Research

9 pages, 224 KiB

Open AccessArticle

Integrative Pediatrics: Successful Implementation of Integrative Medicine in a German Hospital Setting—Concept and Realization

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Children 2018, 5(9), 122; https://doi.org/10.3390/children5090122 - 04 Sep 2018

Cited by 26 | Viewed by 5376

Abstract

Complementary and Alternative Medicine (CAM) has not been systematically institutionalized in pediatric hospital care in Germany so far. For the responsible implementation and systematic evaluation of CAM in pediatric care, a model project was initialized in three different pediatric hospitals in Germany, one [...] Read more.

Complementary and Alternative Medicine (CAM) has not been systematically institutionalized in pediatric hospital care in Germany so far. For the responsible implementation and systematic evaluation of CAM in pediatric care, a model project was initialized in three different pediatric hospitals in Germany, one of them being the “Kinderkrankenhaus St. Marien” in Landshut, Germany. During this project, a concept of the implementation process was developed based on clinical care, teaching, and scientific evaluation. A project group was formed in St. Marien, which included leaders of the hospital, physicians, nurses, and physiotherapists. Over a period of three years, pediatric treatment modalities of the CAM-spectrum were systematically integrated into routine pediatric care and a new integrative medicine department was established. CAM is now being applied in an inpatient as well as outpatient setting, in addition to conventional medical treatments. The modalities now applied include Traditional Chinese Medicine (TCM), relaxation, hypnosis, reflexology, wraps and poultices, aromatherapy, homeopathy, yoga, and herbal medicine. Studies were initiated in some areas. The process and concept leading up to this successful implementation will be described in this article. We show that with motivated team players and structured proceedings, implementation of integrative medicine in a children’s hospital can be successful. Full article

(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)

12 pages, 250 KiB

Open AccessArticle

Can the Mindful Awareness and Resilience Skills for Adolescents (MARS-A) Program Be Provided Online? Voices from the Youth

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Nicholas Chadi

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Elli Weisbaum

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Children 2018, 5(9), 115; https://doi.org/10.3390/children5090115 - 28 Aug 2018

Cited by 14 | Viewed by 5405

Abstract

Mindfulness-based interventions (MBIs) have been shown to improve health and well-being in adolescents with chronic illnesses. Because they are most often delivered in person in a group setting, there are several barriers that limit access to MBIs for youth with limited mobility or [...] Read more.

Mindfulness-based interventions (MBIs) have been shown to improve health and well-being in adolescents with chronic illnesses. Because they are most often delivered in person in a group setting, there are several barriers that limit access to MBIs for youth with limited mobility or who cannot access in-person MBIs in their communities. The objective of this study was to determine if eHealth is a viable platform to increase accessibility to MBIs for teens with chronic illnesses. This study reports the qualitative results of a mixed method randomized trial describing the experience of the Mindful Awareness and Resilience Skills for Adolescents (MARS-A) program, an eight-week MBI, delivered either in person or via eHealth. Participants were adolescents between the ages of 13 and 18 with a chronic illness recruited at a tertiary pediatric hospital in Toronto, Canada. Individual semi-structured post-participation audio-video interviews were conducted by a research assistant. A multiple-pass inductive process was used to review interview transcripts and interpret emergent themes from the participants’ lived experiences. Fifteen participants (8 online and 7 in person) completed post-participation interviews. Four distinct themes emerged from participants in both groups: Creation of a safe space, fostering peer support and connection, integration of mindfulness skills into daily life, and improved well-being through the application of mindfulness. Direct quotations representative of those four themes are reported. Results from this study suggest that eHealth delivery of an adapted MBI for adolescents with chronic illnesses may be an acceptable and feasible mode of delivery for MBIs in this population. EHealth should be considered in future studies of MBIs for adolescents with chronic illnesses as a promising avenue to increase access to MBIs for youth who might not be able to access in-person programs. Full article

(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)

7 pages, 186 KiB

Open AccessArticle

Applied Pediatric Integrative Medicine: What We Can Learn from the Ancient Teachings of Sebastian Kneipp in a Kindergarten Setting

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Marion Eckert

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Melanie Anheyer

Children 2018, 5(8), 102; https://doi.org/10.3390/children5080102 - 26 Jul 2018

Cited by 3 | Viewed by 4011

Abstract

Pediatric integrative medicine focuses on the whole child and the environment in which the child grows up during the treatment of a child’s illness. Nowadays, many different treatment modalities are applied even in children, and doctors need to know about them and, ideally, [...] Read more.

