Consultations in holistic pediatric services for inpatients and outpatient oncology patients at a children's hospital. Arch Pediatr Adolesc Med 2001;155:449-54.

(8.) Woolf AD. Herbal remedies and children: do they work? Are they harmful? Pediatrics 2003;112:240-6.

(9.) Saper RB, Kales SN, Paquin J, Burns MJ, Eisenberg DM, Davis RB, et al. Heavy metal content of ayurvedic herbal medicine products. JAMA 2004;292:2868-73.

(10.) Lanski SL, Greenwald M, Perkins A, Simon HK. Herbal therapy use in a pediatric emergency department population: expect the unexpected. Pediatrics 2003;111:981-5.

Dr. Gardiner is supported by an institutional national research service award for training in alternative medicine research (T32AT00051). The views expressed in this editorial are those of the author and do not represent the views of the National Center for Complementary and Alternative Medicine or the National Institutes of Health.

PAULA GARDINER, ., is a research fellow in the Division for Research and Education in Complementary and Integrative Medical Therapies at Harvard Medical School, Boston, and director of integrative medicine at Tufts University Family Medicine Residency, Malden, Mass.

Address correspondence to Paula Gardiner, ., Landmark Center, 401 Park Dr., Suite 22A-West, Boston, MA 02215 (e-mail:.edu). Reprints are not available from the author.