Children’s Use of Complementary Health Approaches: What the Science Says

May 2017

Clinical Guidelines, Scientific Literature, Info for Patients:
Children’s Use of Complementary Health Approaches

Natural Products

Fish Oil/Omega-3 Fatty Acids

In general, the research on the efficacy of fish oil supplementation for any condition in children consists of some systematic reviews, several observational studies and a few small, randomized controlled trials. Overall, large, high-quality studies on natural products for children is lacking.

What Does the Research Show?

ADHD: A 2012 Cochrane systematic review of 13 trials involving 1,011 children and adolescents with attention-deficit hyperactivity disorder (ADHD) concluded that overall, there is little evidence that polyunsaturated fatty acids (PUFA) supplementation provides any benefit for the symptoms of ADHD in children and adolescents. The majority of data showed no benefit of PUFA supplementation; however, there were some limited data that did show an improvement when omega-3 and omega-6 supplementations were combined.
Asthma: Studies assessing the effects of omega-3 fatty acids on asthma have had conflicting results. In one small, randomized controlled trial of 29 children with asthma, those who took fish oil supplements rich in eicosapentaenoic (EPA) and docosahexaenoic (DHA) for 10 months reduced their symptoms compared to children who took placebo. However, most studies have shown no effect.
Autism Spectrum Disorders: A 2011 Cochrane systematic review of two small, randomized controlled trials with a total of 37 children evaluated omega-3 fatty acids for autism spectrum disorders (ASD) and found insufficient evidence that omega-3 fatty acids supplementation is effective for improving core and associated symptoms of ASD.
Elevated Triglycerides: A small 2014 study of 25 children aged 10 to 19 years with elevated triglyceride levels found that high-dose omega-3 fatty acid supplements were well tolerated, but produced no significantly different effects on triglyceride levels compared to placebo.
Insulin Resistance: A 2013 study of 201 obese, insulin-resistant children and adolescents assessed the effect of Metformin or omega-3 polyunsaturated fatty acids on insulin resistance, lipid profile, and body mass index (BMI) and found that omega-3 polyunsaturated fatty acids significantly decreased the concentrations of glucose and insulin. The effects of Metformin on insulin levels were negligible. Omega-3s significantly improved triglyceride levels as well as BMI.

Safety

Although fish oil/omega-3 fatty acid supplements appear to be well tolerated in adults, the long-term safety profile of these supplements in children has not been well studied. An Australian study in 616 infants who received supplements of tuna fish oil or a Sunola oil (a low in omega-3 fatty acids control), from 6 months of age to 5 years did not report any adverse effects.

Melatonin

The research on efficacy of melatonin supplementation for managing sleep disorders in children consists of only a few small controlled trials in primarily children with disabilities.

What Does the Research Show?

A 2016 randomized controlled trial of 48 children and adolescents aged 1 to 18 years with sleep disturbance and physician-diagnosed atopic dermatitis involving at least 5 percent of the total body surface area found that after melatonin treatment, the participants saw improvements in their atopic dermatitis compared to placebo, and the sleep onset-latency was shortened by 21.4 minutes compared to placebo.
A 2011 review of herbal medicines, including melatonin, in the pediatric population concluded that although some studies of melatonin have noted benefit, particularly for a reduction in sleep onset, research has been limited by small sample sizes, differing doses, and varying methodology.
A 2012 study in Europe of 146 children ages 3 years to 15 years 8 months with a range of neurological and developmental disorders had similar results—a modest increase (22.4 minutes) in total sleep time as well as a reduction in sleep onset.
A 2014 review on the effect of melatonin supplementation for sleep disorders in children with autism spectrum disorders (ASD) found that melatonin may be beneficial in children with ASD who have problems with sleep latency or sleep maintenance.

Safety

Melatonin appears to be safe for adults when used short-term, but there is a lack of research on its long-term safety in children.

Mind and Body Practices

Mindfulness Meditation

Although only a few randomized controlled trials on meditation and mindfulness techniques have been conducted in children, findings from these studies suggest some benefits for anxiety, depressive, and other negative affect, behavioral and emotional symptoms, and somatic functioning.

What Does the Research Show?

A 2016 review concluded that mindfulness reduces psychological symptoms, such as anxiety, and improves emotion regulation; improves attention and ability to focus; and reduces maladaptive coping and rumination. However, there remains a need for rigorous scientific evaluation of mindfulness interventions for children and youth.
A 2014 review found that meditative and movement techniques have been shown to produce benefits for anxiety, depressive, and other negative affect, behavioral and emotional symptoms, and somatic functioning. The review concluded that some clinicians may consider meditation and mindfulness techniques for limited clinical use as adjunctive therapies in selected cases. Nevertheless, clinicians need to be mindful that risks and potential contraindications are not yet well defined, and are advised to consider consents for these interventions.

Safety

Meditation is generally considered safe for most people, and no significant adverse effects have been identified.

Yoga

The evidence base on the efficacy of yoga and other movement therapies in children for any condition consists of a limited number of studies, many with small sample sizes and high risk of bias.

What Does the Research Show?