Pediatric integrative medicine focuses on the whole child and the environment in which the child grows up during the treatment of a child’s illness. Nowadays, many different treatment modalities are applied even in children, and doctors need to know about them and, ideally, be able to apply different approaches in the process of treating a child themselves. The program Pediatric Integrative Medicine in Residency (PIMR) already provides residents with several tools to provide this kind of service for the child. In our PIMR pilot program in Germany, we chose to diversify our knowledge about treatment and prevention options by visiting a Kneipp-certified kindergarten in Germany. The philosophy of Sebastian Kneipp focuses on five pillars of health, which incorporate aspects of prevention, self-awareness, self-responsibility, and consciousness of health by means of hydrotherapy, herbal medicine, exercise, nutrition, and lifestyle-medicine. These are being taught to the children during the early years they spend in kindergarten, and represent integral parts of integrative medicine. Integration of Kneipp-based health programs within a kindergarten setting can work well and provides an effective means of early prevention education in childhood. Full article

(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)

10 pages, 606 KiB

Open AccessArticle

Family-Based Mindful Eating Intervention in Adolescents with Obesity: A Pilot Randomized Clinical Trial

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Bonnie Donelan-Dunlap

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Amit Sood

Children 2018, 5(7), 93; https://doi.org/10.3390/children5070093 - 06 Jul 2018

Cited by 21 | Viewed by 5929

Abstract

Mindfulness has gained attention in the treatment of obesity. However, there is a paucity of data on family-based training in mindful eating in children. The objective of this pilot randomized clinical trial was to evaluate the feasibility and acceptability of a family-based mindful [...] Read more.

Mindfulness has gained attention in the treatment of obesity. However, there is a paucity of data on family-based training in mindful eating in children. The objective of this pilot randomized clinical trial was to evaluate the feasibility and acceptability of a family-based mindful eating intervention (MEI) in adolescents with obesity, and to compare the efficacy of the MEI versus standard dietary counseling (SDC) for decreasing weight and improving cardiometabolic risk markers. Twenty-two adolescents (age 14.5–17.9 years) and parent pairs were randomized to the MEI or SDC. The MEI was administered in four 90-min sessions over 10 weeks and SDC was provided at baseline, 12 weeks, and 24 weeks. Despite the requirement of more frequent visits with the MEI, adolescents and parents attended 100% of the sessions and there were no dropouts in that group. High density lipoprotein (HDL) cholesterol increased in the SDC group, but not in the MEI group. Adolescents receiving the MEI demonstrated an increase in awareness at 24 weeks (p = 0.01) and a decrease in distraction during eating at 12 weeks (p = 0.04), when compared with the SDC group. The family-based MEI showed feasibility and acceptability in adolescents with obesity. Future studies with more intense therapy and larger sample sizes are warranted to examine the role of mindful eating in treating pediatric obesity. Full article

(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)

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16 pages, 673 KiB

Open AccessArticle

Pediatric Integrative Medicine in Residency Program: Relationship between Lifestyle Behaviors and Burnout and Wellbeing Measures in First-Year Residents

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Children 2018, 5(4), 54; https://doi.org/10.3390/children5040054 - 23 Apr 2018

Cited by 8 | Viewed by 5389

Abstract

It is widely recognized that burnout is prevalent in medical culture and begins early in training. Studies show pediatricians and pediatric trainees experience burnout rates comparable to other specialties. Newly developed Accreditation Council for Graduate Medical Education (ACGME) core competencies in professionalism and [...] Read more.

It is widely recognized that burnout is prevalent in medical culture and begins early in training. Studies show pediatricians and pediatric trainees experience burnout rates comparable to other specialties. Newly developed Accreditation Council for Graduate Medical Education (ACGME) core competencies in professionalism and personal development recognize the unacceptably high resident burnout rates and present an important opportunity for programs to improve residents experience throughout training. These competencies encourage healthy lifestyle practices and cultivation of self-awareness, self-regulation, empathy, mindfulness, and compassion—a paradigm shift from traditional medical training underpinned by a culture of unrealistic endurance and self-sacrifice. To date, few successful and sustainable programs in resident burnout prevention and wellness promotion have been described. The University of Arizona Center for Integrative Medicine Pediatric Integrative Medicine in Residency (PIMR) curriculum, developed in 2011, was designed in part to help pediatric programs meet new resident wellbeing requirements. The purpose of this paper is to detail levels of lifestyle behaviors, burnout, and wellbeing for the PIMR program’s first-year residents (N = 203), and to examine the impact of lifestyle behaviors on burnout and wellbeing. The potential of the PIMR to provide interventions addressing gaps in lifestyle behaviors with recognized association to burnout is discussed. Full article

(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)

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Review

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22 pages, 1299 KiB

Open AccessReview

Multidisciplinary Pain Management for Pediatric Patients with Acute and Chronic Pain: A Foundational Treatment Approach When Prescribing Opioids

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Children 2019, 6(2), 33; https://doi.org/10.3390/children6020033 - 21 Feb 2019

Cited by 51 | Viewed by 16580

Abstract

Opioid therapy is the cornerstone of treatment for acute procedural and postoperative pain and is regularly prescribed for severe and debilitating chronic pain conditions. Although beneficial for many patients, opioid therapy may have side effects, limited efficacy, and potential negative outcomes. Multidisciplinary pain [...] Read more.

