Alternatives for children

Sara Weinstein and her family had tried about everything, but her severe back pain clawed through it all.

For more than three years, the Lower Moreland High School student, now 17, had gone through the traditional medical bag of tricks: five doctors, X-rays, an MRI, even exploratory surgery, and still, "I couldn't even bend down to pick up a shirt," she said. "We sort of gave up trying to figure out what was wrong with me."

Finally, in a last-ditch attempt, her family doctor referred her in June to the Integrative Pediatrics Program at Thomas Jefferson University. "I was skeptical," Sara said. "I hadn't done any of that stuff before."

For her, "that stuff" was a regimen of vitamins and supplements, a high-fiber diet, and a series of controlled-breathing exercises.

While a diagnosis is as elusive as ever, Sara says it has sharply reduced her pain. "I can do anything now," she says. "I'm a lot happier."

Her Jefferson pediatrician, Christina DiNicola, prescribed the regimen after a 90-minute visit with Sara and her mother, Michele. "After I interviewed her, I thought [the pain] was emotional and hormonal," said DiNicola. She kept Sara on an anti-inflammatory drug prescribed by her doctor along with the supplements regimen, and "the combination of all those things did the trick."

Integrative medicine is becoming more common in pediatrics, said Lawrence Rosen, a pediatrician in Oradell, N.J., and chair of the American Academy of Pediatrics Section on Complementary and Integrative Medicine.

"The number of families with new babies interested in natural and ecologically sustainable care is skyrocketing," he says. "I can tell that from my own practice."

Still, those methods haven't made it into the mainstream.

Partly, this is an issue of time and money. The 90-minute visit and 12-page questionnaire were keys to finding the right care, DiNicola says, but insurance often doesn't cover visits that long.

The Weinsteins paid out of pocket. Other integrative-pediatrics programs are heavily subsidized by foundations, like those at the Nemours/Alfred I. duPont Hospital for Children in Wilmington.

Physicians practicing integrative medicine also face obstacles, such as the refusal of Medicaid and most health plans to cover many treatments. Results that meet evidence-based standards are limited, and patients can improve for unknown reasons.

Integrative care in pediatrics faces its own set of problems:

Children are often less articulate about their symptoms.

They may be less inclined to accept care their peers find odd.

Trials of acupuncture, massage, and other complementary care have largely been done on adults and might not hold true for children.

Test subjects are also harder to find. Alan Woolf, a pediatrician at Children's Hospital Boston, notes that children can't enroll themselves in trials, and researchers who approach parents for consent must jump through formidable hoops.

"Kids are not just small adults," adds pediatrician Kathi Kemper of the Center for Integrative Medicine at Wake Forest University. "They breathe faster, their hearts beat faster, their blood pressure is lower. Faster breathing means they are more affected by air pollution."

Many patients, like Sara Weinstein, come when they have run out of answers.

Lori Brady, of Mickleton, Gloucester County, said that her son, Nicholas, was diagnosed early with multiple sclerosis and that from ages 2 to 5, he was treated at a major hospital where the only remedy offered for his excruciating pain was morphine and methadone. Brady said she had heard of a duPont neurologist whose nurse had trained in healing-touch therapy, which claims to manipulate the energy field around the patient.

She says the therapy has helped reduce Nicholas' pain to manageable levels, except for short relapses. "He used to say it was like riding the waves of pain," Brady says.

The nurse, Walle Adams-Gerdts, also works in bone-marrow oncology. "It's allowed me to weave together my knowledge" of standard and integrative care, she says.

This has become the custom at duPont, where conventional and integrative medicine are joined with an emphasis on stress reduction and healthy lifestyles.

Frances Zappalla, a pediatric cardiologist at duPont, incorporates herbs, meditation, and weight control with standard care. "You look at the patient as a whole," she says, "not just as a medical problem."

Whatever the benefits of integrative medicine, physicians say they should have a bigger payoff on children than on adults.

"If a 60-year-old learns to meditate to lower his blood pressure," says Kemper, "that skill may benefit him for the next 20 years.

"If a 10-year-old learns to meditate to control his stress or blood pressure or help reduce his pain, he has lifelong skills that may benefit him for the next 70 years."