A 2015 systematic review of 16 studies (including 6 randomized controlled trials, 2 nonrandomized preintervention-postintervention control-group designs, 7 uncontrolled preintervention-postintervention studies, and 1 case study) for yoga interventions addressing anxiety among children and adolescents concluded that nearly all studies included in the review indicated reduced anxiety following a yoga intervention. However, the reviewers noted that because of the wide variety of study populations, limitations in some study designs, and variable outcome measures, further research is needed to enhance the ability to generalize and apply yoga to reduce anxiety.
A 2008 systematic review found some physiological benefits of yoga for children that may provide benefits through the rehabilitation process, but many of the studies included in the review were of poor quality and small sample size.
A 2010 randomized controlled trial examined the effects of yoga on eating disorders in 50 girls and 4 boys aged 11 to 21 compared to standard care. Participants in the yoga group saw improvements in their eating disorder upon examination and had significantly reduced food preoccupation immediately after yoga sessions.

Safety

Yoga is generally low-impact and safe for healthy people when practiced appropriately under the guidance of a well-trained instructor.
Overall, those who practice yoga have a low rate of side effects, and the risk of serious injury from yoga is quite low.

References

Aben A, Danckaerts M. Omega-3 and omega-6 fatty acids in the treatment of children and adolescents with ADHD. Tijdschr Psychiatr. 2010; 52(2):89–97.
Black LI, Clarke TC, Barnes PM, Stussman BJ, Nahin RL. Use of complementary health approaches among children aged 4-17 years in the United States: National Health Interview Survey, 2007–2012. National health statistics reports; no 78. Hyattsville, MD: National Center for Health Statistics. 2015.
Brew BK, Toelle BG, Webb KL, et al. Omega-3 supplementation during the first 5 years of life and later academic performance: a randomised controlled trial. Eur J Clin Nutr. 2014; August 13, 2014. [Epub ahead of print.]
Carei TR, Fyfe-Johnson AL, Breuner CC, et al. Randomized controlled clinical trial of yoga in the treatment of eating disorders. J Adolesc Health. 46(4):346–351.
Chang YS, Lin MH, Lee JH, et al. Melatonin supplementation for children with atopic dermatitis and sleep disturbance: a randomized clinical trial. JAMA Pediatr. 2016;170(1):35-42.
Damiani JM, Sweet BV, Sohoni P. Melatonin: an option for managing sleep disorders in children with autism spectrum disorder. Am J Health Syst Pharm. 2014;71(2):95–101.
De Ferranti SD, Milliren CE, Denhoff ER, et al. Using high-dose omega-3 fatty acid supplements to lower triglyceride levels in 10- to 19-year-olds. Clin Pediatr (Phila). 2014;53(5):428–438.
Feucht C, Patel DR. Herbal medicines in pediatric neuropsychiatry. Pediatr Clin North Am. 2011;58(1):33–54.
Galantino ML, Galbavy R, Quinn L. Therapeutic effects of yoga for children: a systematic review of the literature. Pediatr Phys Ther. 2008;20(1):66–80.
Gillies D, Sinn JKH, Lad SS, et al. Polyunsaturated fatty acids (PUFA) supplements for attention deficit hyperactivity disorder (ADHD) in children and adolescents. Cochrane Database Syst Rev. 2012;7:CD007986.
Gringras P, Gamble C, Jones AP, et al. Melatonin for sleep problems in children with neurodevelopmental disorders: randomised double masked placebo controlled trial. BMJ. 2012; 345:e6664.
Hunt K, Ernst E. The evidence-base for complementary medicine in children: a critical overview of systematic reviews. Arch Dis Child. 2011;96(8):769–776.
Itomura M, Hamazaki K, Sawazaki S et al. The effect of fish oil on physical aggression in schoolchildren - a randomized, double-blind, placebo-controlled trial. J Nutr Biochem. 2005;16:163–71.
James S, Montgomery P, Williams K. Omega-3 fatty acids for autism spectrum disorders. Cochrane Database Syst Rev. 2011;11:CD007992.
Juárez-López C, Klünder-Klünder M, Madrigal-Azcárate A, et al. Omega-3 polyunsaturated fatty acids reduce insulin resistance and triglycerides in obese children and adolescents. Pediatr Diabetes. 2013;14(5):377–383.
Nagakura T, Matsuda S, Shichijyo K, Sugimoto H, Hata K. Dietary supplementation with fish oil rich in omega-3 polyunsaturated fatty acids in children with bronchial asthma. Eur Resp J. 2000;16(5):861–865.
Okamoto M, Misunobu F, Ashida K, et al. Effects of dietary supplementation with n-3 fatty acids compared with n-6 fatty acids on bronchial asthma. Int Med. 2000;39(2):107–111.
Perry-Parrish C, Copeland-Linder N, Webb L, et al. Mindfulness-based approaches for children and youth. Curr Probl Pediatr Adolesc Health Care. 2016;46(6):172-178.
Simkin DR, Black NB. Meditation and mindfulness in clinical practice. Child Asolesc Psychiatr Clin N Am. 2014;23(3):487-534.
Weaver LL, Darragh AR. Systematic review of yoga interventions for anxiety reduction among children and adolescents. Am J Occup Ther. 2015;69(6):1-9.

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