Opioid therapy is the cornerstone of treatment for acute procedural and postoperative pain and is regularly prescribed for severe and debilitating chronic pain conditions. Although beneficial for many patients, opioid therapy may have side effects, limited efficacy, and potential negative outcomes. Multidisciplinary pain management treatments incorporating pharmacological and integrative non-pharmacological therapies have been shown to be effective in acute and chronic pain management for pediatric populations. A multidisciplinary approach can also benefit psychological functioning and quality of life, and may have the potential to reduce reliance on opioids. The aims of this paper are to: (1) provide a brief overview of a multidisciplinary pain management approach for pediatric patients with acute and chronic pain, (2) highlight the mechanisms of action and evidence base of commonly utilized integrative non-pharmacological therapies in pediatric multidisciplinary pain management, and (3) explore the opioid sparing effects of multidisciplinary treatment for pediatric pain. Full article

(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)

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20 pages, 578 KiB

Open AccessReview

Pediatric Integrative Medicine in Academia: Stanford Children’s Experience

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Children 2018, 5(12), 168; https://doi.org/10.3390/children5120168 - 12 Dec 2018

Cited by 7 | Viewed by 6789

Abstract

Pediatric integrative medicine is an emerging field which, to date, has not been described in detail in academic medical centers in the United States. Early research of pediatric integrative medicine modalities shows promise for the treatment of common pediatric conditions such as irritable [...] Read more.

Pediatric integrative medicine is an emerging field which, to date, has not been described in detail in academic medical centers in the United States. Early research of pediatric integrative medicine modalities shows promise for the treatment of common pediatric conditions such as irritable bowel syndrome, acute and chronic pain, headache, and allergy, among others. In light of the growing prevalence of pediatric illnesses and patient complexity, it is crucial to emphasize the patient’s overall well-being. As academic centers around the world start to develop pediatric integrative medicine programs, the aim of this manuscript is to briefly highlight evidence of effective integrative treatments in pediatric subspecialties, to describe the establishment of our integrative medicine program, to summarize its early efforts, and to discuss potential barriers and keys to success. Full article

(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)

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11 pages, 245 KiB

Open AccessReview

Pharmacological Strategies for Decreasing Opioid Therapy and Management of Side Effects from Chronic Use

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Children 2018, 5(12), 163; https://doi.org/10.3390/children5120163 - 05 Dec 2018

Cited by 3 | Viewed by 5912

Abstract

As awareness increases about the side effects of opioids and risks of misuse, opioid use and appropriate weaning of opioid therapies have become topics of significant clinical relevance among pediatric populations. Critically ill hospitalized neonates, children, and adolescents routinely receive opioids for analgesia [...] Read more.

As awareness increases about the side effects of opioids and risks of misuse, opioid use and appropriate weaning of opioid therapies have become topics of significant clinical relevance among pediatric populations. Critically ill hospitalized neonates, children, and adolescents routinely receive opioids for analgesia and sedation as part of their hospitalization, for both acute and chronic illnesses. Opioids are frequently administered to manage pain symptoms, reduce anxiety and agitation, and diminish physiological stress responses. Opioids are also regularly prescribed to youth with chronic pain. These medications may be prescribed during the initial phase of a diagnostic workup, during an emergency room visit; as an inpatient, or on an outpatient basis. Following treatment for underlying pain conditions, it can be challenging to appropriately wean and discontinue opioid therapies. Weaning opioid therapy requires special expertise and care to avoid symptoms of increased pain, withdrawal, and agitation. To address this challenge, there have been enhanced efforts to implement opioid-reduction during pharmacological therapies for pediatric pain management. Effective pain management therapies and their outcomes in pediatrics are outside the scope of this paper. The aims of this paper were to: (1) Review the current practice of opioid-reduction during pharmacological therapies; and (2) highlight concrete opioid weaning strategies and management of opioid withdrawal. Full article

(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)

12 pages, 261 KiB

Open AccessReview

A Review of Non-Pharmacological Treatments for Pain Management in Newborn Infants

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Children 2018, 5(10), 130; https://doi.org/10.3390/children5100130 - 20 Sep 2018

Cited by 70 | Viewed by 15284

Abstract

Pain is a major problem in sick newborn infants, especially for those needing intensive care. Pharmacological pain relief is the most commonly used, but might be ineffective and has side effects, including long-term neurodevelopmental sequelae. The effectiveness and safety of alternative analgesic methods [...] Read more.

Pain is a major problem in sick newborn infants, especially for those needing intensive care. Pharmacological pain relief is the most commonly used, but might be ineffective and has side effects, including long-term neurodevelopmental sequelae. The effectiveness and safety of alternative analgesic methods are ambiguous. The objective was to review the effectiveness and safety of non-pharmacological methods of pain relief in newborn infants and to identify those that are the most effective. PubMed and Google Scholar were searched using the terms: “infant”, “premature”, “pain”, “acupuncture”, “skin-to-skin contact”, “sucrose”, “massage”, “musical therapy” and ‘breastfeeding’. We included 24 studies assessing different methods of non-pharmacological analgesic techniques. Most resulted in some degree of analgesia but many were ineffective and some were even detrimental. Sucrose, for example, was often ineffective but was more effective than music therapy, massage, breast milk (for extremely premature infants) or non-invasive electrical stimulation acupuncture. There were also conflicting results for acupuncture, skin-to-skin care and musical therapy. Most non-pharmacological methods of analgesia provide a modicum of relief for preterm infants, but none are completely effective and there is no clearly superior method. Study is also required to assess potential long-term consequences of any of these methods. Full article

(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)

25 pages, 295 KiB

Open AccessReview

Integrating Pediatric Hypnosis with Complementary Modalities: Clinical Perspectives on Personalized Treatment

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Children 2018, 5(8), 108; https://doi.org/10.3390/children5080108 - 07 Aug 2018

Cited by 8 | Viewed by 5741

Abstract

While pediatric integrative medicine (PIM) emphasizes an “evidence-based practice using multiple therapeutic modalities”; paradoxically, literature reviews examining the prevalence and/or efficacy of such mind–body approaches often address PIM modalities separately. Such contributions are relevant, yet documentation of how to deliver combined complementary approaches [...] Read more.

While pediatric integrative medicine (PIM) emphasizes an “evidence-based practice using multiple therapeutic modalities”; paradoxically, literature reviews examining the prevalence and/or efficacy of such mind–body approaches often address PIM modalities separately. Such contributions are relevant, yet documentation of how to deliver combined complementary approaches in children and youth are scarce. Nevertheless, integrative practitioners in clinical practice routinely mix approaches to meet the individual needs of each patient. Best practices are flexible, and include blending and augmenting services within the same session, and/or connecting modalities sequentially for an incremental effect, and/or referring to outside resources for additional interventions. Resonating with integrative medicine’s definition, this article’s goal is to demonstrate paradigms that “bring together complementary approaches in a coordinated way within clinical practice” by linking clinical hypnosis, the trail-blazer modality in PIM’s history, with mindfulness, biofeedback, acupuncture, and yoga. Following the consideration of the overlap of guided imagery with hypnosis and an abridged literature report, this clinical perspective considers the selection of modalities within a collaborative relationship with the child/teen and parents, emphasizing goodness-of-fit with patients’ contexts, e.g., symptoms, resources, interests, goals, and developmental stage. Case vignettes illustrate practical strategies for mixing approaches. Full article

(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)

10 pages, 209 KiB

Open AccessReview

Pediatric Headache Clinic Model: Implementation of Integrative Therapies in Practice

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Children 2018, 5(6), 74; https://doi.org/10.3390/children5060074 - 12 Jun 2018

Cited by 15 | Viewed by 6371

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The demand for integrative medicine has risen in recent years as research has demonstrated the efficacy of such treatments. The public has also become more conscientious of the potential limitations of conventional treatment alone. Because primary headache syndromes are often the culmination of [...] Read more.

The demand for integrative medicine has risen in recent years as research has demonstrated the efficacy of such treatments. The public has also become more conscientious of the potential limitations of conventional treatment alone. Because primary headache syndromes are often the culmination of genetics, lifestyle, stress, trauma, and environmental factors, they are best treated with therapies that are equally multifaceted. The Children’s Mercy Hospital, Kansas City, Missouri Headache Clinic has successfully incorporated integrative therapies including nutraceuticals, acupuncture, aromatherapy, biofeedback, relaxation training, hypnosis, psychology services, and lifestyle recommendations for headache management. This paper provides a detailed review of the implementation of integrative therapies for headache treatment and discusses examples through case studies. It can serve as a model for other specialty settings intending to incorporate all evidenced-based practices, whether complementary or conventional. Full article

(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)

Other

Jump to: Research, Review

13 pages, 242 KiB

Open AccessOpinion

The Elephant in the Room: The Need for Increased Integrative Therapies in Conventional Medical Settings

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Children 2018, 5(11), 154; https://doi.org/10.3390/children5110154 - 16 Nov 2018

Cited by 4 | Viewed by 4611

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Pediatric integrative therapy programs are essential to the treatment and well-being of patients. Identifying an effective integrative therapy model within conventional pediatric medical settings, however, often proves difficult. Our goal in this article is to explore varied solutions to increase access and inclusion [...] Read more.

Pediatric integrative therapy programs are essential to the treatment and well-being of patients. Identifying an effective integrative therapy model within conventional pediatric medical settings, however, often proves difficult. Our goal in this article is to explore varied solutions to increase access and inclusion of integrative therapies in an effort to promote best practice and holistic care. The main methods applied in this article are vignettes that illustrate how the integrative therapies in a metropolitan academic hospital successfully treat the patient by complementing conventional medicine. This leads to comprehensive care. The central finding of the article proposes viable solutions to increase interdisciplinary collaboration both internally within the institution and externally. Integrative therapists detail how they were able to increase visibility and yield best practice through increased educational initiatives and interdisciplinary collaboration. Full article

(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)

2 pages, 160 KiB

Open AccessCorrection

Correction: Esparham, A., et al., Pediatric Integrative Medicine: Vision for the Future. Children, 2018, 5, 111

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Children 2018, 5(9), 123; https://doi.org/10.3390/children5090123 - 05 Sep 2018

Cited by 2 | Viewed by 2972

Abstract

The authors wish to make the following corrections to their paper [...] Full article

(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)

13 pages, 1620 KiB

Open AccessBrief Report

Pediatric Integrative Medicine: Vision for the Future

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Children 2018, 5(8), 111; https://doi.org/10.3390/children5080111 - 20 Aug 2018

Cited by 16 | Viewed by 5362 | Correction

Abstract

Pediatric integrative medicine (PIM) is of significant interest to patients, with 12% of the general pediatric population and up to 80% of children with chronic conditions using PIM approaches. The field of PIM has evolved over the past 25 years, approaching child health [...] Read more.

Pediatric integrative medicine (PIM) is of significant interest to patients, with 12% of the general pediatric population and up to 80% of children with chronic conditions using PIM approaches. The field of PIM has evolved over the past 25 years, approaching child health with a number of guiding principles: preventive, context-centered, relationship-based, personalized, participatory, and ecologically sustainable. This manuscript reviews important time points for the field of PIM and reports on a series of meetings of PIM leaders, aimed at assessing the state of the field and planning for its future. Efforts in the first decade of the 2000s led to increased visibility in academic and professional pediatric organizations and through international listservs, designed to link those interested in and practicing PIM, all of which continue to flourish. The PIM leadership summits in recent years resulted in specific goals to advance PIM further in the following key areas: research, clinical practice, professional education, patient and family education, and advocacy and partnerships. Additionally, goals were developed for greater expansion of PIM professional education, broader support for pediatric PIM research, and an expanded role for PIM approaches in the provision of pediatric care. Full article

(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)

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8 pages, 812 KiB

Open AccessBrief Report

Implementing Integrative Nursing in a Pediatric Setting

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Megan E. Voss

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Mary Jo Kreitzer

Children 2018, 5(8), 103; https://doi.org/10.3390/children5080103 - 31 Jul 2018

Cited by 7 | Viewed by 5190

Abstract

Pediatric blood and marrow transplantation (BMT) is one of the most challenging allopathic treatments a patient and family can be faced with. A large Midwest academic health center, and leader in pediatric BMT, made the decision in 2013 to incorporate integrative nursing as [...] Read more.

Pediatric blood and marrow transplantation (BMT) is one of the most challenging allopathic treatments a patient and family can be faced with. A large Midwest academic health center, and leader in pediatric BMT, made the decision in 2013 to incorporate integrative nursing as the care delivery model. Nurses trained in advanced nursing practice and specialized in integrative health and healing performed a deep-dive needs assessment, national benchmarking, a comprehensive review of the literature, and ultimately designed a comprehensive integrative program for pediatric patients and their families undergoing BMT. Four years after implementation, this paper discusses lessons learned, strengths, challenges and next phases of the program, including a research agenda. The authors conclude that it is feasible, acceptable and sustainable to implement a nurse-led integrative program within an academic health center-based pediatric BMT program. Full article

(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)

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